Journal of Oncology Pharmacy Practice最新文献

Background: Cancer is a growing public health concern in Ghana, with rising prevalence, incidence, and mortality rates. Clinicians play a crucial role in cancer prevention and control by providing accurate information and early detection services. This study assessed the level of cancer knowledge among a cross-section of clinicians in the Bono region of Ghana, focusing on their knowledge of cancer, signs, symptoms, and risk factors.

Method: This was a cross-sectional study conducted using a validated questionnaire. The recruitment included doctors, pharmacists, nurses, laboratory technologists, radiographers, pharmacy technologists and other healthcare staff from four hospitals. Correlation between continuous variables and knowledge, signs and symptoms, and risk factors of cancer were assessed using bivariate correlation analysis.

Results: Our findings showed that the majority of participants (96.6%, n = 237) had adequate knowledge of cancer, with most (91.7%, n = 225 and 62.8%, n = 154) demonstrating adequate knowledge of cancer signs and risk factors, respectively. However, significant knowledge gaps were identified regarding specific warning signs and symptoms, such as indigestion, changes in bowel or bladder habits, and persistent cough or hoarseness. Moreover, a substantial portion of participants lacked knowledge of risk factors like excessive meat intake, insufficient physical activity, and a lack of fruits and vegetables.

Conclusion: This study underscores the need to implement strategies for enhancing cancer awareness and knowledge among healthcare professionals in Ghana, with a particular focus on addressing the identified knowledge gaps. Clinicians should be empowered to effectively educate the public on cancer signs, symptoms, risk factors, and the importance of early detection.

Introduction: Taxane medications, paclitaxel, and docetaxel, are chemotherapy agents that have a higher incidence of reported hypersensitivity and infusion reactions. To help classify these reactions, the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) is utilized. Prophylactic medications have been used to decrease the incidence and severity of these events. At our institution, medications that patients can receive prior to the initiation of a taxane infusion are a histamine 1 receptor antagonist (H1RA), histamine 2 receptor antagonist (H2RA), a steroid or a combination of these medications. The purpose of this retrospective review was to compare the rates and severity of infusion reactions based on the timing of prophylactic medication administration in the first and second doses of taxane infusions.

Methods: Patients who received paclitaxel or docetaxel from January 30^th, 2022, through January 30^th, 2023, were included in the analysis. To assist in the identification of a reaction, taxane administrations were flagged for review if a rescue medication was administered after the start of a paclitaxel or docetaxel infusion. The rates and severity of infusion reactions were analyzed based on the timing of prophylactic medication administration. A sub-group analysis comparing infusion reaction characteristics between taxanes given, was performed.

Results: Of the 1486 taxane infusions that were completed within the year, 249 infusion reactions were confirmed and graded utilizing the NCI CTCAE. When examining the first and second doses of a taxane (N = 536), we identified 222 infusions reactions. The odds of a patient having an infusion reaction, during the first and second doses, was found to be less likely for patients given a prophylactic medication 30 min prior to receiving a taxane compared to those who did not receive a pre-medication (p = 0.037).

Conclusion: This multisite retrospective study showed that administration of prophylactic medications 30 to 80 min prior to the first and second infusion of a taxane was the optimal timing to decrease the likelihood of patients having an infusion reaction. No difference in the severity of the reaction was seen. Most patients were able to complete the entire infusion, regardless of what rescue medications were used following the infusion reaction.

Background and aims: Melanoma now presents an average risk of 1 in 50 in the Western world. Talimogene laherparepvec (T-VEC), an FDAapproved oncolytic virus derived from Herpes Simplex Virus type 1 (HSV-1), has proven effective in reducing morbidity and mortality from melanoma but causes adverse effects like chills, fever, exhaustion, and injection site discomfort. Research focuses on combining T-VEC with immune checkpoint inhibitors, such as pembrolizumab, to enhance its efficacy and broaden its application.

Methods: A systematic search was conducted using PubMed, Scopus, Web of Science, Google Scholar, and ProMED, adhering to PRISMA guidelines. Results were tabulated and analyzed.

Results: This review included 15 studies comprising nine cohorts, four case reports, a case series, and a randomized control trial, involving 779 melanoma patients in stages IIIB to IV, 58% of whom were male with a mean age of 65 years. Treatment duration with T-VEC averaged 35.07 weeks, with dosages ranging from 10^6 to 10^8 PFU/ml. The intervention yielded a mean DRR of 41.87% and an ORR of 62.2%. The most common side effect was chills, affecting 21.69% of participants. Pyrexia was reported by 20.41% of participants, followed by influenzalike illness (14.89%).

Conclusion: T-VEC effectively improves ORR and DRR in melanoma patients. However, further research is needed on combination therapy prospects and its adverse effects.

