The effects of pharmacist interventions on adult outpatients with cancer: A systematic review

Colombo, L; Aguiar, Patrícia Melo; Lima, T M; Storpirtis, Sílvia

doi:10.1111/jcpt.12562

Cited by 58 publications

(66 citation statements)

References 30 publications

(173 reference statements)

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“…Such modifications may have clinical consequences for patients: in the most severe cases PIs can prevent hospitalization for chemotherapy toxicity, permanent disability such as renal failure, or paresthesia, especially by detecting dosage problems or contraindications [8][9][10]. In others cases PIs can improve quality of life, patient satisfaction and adherence with counseling [11]. Taking into account the high direct cost of injectable antineoplastics PIs may have economic impact with cost savings: by dosage adjustments or by drug waste minimization with rounding of drug dosages and selection of the most convenient vial size [12].…”

Section: Introductionmentioning

confidence: 99%

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

Zecchini

Chanoine

et al. 2020

BMC Health Serv Res

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Background: Pharmacists play a key role in ensuring the safe use of injectable antineoplastics, which are considered as high-alert medications. Pharmaceutical analysis of injectable antineoplastic prescriptions aims to detect and prevent drug related problems by proposing pharmacist interventions (PI). The impact of this activity for patients, healthcare facilities and other health professionals is not completely known. This study aimed at describing the clinical, economic, and organizational impacts of PIs performed by pharmacists in a chemotherapy preparation unit.Methods: A prospective 10-week study was conducted on PIs involving injectable antineoplastic prescriptions. Each PI was assessed by one of the four multidisciplinary expert committees using a multidimensional tool with three independent dimensions: clinical, economic and organizational. An ancillary quantitative evaluation of drug cost savings was conducted. Results: Overall, 185 patients were included (mean age: 63.5 ± 13.7 years; 54.1% were male) and 237 PIs concerning 10.1% prescriptions were recorded. Twenty one PIs (8.9%) had major clinical impact (ie: prevented hospitalization or permanent disability), 49 PIs (20.7%) had moderate clinical impact (ie: prevented harm that would have required further monitoring/treatment), 62 PIs (26.2%) had minor clinical impact, 95 PIs (40.0%) had no clinical impact, and 9 PIs (3.8%) had a negative clinical impact. For one PI (0.4%) the clinical impact was not determined due to insufficient information. Regarding organizational impact, 67.5% PIs had a positive impact on patient management from the healthcare providers' perspective. A positive economic impact was observed for 105 PIs (44.3%), leading to a saving in direct drug costs of 15,096 €; 38 PIs (16.0%) had a negative economic impact, increasing the direct drug cost by 11,878 €. Overall cost saving was 3218€. Conclusions: PIs are associated with positive clinical, economic and organizational impacts. This study confirms the benefit of pharmacist analysis of injectable antineoplastic prescriptions for patient safety with an overall benefit to the healthcare system.

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Section: Introductionmentioning

confidence: 99%

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

Zecchini

Chanoine

et al. 2020

BMC Health Serv Res

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“…The professionals have the opportunity to contribute directly to patient care in order to reduce morbimortality related to medication use, promoting health and preventing diseases (3). From this premise, current systematic review showed that clinical pharmacist interventions have significantly improved many health outcome measures in outpatients with cancer (4). However, the literature shows that most pharmacist–patient interactions still occur following a biomedical model with patients playing a passive role and pharmacists focusing primarily on providing medication-related information (5).…”

Section: Introductionmentioning

confidence: 99%

Pharmacist–Patient Communication in Prostate Cancer as a Strategy to Humanize Health Care: A Qualitative Study

Scarabelin

Dosea

Aguiar

et al. 2018

Journal of Patient Experience

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Background: Pharmacists require effective communication skills to enhance involvement in patient care. Nevertheless, there are few qualitative studies exploring "how" pharmacist-patient communication occurs and none targets patients with cancer. Objective: To describe the perceptions of outpatients with prostate cancer regarding the communication process during clinical pharmacy service in a community pharmacy. Methods: A qualitative study was performed from semistructured interviews with 10 patients. These interviews were audiotape-recorded and transcribed comprehensively, and the data were analyzed using content analysis. The validation of the categories and registration units was made by 2 independent authors and reviewed by a third author. Results: Three categories were established from the content analysis (general perceptions of the pharmacist-patient communication, potentialities of effective communication, and points for improvement). Communication is a complex process and involves, in addition to information exchange, the sharing of thoughts, desires, and fears. Our findings hold that effective communication skills by pharmacist can help patients validate their concerns, develop a trusting patientpharmacist relationship, address drug therapy problems, and lead to better health outcomes. Conclusion: Pharmacistpatient communication is an important strategy for humanized practice. This allows the pharmacist to see beyond an individual with health problems to a human being with particularized needs.

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“…Carrying out the CMR at the same time with CGA by a multidisciplinary team including a clinical pharmacist, 55 in order to search potential DDI and avoid iatrogenia, can explain the lack of observed association between polypharmacy and systemic therapy discontinuation in our survey, as previously shown elsewhere. 56 , 57 …”

Section: Discussionmentioning

confidence: 99%

<p>Medication Reconciliation Associated with Comprehensive Geriatric Assessment in Older Patients with Cancer: ChimioAge Study</p>

Couderc¹,

Boisseranc²,

Rey³

et al. 2020

CIA

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Background Polymorbidity induces polypharmacy in older patients may lead to potential drug–drug interactions (DDI) which can modify the tolerance and safety of oncological treatments and alter the intended therapeutic effect. The objective of our study was to describe the decision-making process for oncological treatment and related outcomes, in a population of older adults undergoing a comprehensive geriatric assessment (CGA) associated to a comprehensive medication reconciliation (CMR) prior to initiating oncological treatment. Methods ChimioAge is a prospective observational study conducted between 01/2017 and 07/2018 at Marseille University Hospital and approved by the French National Ethics Committee. It comprised all consecutive patients aged 70 years and over who were referred for a CGA as part of CMR, before initiating systemic treatment. Results One hundred and seventy-one cancer patients were included. Mean age was 79.2 years, over half had metastatic cancers, 75% had an ECOG performance status zero or one, and two-thirds were independent in daily activities. Two-thirds of the patients had polypharmacy and the CMR identified potential DDI with systemic treatment in 43.3% of patients. Following the CGA, the CMR and the hospital oncologists decision, 30% of the patients received adapted systemic treatment with reduced doses at initiation. They presented fewer toxicities – irrespective of grade and type – than patients who received standard treatment (p<0.001) and had comparable overall survival (Log rank p=0.21). Conclusion This is one of the first studies to highlight the value in conducting CMR and a CGA simultaneously before initiating systemic treatment in older patients with cancer. These two evaluations could give oncologists decisive information to personalize cancer treatment of older patients and optimize treatment dose to offer the best efficacy and minimize toxicity.

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The effects of pharmacist interventions on adult outpatients with cancer: A systematic review

Cited by 58 publications

References 30 publications

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study

Pharmacist–Patient Communication in Prostate Cancer as a Strategy to Humanize Health Care: A Qualitative Study

<p>Medication Reconciliation Associated with Comprehensive Geriatric Assessment in Older Patients with Cancer: ChimioAge Study</p>

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