Journal of Oncology Pharmacy Practice最新文献

IntroductionChemotherapy remains a cornerstone of cancer treatment, but a narrow therapeutic index and toxic effects on normal tissues frequently constrain its clinical utility. Pharmacovigilance of these drugs is limited due to significant underreporting, which poses a substantial risk to patient safety. We aimed to assess the frequency, types, severity, and management of ADRs in chemotherapy patients.MethodsA 12-month cross-sectional study was conducted in a tertiary-care hospital, including 327 chemotherapy patients. The data was collected in a suspected ADR reporting form by the Central Drugs Standard Control Organisation (CDSCO) and reported to the ADR Monitoring Centre and Vigiflow at the National Coordinating Centre (NCC). The suspected drugs were evaluated for causality using the Modified Naranjo scale, and ADR severity was assessed with the Hartwig et al. severity scale.ResultsOut of 327 patients, 230 developed ADR (70%). A total of 372 ADRs were reported, which indicated 1.6 events per patient. ADRs primarily occurred in the 40-60-year age group (57.0%), with a predominance among females (64.8%). Common ADRs included thrombocytopenia (11.2%), neutropenia (9.9%), and diarrhoea (7.7%). Ovarian (17.3%) and breast cancer patients (15.6%) had the highest ADR incidence. Platinum-based agents and antimetabolites were the common culprit drugs. Causality assessment showed 36.1% of ADRs as 'possible' and 61.7% as 'probable.' The severity of ADRs was categorised as 'mild' (49.13%), 'moderate' (46.08%), and 'severe' (4.79%).ConclusionThe study emphasises the critical need for vigilant surveillance to minimise the impact of these complications on treatment outcomes. Future studies could stratify data by cancer stage.

IntroductionWhile the co-administration of oral protein kinase inhibitors (PKIs) and gastric acid suppressants (GASs) is widespread, the impact of GASs on the pharmacokinetics and survival outcomes of PKIs has remained systematically uninvestigated. The present study aimed to address this knowledge gap and to verify whether PKI plasma concentrations can predict these interactions.MethodsMEDLINE and CENTRAL databases were searched until April 4, 2025. We included studies of PKIs where their plasma concentrations and the survival outcomes of participants taking PKIs with GASs. All studies eligible for this analysis were assessed using the appropriate risk-of-bias tool. For the meta-analysis, we estimated the ratio of the mean plasma concentrations and the hazard ratios of survival outcomes.ResultsThis meta-analysis included 17,339 participants from 38 studies, including 11 PKIs. Our results revealed that the co-administration of PKIs with GASs led to a concurrent decrease in plasma concentrations and a shorter OS in 8 out of 11 PKIs, as well as a shorter PFS in 10 PKIs.ConclusionsWe found that changes in the plasma concentrations of PKIs administered with GASs could predict the changes in survival outcomes in cancer patients. One major limitation of this meta-analysis was that 68% of the eligible studies had a retrospective design.

IntroductionReuse of antineoplastic and supportive drugs can reduce costs by cutting down the amount of chemotherapy drug waste generated. Therefore, this study aims to analyze the disposal and reuse of preparations which contain these two pharmaceutical classes.MethodsThis is a prospective study conducted with pediatric and adult patients who did not undergo one or more chemotherapy session between July and November of 2024. The chemotherapy preparations were classified as reused or discarded and quantified. The reasons for drug disposal and patient's sociodemographic data were also analyzed.ResultsOne hundred and forty patients composed the studied population, all of them responsible for 188 missed chemotherapy sessions. The study's population is predominately adult, male, residing at Rio de Janeiro city and with less than 12 years of education. Almost half of the population (47.9%) had one or more comorbidity. The most prevalent tumors were those of the digestive system (40.1%). The drug disposal rate was 2.11%. The chemotherapy suspension rate was higher (66.3%) than non-attendance (32.6%). The patient's worsening clinical condition was the main reason (45.2%) that led to chemotherapy suspension, while miscommunication (37.1%) was the main reason attributed to non-attendance. Oxaliplatin was the most discarded drug whereas vincristine was the most reused drug.ConclusionsRate of chemotherapeutic drug disposal is higher than their reuse. Although session suspension and non-attendance are caused by different reasons, both can be reduced by implementation of an effective communication routine between patient and provider in the days prior to the scheduled session.