Purpose: Sinusoidal obstructive syndrome (SOS)/veno-occlusive disease (VOD) is a serious complication in hematopoietic stem-cell transplant (HSCT) patients. Gemtuzumab-ozogamicin (GO) and InO are known to cause SOS/VOD in leukemic and transplant populations. Due to limited data on ursodiol prophylaxis in non-HSCT patients, we aimed to assess hepatotoxicity, SOS/VOD incidences, time to hepatotoxicity, and confirmed SOS/VOD in adults receiving GO or InO ± ursodiol.

Methods: A multicenter, retrospective chart review of adult acute leukemia patients who received ≥1 dose of GO or InO at DFCI/some of the Harvard Cancer Centers during 4-year period (9/1/2017-9/1/2021). Acute promyelocytic leukemia patients and post-GO or InO HSCT-recipients (100-day follow-up period) were excluded. Descriptive summaries are provided, direct comparisons were made using Student T-test (continuous variables) and Fisher's exact test (categorical variables).

Results: In our population (N = 82), 87.8% received ursodiol and 12.2% did not. There were no significant differences in baseline to peak hepatic labs. The No-Ursodiol Group had higher incidence of Grade 3 aspartate aminotransferase (AST) transaminitis vs. the Ursodiol Group (60% vs. 20.8%; p = 0.015), and a trend towards shorter mean time to Grade 3 AST transaminitis (18.5 vs. 23.8 days; p = 0.30). Moreover, 4.2% of Ursodiol Group developed SOS/VOD vs. 0% in the No-Ursodiol Group (NS). Three patients developed SOS/VOD: 2 received GO, 1 received InO, and 2 were alive by the end of the follow-up period.

Conclusion: In our cohort, ursodiol prophylaxis in adults receiving GO/InO is not associated with lower incidences of hepatotoxicity, SOS/VOD, or time to Grade 3 AST transaminitis, but is associated with decreased incidence of AST elevations.

Introduction: Data on the optimal management of patients with hematologic malignancies and chemotherapy-induced nausea and vomiting (CINV) are lacking, particularly for multiday chemotherapy regimens. We report our institutional experience in patients with B-cell lymphoma receiving multiday dose-adjusted R-EPOCH chemotherapy utilizing two CINV prophylaxis strategies.

Methods: We performed a retrospective, single-center, cohort study evaluating hospitalized patients with aggressive non-Hodgkin B-cell lymphoma receiving DA-R-EPOCH (April 2016 to October 2022). All patients received prophylactic corticosteroid and 5HT3-receptor antagonist, and were categorized by the addition of an NK1 receptor antagonist (NK1RA) or not. The primary outcome was complete response (CR, no vomiting, and no rescue medication use) over 120 h. Secondary outcomes included as-needed antiemetic use (acute, delayed, and overall phases), CR without escalating prophylactic antiemetics in cycle 2, and complete control. We performed a descriptive analysis and multivariate logistic regression for NK1RA use, adjusting for age and sex.

Results: Of 128 patients, 56 (43.8%) received an NK1RA as part of their antiemetic regimen, and 72 (56.3%) did not. No patients received prophylactic olanzapine. CR was achieved in 32 (57.1%) of those who received an NK1RA and 30 (41.7%) who did not (OR 0.45; 95% CI, 0.21-0.96; p = 0.039). We observed trends between groups in as-needed antiemetics use (29 [51.8%] vs. 49 [68.1%]; p = 0.061), with most use in the delayed phase (22 [39.3%] vs. 37 [51.4%], p = 0.173). We found no difference in healthcare utilization between the first and second cycle.

Conclusion: CINV control in patients with non-Hodgkin B-cell lymphoma receiving DA-R-EPOCH in the hospital was suboptimal. These data support the need to optimize prophylactic antiemetic regimens for patients receiving DA-R-EPOCH.

Introduction: Horse antithymocyte globulin carries a black box warning for life-threatening anaphylactic reactions, and prescribing information recommends test doses to identify patients at highest risk of this adverse effect. The predictive value of such test doses is not well validated, and practicality of use is unclear.

Methods: This was a planned secondary analysis of a multicenter, retrospective cohort study in adults with severe aplastic anemia being managed with horse antithymocyte globulin as part of their treatment regimen. Qualitative and quantitative descriptions of test doses and infusion reactions are summarized, alongside key institutional administration practices.

Results: Of 49 patients who received intradermal test doses, two experienced positive reactions and went onto receive their full horse antithymocyte globulin course through prolonged infusion time or desensitization. Infusion reaction rate in patients with negative test doses was 61%, corresponding to a negative predictive value of 39%. Premedication, infusion time, and infusion reaction management were similar across institutions.

Conclusion: Horse antithymocyte globulin has a high risk of infusion reactions that must be monitored and managed closely. However, test doses do not consistently predict who will experience an infusion reaction, and their practicality may be limited with current administration practices.

Background: Our research focused on assessing the satisfaction of cancer patients with oncology pharmacy services, as well as evaluating the satisfaction levels of other healthcare and supportive staff associated with the oncology pharmacy unit.

