Journal of Oncology Pharmacy Practice最新文献

IntroductionAntineoplastic drug contamination can result in severe health effects for healthcare workers exposed to them. Despite the worldwide growing concern regarding these drugs and sustained monitoring efforts in developed countries, there is almost no data about surface contamination levels in Argentina, in particular, and South America, in general.MethodsAntineoplastic drug contamination was measured in three Argentinean public hospitals (pharmacy and daycare center areas) by surface wiping and liquid chromatography coupled with tandem mass spectrometry.Results and DiscussionEleven drugs were detected, in 51 of 58 sampled surfaces, in variable concentrations from 0.00064 to 7.3 ng cm^-2, with cyclophosphamide, gemcitabine, and paclitaxel as the most prevalent drugs. This highly variable antineoplastic distribution reflects differences in facility layout, number of patients, antineoplastic drug use, etc., at each hospital. Values exceeding the 1 ng cm^-2 threshold were detected in 13 surfaces of the two hospitals handling the largest amounts of antineoplastic drugs. The cyclophosphamide 75th percentile averaged 0.030 ng cm^-2 comparable to the high values reported more than 10 years ago for developed countries, emphasizing the potential of reducing antineoplastic contamination by implementing routine monitoring and improved cleaning and handling procedures.ConclusionThis study is the first survey of multi-compound surface antineoplastic contamination in Argentinean (and South American) hospitals, providing a baseline against which future studies can be compared. Widespread antineoplastic contamination has been detected on numerous surfaces, with concentrations surpassing suggested threshold exposure levels (1 ng cm^-1) for some surfaces in two of the sampled hospitals.

ObjectiveThis study aims to develop standardized recommendations for the implementation of Automated Dispensing Systems (ADS) in oncology wards, focusing on enhancing patient safety, operational efficiency, and the integration of these systems into hospital workflows.MethodA structured methodology was employed, combining documentary analysis of ADS practices at CHUIS, synthesis of strategies for implementation, and development of evidence-based recommendations validated by a multidisciplinary panel.ResultsThe primary outcome of this study was the development of standardized recommendations tailored for ADS implementation in oncology wards. Key findings included the importance of phased planning, targeted training (60 h), and integration with existing hospital IT systems. These recommendations emphasized initial audits, stakeholder engagement, and continuous monitoring to ensure sustainable and replicable practices. Enhanced medication management processes, including reductions in cytotoxic drug costs (9%), expiration-related losses (98.3%), and stockouts (41.1%), further demonstrated the transformative potential of ADS.DiscussionThe study underscores the critical role of tailored, evidence-based strategies in facilitating successful ADS adoption. These recommendations align with international safety standards and provide a scalable framework adaptable to diverse oncology settings. Limitations include the need for further exploration of resource adaptability and long-term impact on patient outcomes. The integration of emerging technologies, such as AI, presents opportunities for future optimization.ConclusionThis research highlights the value of standardized recommendations for ADS implementation in oncology wards. By addressing operational challenges and integrating innovative solutions, this study offers a practical model for enhancing oncology pharmacy practices globally.

ObjectiveThe article explores phytoconstituents as alternatives to corticosteroids for radiodermatitis, emphasizing antioxidant, antimicrobial, and anti-inflammatory properties. It summarizes recent research on phytoconstituents mitigating radiation-induced skin damage and contributing to "oncocosmetics" development for cancer patients undergoing radiotherapy.Data SourcesScientific literature was reviewed, including studies on radiodermatitis symptoms, phytoconstituent mechanisms, and their effectiveness in treating radiation-induced skin injuries. Search criteria included peer-reviewed articles on therapeutic applications and cosmeceutical formulations.Data SummaryRadiodermatitis affects 95% of individuals exposed to ionizing radiation during radiotherapy, presenting symptoms like erythema, pruritus, ulcers, and necrosis. Current treatments rely heavily on corticosteroids, which cause side effects like skin atrophy and systemic reactions. Phytoconstituents offer safer alternatives by neutralizing free radicals and protecting against radiation-induced skin damage. Their antioxidant, antimicrobial, and anti-inflammatory actions align with mechanisms involved in radiodermatitis healing. Research highlights their efficacy in preventing bacterial superinfection and promoting skin recovery. Phytoconstituents are increasingly incorporated into cosmeceutical products for cancer patients.ConclusionsPhytoconstituent-based preparations promise safer alternatives to corticosteroids for managing radiodermatitis. Their use in oncocosmetics can reduce side effects while improving patient outcomes. Further research into phytoconstituent formulations is needed for radiation-induced skin injuries.