IntroductionMulticriteria Decision Analysis (MCDA) comprises a set of methods that support decision making in Health Technology Assessment (HTA). MCDA studies that support the incorporation of new treatments for non-metastatic HER2-positive breast cancer are still rare.ObjectiveTo elaborate a MCDA comparing 8 treatments alternatives for women with non-metastatic, HER2+, hormone receptor positive (HR+), postmenopausal breast cancer, who did not achieve a pathological complete response (PCR) after neoadjuvant chemotherapy with taxane plus anti-HER2 therapy.MethodsAn MCDA approach specifically built for application in oncology was used. The study was developed at the Cancer Institute of the State of São Paulo (ICESP) according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) recommendations.ResultsIt was possible to obtain a ranking of the 8 alternatives: the first, second and third position were respectively: neoadjuvant treatment without anthracycline and anti-HER2 therapy with only trastuzumab followed by adjuvant trastuzumab (global value 0.739); neoadjuvant treatment with anthracycline and anti-HER2 trastuzumab alone followed by adjuvant trastuzumab (global value 0.717) and neoadjuvant treament with anthracycline plus trastuzumab alone or double anti-HER2 blockade with trastuzumab and pertuzumab, followed by adjuvant T-DM1 (global value 0.697). The criteria that received the greatest weight from stakeholders were in descending order: disease-free survival, cost, severity of the disease, adverse reactions and overall survival.ConclusionMCDA made it possible to compare treatment alternatives for non-metastatic, HER2+, HR + breast cancer, with the most innovative technology T-DM1 appearing fourth.

Introduction5-Fluorouracil (5-FU) is a chemotherapeutic agent used in various malignancies. 5-FU-induced leukoencephalopathy is a rare but reversible neurotoxic effect occurring within days of administration. Symptoms include confusion, agitation, and cognitive disturbances, with severe cases potentially causing coma. Diagnosis is supported by magnetic resonance imaging (MRI) showing characteristic brain changes. Treatment involves discontinuing 5-FU and initiating supportive care. Most patients recover within one week, but relapse may occur with repeated exposure, making early recognition critical.Case reportA 42-year-old male with recurrent Stage IV gastric adenocarcinoma and chronic kidney disease developed progressive 5-FU-related leukoencephalopathy after repeated exposure. MRI findings and symptoms of confusion, disorientation, and memory deficits were consistent with 5-FU leukoencephalopathy. Initial work-up was inconclusive, therefore, treatment was continued. Neurologic symptoms worsened after further cycles, leading to chemotherapy discontinuation and surgical resection. Disease recurrence led to reinitiation of modified 5-FU therapy, triggering acute neurotoxicity confirmed by MRI.Management and outcomeThe patient was managed by discontinuing 5-FU, beginning high-dose intravenous thiamine and methylprednisolone, and providing supportive care. Neurologic symptoms including confusion, facial diplegia, and unsteady gait gradually resolved. By Day 9, he returned to baseline mental status without deficits.DiscussionEarly recognition and intervention in 5-FU-induced leukoencephalopathy is crucial, especially in patients with renal dysfunction or repeated exposures. Dihydropyrimidine dehydrogenase (DPD) deficiency has not been directly implicated in this condition. Metabolic disruption and thiamine depletion contribute to pathogenesis. Prompt 5-FU discontinuation and initiation of supportive care can hasten recovery. Clinical vigilance is imperative in patients with known risk factors.

