Appropriate prescribing of antiemetics with oral oncolytic therapy: a single center experience

C. Suen, M. Hughes, C. Timlin, Christine Cambareri, Richard Kriska, Gregory Strong, Joseph Favatella, Richard Demers, D. Capozzi
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Abstract

Abstract Background: Chemotherapy-induced nausea and vomiting (CINV) is a common and significant side-effect of chemotherapy that can impact a patient’s quality-of-life (QoL). As oral oncolytic therapies (OOT) become a common treatment option, they pose unique challenges for providers and patients. Unlike infusion therapies, a single-day administration, OOT may require daily dosing during a treatment cycle and, therefore, require patients to be proactive in terms of supportive care monitoring and prevention. The American Society of Clinical Oncology provides recommendations for appropriate emetic prophylaxis, however, due to limited data for OOT, only offer recommendations for single-day IV chemotherapy. Aims: The objective of this quality improvement study was to review the appropriate prescribing of antiemetics with OOT, in the specialty and ambulatory setting, and evaluate the opportunity to enhance medication safety and improve vigilance of concurrent prescribing with pharmacist involvement. Methods: All patients ordered for OOT between January and December 2018 to the Hospital of the University of Pennsylvania specialty pharmacy were reviewed for concurrent antiemetic prescriptions. Patients were excluded if prescriptions were sent to a satellite or outside institution pharmacy. Patients who were identified to have a discordant antiemetic:OOT prescribing ratio were evaluated for adverse events such as CINC-related office visits or hospitalization; as documented in the electronic medical record. Results: A total of 1,630 OOT prescriptions were written for 354 patients. Two hundred and sixty-eight patients were excluded for the following reasons; 117 (33.0%) were prescribed to a satellite or outside pharmacy and 151 (42%) had concordant antiemetics. Eighty-six patients were included based on initial discordance given that OOT and antiemetics were not ordered within the same office visit. Upon further evaluation, 60 were found to have active antiemetics ordered as part of a previous line of therapy and, therefore, had an adequate supply. Of the n = 26 without antiemetics, n = 4 were deemed to not require antiemetics, while n = 22 were confirmed to lack prescriptions. There were no reports of CINV that required urgent care or hospitalizations. Conclusions: OOT is becoming increasingly common, with unique risks such as CINV. The authors plan to increase the pharmacist involvement with the prescribing and counseling of new OOT to promote improved supportive care measures, communication between patients and providers, and potential avoidance of patient harm and improved QoL.
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合适的止吐药处方与口服溶瘤治疗:单中心经验
摘要背景:化疗引起的恶心呕吐(CINV)是化疗的一种常见且显著的副作用,可影响患者的生活质量。随着口服溶瘤疗法(OOT)成为一种常见的治疗选择,它们给提供者和患者带来了独特的挑战。与输液疗法不同,OOT可能需要在治疗周期内每天给药,因此需要患者在支持性护理监测和预防方面积极主动。美国临床肿瘤学会提供了适当的催吐预防建议,但由于OOT的数据有限,仅提供了单日IV化疗的建议。目的:本质量改进研究的目的是审查在专科和门诊环境中使用OOT止吐药的适当处方,并评估在药剂师参与的情况下提高药物安全性和提高对同时开处方的警惕性的机会。方法:对2018年1月至12月期间在宾夕法尼亚大学专科药房医院订购的所有OOT患者同时开具的止吐处方进行审查。如果处方被发送到附属机构或机构外药房,患者将被排除在外。对被确定具有不一致的止吐:OOT处方比率的患者进行不良事件评估,如CINC相关的办公室就诊或住院治疗;如电子医疗记录中所记录的。结果:共为354名患者开出1630张OOT处方。一百六十八名患者因以下原因被排除在外;117例(33.0%)是在卫星或外部药房开具的,151例(42%)有一致的止吐药。考虑到OOT和止吐药不是在同一次就诊中订购的,基于最初的不一致性,纳入了86名患者。经过进一步评估,发现有60人订购了作为前一系列治疗的一部分的活性止吐药,因此供应充足。在n = 26例无止吐药,n = 4人被认为不需要止吐药,而n = 22人被证实缺乏处方。没有需要紧急护理或住院治疗的CINV报告。结论:OOT正变得越来越普遍,具有独特的风险,如CINV。作者计划增加药剂师对新OOT处方和咨询的参与,以促进改善支持性护理措施、患者和提供者之间的沟通,以及潜在的避免患者伤害和改善生活质量。
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Journal of Drug Assessment
Journal of Drug Assessment PHARMACOLOGY & PHARMACY-
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