IntroductionThe growing interest of cannabidiol (CBD) in medical care prompted French health authorities to explore the potential of CBD in cancer-related severe symptoms. This study aimed to assess the prevalence of CBD use among cancer patients with potential associated factors and to measure the cancer patient's health literacy (HL) on CBD consumption.MethodsIn a prospective study in oncology day-care hospital including patients from 29 October to 20 December 2021, we collected demographic, biological, and oncological characteristics. Patient CBD HL was measured by the hetero-questionnaire 8-item-CBD HL scale (HLS-8-CBD) whose conception has been validated by a psychometric analysis.ResultsAmong 363 participants, 20 patients (5.5%) reported CBD use. Factors associated with CBD use were: age <60 years (odd ratio = 7.80[1.36-13.32], p < 10^-4 versus ≥60 years), smoking history (OR = 5.53[1.81-16.88], p < 0.01), and no smoking cessation (OR = 5.07[1.66-15.46], p < 0.01). CBD use was also associated with a better CBD total HL score than non-users (p-value = 0.02).ConclusionIdentification of factors associated with CBD use and a relatively high patient CBD HL in CBD users showed that CBD use in cancer patients care represented a new concern and should enhance health professionals to consider CBD with its associated drug-related problems.

IntroductionVinorelbine, a semi-synthetic vinca alkaloid with anticancer activity by binding to tubulin, has shown to be successful in the treatment of cancer types including advanced non-small cell lung cancer, uterine cancer, and metastatic breast cancer. Myelosuppression, hematological effects, nausea, vomiting, exhaustion, and neuropathy are some of the most typical side effects of vinorelbine. We discuss the unusual presentation of vinorelbine-induced tetraplegia in a breast cancer patient.Case ReportA 66-year-old patient with breast cancer, who was followed up with adjuvant aromatase inhibitor therapy after mastectomy, presented with lung and bone metastases. She progressed in the follow-ups after receiving platinum and taxane chemotherapy, vinorelbine treatment was then started. The patient complained of weakness, weariness, and trouble walking after receiving a total dose of 180 mg. Tetraplegia was found after a neurological assessment.Management and OutcomeIt was thought that vinorelbine was responsible for the recent acute weakness. The patient's vinorelbine treatment was stopped. During follow-up, upper extremity paresis regressed, while lower extremities muscle strength remained unchanged.DiscussionVinorelbine, frequently used in oncology practice, causes some side effects. Although very rare in the literature, in this case severe peripheral neuropathy has been reported in the follow-up of post-vinorelbine quadriparesis.

BackgroundThe CREATE-X trial demonstrated that adjuvant capecitabine was effective in prolonging survival in high-risk triple-negative breast cancer (TNBC) patients. However, the recommended dose is generally not well tolerated by the US population. The goal of this study is to analyze dosing patterns in an ethnically diverse cohort to better characterize tolerability and inform future dosing guidelines.MethodsIn our single-center retrospective study, we evaluated safety and tolerability in TNBC patients undergoing adjuvant capecitabine treatment. The primary endpoint, relative dose intensity (RDI) across eight cycles, was examined alongside subgroup analyses based on age, race, BMI, and initial dose. Secondary endpoints include capecitabine-related side effects and survival.Results67 patients who completed adjuvant capecitabine at University of Chicago Medicine (UCM) between January 2017 and November 2022 were eligible. The mean RDI across eight cycles of treatment was 60.2% (95% CI: 0.554-0.650). When compared to the CREATE-X trial, the RDI in our population was significantly lower (0.602 vs. 0.787, p < 0.001). There was no statistically significant difference in average RDI across eight cycles for patients stratified by age, BMI, race, or initial starting dose. The most frequently reported adverse events were hand-foot syndrome (73%), diarrhea (27%), and fatigue (22%), consistent with prior studies.ConclusionsOur data demonstrates that a significant portion of patients have a lower tolerated dose of capecitabine in comparison to the recommended adjuvant dose. Acknowledging the limitations of our single-center analysis, RDI was not significantly affected by age, race, BMI, or initial starting dose.

BackgroundMany oral medications are manufactured as solid dosage forms, posing challenges for patients with dysphagia-including older adults and children-and creating occupational hazards for healthcare workers who must crush or manipulate hazardous drugs. Existing methods for preparing such medications often involve open systems, exposing staff to cytotoxic agents and risking cross-contamination.ObjectiveTo develop and evaluate a novel, single-use closed-system drug-transfer device (CSTD) designed to crush and dissolve or suspend solid oral medications within a sealed environment, enhancing safety for healthcare workers and improving medication access for patients with swallowing difficulties.MethodsWe developed a prototype CSTD comprising a 20 mL transparent barrel, a mechanical crushing piston with an integrated mesh, one-way fluid inlet, and a sealed outlet port for administration. Device sealing integrity was evaluated using vacuum methylene blue ingress testing, while drug extraction efficiency was quantified using high-performance liquid chromatography (HPLC) analysis of paracetamol solutions prepared with the device.ResultsSealing integrity tests demonstrated no dye ingress under vacuum conditions, confirming a robust closed system. HPLC analysis of paracetamol solutions showed recoveries exceeding 98%, indicating effective crushing and dissolution. The device offers a practical closed-system approach for handling hazardous oral medications and enables safe administration via oral or enteral routes.ConclusionThis novel CSTD represents a promising innovation to improve occupational safety during hazardous drug handling and to enhance treatment accessibility for patients with dysphagia. Further clinical evaluation and regulatory review are underway.