BackgroundEsophageal cancer remains a leading cause of cancer-related mortality worldwide, with docetaxel, cisplatin, and fluorouracil (DCF) chemotherapy being a standard treatment option for locally advanced disease. However, DCF is associated with a high incidence of febrile neutropenia (FN), a serious complication that can lead to treatment delays, hospitalizations, and increased morbidity. Pegfilgrastim, a long-acting granulocyte colony-stimulating factor (G-CSF), is recommended for FN prevention, but its efficacy in esophageal cancer patients receiving DCF chemotherapy remains unclear.MethodsA systematic literature search of PubMed, Cochrane Library, Scopus, and Web of Science identified eligible studies. Retrospective and prospective studies comparing prophylactic pegfilgrastim with placebo or no G-CSF in patients undergoing DCF therapy were included. Eight reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. The extracted data were then verified by two additional reviewers. A meta-analysis was conducted to calculate pooled effect sizes.ResultsPooled analysis showed that pegfilgrastim significantly reduced FN incidence (OR = 0.283, 95% CI: 0.102-0.782, p = 0.015). FN rates ranged from 3.3% to 30.8% in the pegfilgrastim group versus 26.7% to 60.6% in the control group. Pegfilgrastim was also associated with lower rates of severe neutropenia and shorter hospital stays, with no significant increase in adverse events.ConclusionsIn our study, Pegfilgrastim prophylaxis significantly reduces FN risk, severe neutropenia, and hospital stays in esophageal cancer patients receiving DCF chemotherapy, without increasing major complications. These findings support its routine use in this population, though further prospective randomized trials are needed to optimize dosing strategies and confirm long-term benefits.

BackgroundAfter hospital discharge, recipients of allogeneic hematopoietic stem cell transplantation (HSCT) must adhere to immunosuppressants to reduce the risk of complications such as graft-versus-host disease (GvHD). The use of therapeutic drug monitoring (TDM), a measure of medication adherence (MA), in the transplantation field has received limited research attention.ObjectivesWe used TDM to measure MA to the oral calcineurin inhibitors (CNIs) cyclosporine A (CSA) and tacrolimus (FK), from the patient's first follow-up visit after discharging up to 100 days after HSCT. The secondary aim was to identify risk factors for medication non-adherence (MNA) and the relationship between MNA and HSCT-related complications.Materials and MethodsA retrospective observational study was conducted at an academic hospital in northeast Italy. We included 269 adults undergoing allogeneic HSCT and a total of 1493 CNI serum assays.ResultsUsing an MA threshold of ≥ 80%, 37.2% of patients were adherent (57.9% to CSA and 17.9% to FK). There were no differences at the analyzed time points; however, MNA with TDM below the target range increased over time. There were no risk factors for MNA, nor differences in GvHD or hospital readmissions between adherent and non-adherent patients.ConclusionTDM can be used to assess MA to CNIs up to 100 days after HSCT, but due to the limitations of this measure, it would be useful to corroborate the results with other MA measurement systems. Prospective studies are required to identify risk factors, outcomes of MNA, and to validate which MA threshold could establish clinical relevance.

IntroductionOccupational exposure to antineoplastic drugs remains a significant concern for healthcare workers. Surface contamination is a key indicator of exposure risks and reflects the effectiveness of practices. This study aimed to describe contamination with 11 antineoplastic drugs on 12 surfaces in Canadian healthcare centres participating in the 2025 monitoring program and to examine practices implemented by these centres, including the potential influence of hazardous drug committees.MethodsEach centre sampled six standardized sites in oncology pharmacies and six in outpatient clinics. Ultra-performance liquid chromatography-tandem mass spectrometry quantified cyclophosphamide, docetaxel, doxorubicin, etoposide, 5-fluorouracil, gemcitabine, irinotecan, methotrexate, paclitaxel and vinorelbine. Inductively coupled plasma mass spectrometry quantified platinum-based drugs. The Kolmogorov-Smirnov test assessed differences in contamination, and chi-square tests compared practice implementation.ResultsA total of 127 centres participated. Overall, 35% (504/1 453) of surfaces were contaminated, most frequently cyclophosphamide (22%, 90^th percentile 0.0052 ng/cm²) and gemcitabine (14%, 0.0017 ng/cm²). The most contaminated sites were the front grille inside the biological safety cabinet (70%) and the armrest of the treatment chair (67%). More than half of centres (67/122, 55%) reported having a hazardous drugs committee. Cyclophosphamide surface contamination differed by committee presence and meeting frequency (p = 0.034). Centres with a committee were more likely to implement certain handling practices, including cleaning vials before storage (p = 0.004).ConclusionsSurface contamination remains frequent but at low concentrations, with evidence of improvement over time. Multidisciplinary committees, continuous monitoring and broader staff engagement are essential to strengthen safety culture and reduce occupational exposure.