Methodology: This qualitative cross-sectional study, based on a questionnaire, aimed to evaluate the best practices of oncology pharmacy services for patients and the efficiency of services provided by healthcare professionals and administrators at Benjamin Mkapa Hospital (BMH). The study was conducted at the adult oncology unit from July to August 2022. It included all consenting patients and staff who attended or served in the unit and met the inclusion criteria during this period.

Results: A total of 62 cancer patients and 53 BMH staff members working closely with the unit were interviewed. Among the patients, approximately 86% expressed satisfaction with the overall care provided by the oncology pharmacy services, 79% were satisfied with the dispensing practices and pharmaceutical care, and 64% were pleased with the patient-pharmacy personnel relationship. The staff survey, conducted among those closely collaborating with the oncology pharmacy unit, revealed that 85% were satisfied with the unit's plan and mission, 72% were content with the teamwork and motivation of the pharmacy personnel, and 92% were satisfied with the competencies of the oncology pharmacy staff.

Conclusion: Our thorough study revealed notably high levels of satisfaction and acceptance concerning the services provided by oncology pharmaceutical personnel. Pharmacists should ensure their presence during patient visits and dedicate adequate time for counselling to enhance patients' therapeutic alliance. Furthermore, optimising pharmacy workflow and adopting a patient-centred approach will help create a more organised and welcoming environment, reducing turnaround time.

Background: Tacrolimus is administered via a continuous or intermittent IV infusion to prevent acute graft versus host disease (aGvHD) in pediatric hematopoietic stem cell transplant (HSCT) recipients. Limited comparison data is available.

Objectives: The primary objective was to compare the proportion of therapeutic tacrolimus trough levels in the first 30 days post-stem cell infusion. Secondary outcomes were prevalence of aGvHD, intra-patient variability (IPV) and safety.

Study design: This was a retrospective cohort study that included pediatric HSCT recipients between March 1, 2015 and October 31,2021 at BC Childrens Hospital. Adverse events were assessed using the Naranjo scoring tool.

Results: Overall, 60 transplants in 59 patients were included; n = 36 intermittent IV and n = 24 continuous IV. Median proportion of blood levels (intermittent and continuous) within 8-12 ug/L was 38% and 56%, respectively (p = 0.04). IPV was 33% and 31% and aGvHD was 39% and 38% in intermittent and continuous respectively. There was a higher proportion of adverse effects in the intermittent group with the exception of hypomagnesemia.

Conclusions: Continuous IV tacrolimus provided a higher proportion of levels within therapeutic range. Neither achieved therapeutic trough levels in more than 56% of transplants. However, there was large intra-patient variability in both groups.

Objective: This article aims to expand on the existing literature regarding the incidence of withdrawal pain following discontinuation of Trk inhibitors and to explore strategies that mitigate this withdrawal pain.

Data source: A retrospective observational study was conducted among patients who were at least 18 years-old or older and had documentation of starting larotrectinib or entrectinib at University of California, San Francisco (UCSF) between November 2018 and November 2022. Data were collected from electronic records and pharmacy databases and a total of 21 patients were identified in this study.

Data summary: Of the 21 patients included in this study, five patients (24%) experienced pain during temporary or permanent discontinuation of Trk inhibitor with the onset of withdrawal pain ranging from a few hours to three days following discontinuation. Various strategies were implemented to manage this pain including restarting of Trk inhibitor, tapering of Trk inhibitor on discontinuation, minimizing dose interruptions and use of prescription pain medications.

Conclusion: This article illustrates the presence of withdrawal pain syndrome in patients stopping a Trk inhibitor treatment and highlight the need for patient education to avoid missing any doses and for development of a guideline for Trk inhibitor discontinuation.

Objective: Chemotherapy medications are usually having high costs, and new targeted drugs can be especially expensive, representing a challenge on healthcare, particularly in low- and middle-income countries. As cytotoxic leftover management is crucial for reducing medication wastage, the aim of this study is to evaluate and optimize leftover management circuit in NIO'S Pharmacy Centralized Chemotherapy Preparation Unit (CCPU) through a Failure Mode, Effects and Criticality Analysis (FMECA), and propose continuous improvement element to enhance the security of the process.

Method: The FMECA were conducted in NIO's CCPU from March to May 2023, then continuous improvement plan was established to enhance the security of the process. The failure modes, their causes, impact, and criticality were assessed through criticality index calculation (CI = severity × frequency × detectability), and the risk concerned safety and effectiveness disruptions in chemotherapy preparation circuit using cytotoxic leftover.

Results: Leftover management circuits were described in flowchart form, where 18 failure modes were detected in four different steps of the process from chemotherapy preparation to disposal. Failure with highest critical index were detected in the case of equipment malfunction, improper storage temperature, and humidity. Continuous improvement recommendations were proposed in a table form.

Conclusion: FMECA analysis applied to NIO's chemotherapy leftover management process allowed us to evaluate, secure, and optimize the circuit, and to propose several actions to implement in a perspective of continuous improvement.