IntroductionLet's Communicate Cancer is an educational programme designed to support pharmacy staff in recognising and signposting patients with possible cancer symptoms. This study explored pharmacists' views on its educational impact, suitability, acceptability, and areas for improvement.MethodsAn anonymised cross-sectional digital survey was used to collect pre/post-programme data and was distributed to participants between September and November 2024. Participants were community pharmacists undertaking postgraduate study at the University of Bradford. Quantitative data were analysed using descriptive statistics and differences identified using paired t-tests; free-text responses underwent thematic analysis.ResultsFifty-one pharmacists completed the study. Most were female (56.4%, n = 29) and had practised for 2-3 years (60.8%, n = 31). Baseline confidence in recognising cancer symptoms was low, although correct identification rates were high for lung (88.2%, n = 45) and bowel cancer symptoms (84.3%, n = 43). Post-programme, confidence in recognising symptoms increased (27.4% v 98%), discussing them with patients (27.6% v 96.1%), and signposting to further investigation (41.1% v 96.1%) (p ≤ 0.05 for all questions). Satisfaction with content (96%, n = 49) and design (84.2%, n = 43) was high. Suggested improvements included development of physical near-patient resources to aid conversations.ConclusionLet's Communicate Cancer effectively improved pharmacists' knowledge and confidence in recognising and signposting patients with symptoms of possible cancer. This programme is well positioned to support the emerging role of pharmacists as a resource to identify symptomatic patients for investigation. An ongoing collaboration between the British Oncology Pharmacy Association and the International Society for Oncology Pharmacy Practitioners has been established to support international adoption.

PurposeCancer pain is one of the most distressing symptoms, severely impairing patients' quality of life (QoL). This study aimed to assess cancer pain using multidimensional questionnaires and to evaluate the impact of pharmacist-led interventions on pain management and QoL.MethodsA prospective interventional study was conducted among eligible cancer patients. Pain and QoL were assessed using validated multidimensional questionnaires. Pharmacist interventions included counselling, an educational video, and a patient information leaflet. Patients were reassessed post-intervention, and pre- and post-intervention data were analyzed for statistical significance.ResultsA total of 147 cancer patients were enrolled, with nearly equal gender distribution. Breast, buccal mucosa, and lung cancers were most prevalent. Surgery was the predominant treatment, followed by radiation and chemotherapy. Pharmacist-led interventions significantly improved QoL across physical, emotional, social, sleep, and behavioral domains (all p < 0.01), with overall QoL scores rising from 4.8 ± 1.25 to 10.5 ± 2.13 (p < 0.001). The economic domain showed comparatively slight improvement, reflecting persistent financial strain. Use of non-pharmacological strategies such as meditation, physiotherapy, and psychosocial support increased significantly post-intervention.ConclusionA comprehensive assessment with a multidimensional pain questionnaire revealed the broad impact of cancer pain on patients' lives. Pharmacist-led interventions, combining education, counselling, and supportive care, significantly improved pain control and quality of life across physical, emotional, social, and sleep domains. The persistent economic burden indicates the importance of integrated financial support, but our findings highlight the vital role of clinical pharmacists in delivering holistic, patient-centered cancer pain management.