Pub Date : 2024-07-01Epub Date: 2023-07-27DOI: 10.1177/10781552231189695
Henry Pun, Ian Pang, Kori Leblanc, Patwant Dhillon, Cassandra McEwan, Priya Patel, Rajat Kumar
Background: Cancer and cancer-related treatments are significant independent risk factors for malignant hematology (MH) patients in developing venous thromboembolism (VTE). Treatment of VTE in MH patients at the Princess Margaret Cancer Centre is predominantly initiated with low molecular weight heparin (LMWH) in accordance with guidelines. While guidelines recommend against LMWH use in patients with thrombocytopenia, prescribers may order LMWH conditionally based on platelet values. Currently, there is a lack of consistent practice with variation in both the use of conditional orders as well as the threshold of platelet values for conditional orders. The objectives of the study were to (a) describe the use of conditionally ordered LMWH based on platelet values; (b) determine its safety by measuring administration concordance with conditional orders and bleeding event rates during inpatient admission; and (c) determine its efficacy by measuring the rate of worsening VTE or recurrence during inpatient admission.
Methods: Electronic records of MH inpatients admitted between January 2017 and December 2019 and who were administered at least one dose of an LMWH for the treatment of VTE were screened.
Results: One hundred and eight patients were screened to obtain 50 eligible patients with a median age of 59 years (SD = ±18.8 years). The most frequent MH diagnosis was acute lymphoblastic leukemia (30%). Sixty percent (n = 30) of patients received conditional orders. Out of 571 administrations, 543 (95%) were administered concordantly (Χ2(1) = 472, p < 0.0001). In this group of patients, 8 patients had either documented bleeding or experienced a drop in hemoglobin >10 g/L within a 72 h time frame. No patients experienced a recurrent VTE during inpatient treatment (for up to 40 days post-admission).
Conclusions: It appears that conditionally ordered LMWH can be concordantly administered and is safe and effective in the treatment of VTE in MH patients experiencing thrombocytopenia. There were no reports of worsening or new VTE in our small sample.
{"title":"Single center evaluation on the use of conditionally ordered low molecular weight heparins in malignant hematology patients with venous thromboembolism.","authors":"Henry Pun, Ian Pang, Kori Leblanc, Patwant Dhillon, Cassandra McEwan, Priya Patel, Rajat Kumar","doi":"10.1177/10781552231189695","DOIUrl":"10.1177/10781552231189695","url":null,"abstract":"<p><strong>Background: </strong>Cancer and cancer-related treatments are significant independent risk factors for malignant hematology (MH) patients in developing venous thromboembolism (VTE). Treatment of VTE in MH patients at the Princess Margaret Cancer Centre is predominantly initiated with low molecular weight heparin (LMWH) in accordance with guidelines. While guidelines recommend against LMWH use in patients with thrombocytopenia, prescribers may order LMWH conditionally based on platelet values. Currently, there is a lack of consistent practice with variation in both the use of conditional orders as well as the threshold of platelet values for conditional orders. The objectives of the study were to (a) describe the use of conditionally ordered LMWH based on platelet values; (b) determine its safety by measuring administration concordance with conditional orders and bleeding event rates during inpatient admission; and (c) determine its efficacy by measuring the rate of worsening VTE or recurrence during inpatient admission.</p><p><strong>Methods: </strong>Electronic records of MH inpatients admitted between January 2017 and December 2019 and who were administered at least one dose of an LMWH for the treatment of VTE were screened.</p><p><strong>Results: </strong>One hundred and eight patients were screened to obtain 50 eligible patients with a median age of 59 years (SD = ±18.8 years). The most frequent MH diagnosis was acute lymphoblastic leukemia (30%). Sixty percent (<i>n</i> = 30) of patients received conditional orders. Out of 571 administrations, 543 (95%) were administered concordantly (<i>Χ</i><sup>2</sup>(1) = 472, <i>p</i> < 0.0001). In this group of patients, 8 patients had either documented bleeding or experienced a drop in hemoglobin >10 g/L within a 72 h time frame. No patients experienced a recurrent VTE during inpatient treatment (for up to 40 days post-admission).</p><p><strong>Conclusions: </strong>It appears that conditionally ordered LMWH can be concordantly administered and is safe and effective in the treatment of VTE in MH patients experiencing thrombocytopenia. There were no reports of worsening or new VTE in our small sample.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11179312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9938204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2023-07-11DOI: 10.1177/10781552231187305
Sara Al Dali, Daoud Al-Badriyeh, Amaal Gulied, Anas Hamad, Moza Al Hail, Palli Valappila Abdul Rouf, Wessam El-Kassem, Dina Abushanab
Introduction: Drug-related problems (DRPs) affect the health outcomes of patients during hospitalization. We sought to analyze the clinical pharmacist-documented interventions among hospitalized patients in the cancer hospital in Qatar.
Methods: A retrospective analysis of electronically reported clinical pharmacist interventions of patients admitted to cancer units at Hamad Medical Corporation, Qatar was conducted. Extracted data was based on an overall 3-month follow-up period; March 1-31, 2018, July 15-August 15, 2018 and January 1-31, 2019. Categorical variables were expressed as frequencies and percentages, while continuous variables were expressed as mean ± standard deviation (SD).
Results: A total of 281 cancer patients with 1354 interventions were included. The average age of the study participants was 47 years (SD ± 17.36). The majority of the study population was females (n = 154, 54.80%). The prevailing pharmacist intervention was the addition of a drug therapy (n = 305, 22.53%), followed by medication discontinuation (n = 288, 21.27%) and the addition of a prophylactic agent (n = 174, 12.85%). This pattern was similar across all subgroups (i.e., gender, age, ward), except for the urgent care unit, where an increase in medication dose was the third highest frequently identified intervention (n = 3, 0.22%). The two medication groups associated with the majority of interventions were the anti-infective and fluid/electrolyte agents. Most of the interventions documented were in the oncology ward (73.19%), while the urgent care unit had the least documented interventions (1.62%).
Conclusions: Our analysis showed that clinical pharmacists can effectively identify and prevent DRPs among hospitalized cancer patients.
{"title":"Characteristics of the clinical pharmacist interventions at the National Center for Cancer Care and Research Hospital in Qatar.","authors":"Sara Al Dali, Daoud Al-Badriyeh, Amaal Gulied, Anas Hamad, Moza Al Hail, Palli Valappila Abdul Rouf, Wessam El-Kassem, Dina Abushanab","doi":"10.1177/10781552231187305","DOIUrl":"10.1177/10781552231187305","url":null,"abstract":"<p><strong>Introduction: </strong>Drug-related problems (DRPs) affect the health outcomes of patients during hospitalization. We sought to analyze the clinical pharmacist-documented interventions among hospitalized patients in the cancer hospital in Qatar.</p><p><strong>Methods: </strong>A retrospective analysis of electronically reported clinical pharmacist interventions of patients admitted to cancer units at Hamad Medical Corporation, Qatar was conducted. Extracted data was based on an overall 3-month follow-up period; March 1-31, 2018, July 15-August 15, 2018 and January 1-31, 2019. Categorical variables were expressed as frequencies and percentages, while continuous variables were expressed as mean ± standard deviation (SD).</p><p><strong>Results: </strong>A total of 281 cancer patients with 1354 interventions were included. The average age of the study participants was 47 years (SD ± 17.36). The majority of the study population was females (<i>n</i> = 154, 54.80%). The prevailing pharmacist intervention was the addition of a drug therapy (<i>n</i> = 305, 22.53%), followed by medication discontinuation (<i>n</i> = 288, 21.27%) and the addition of a prophylactic agent (<i>n</i> = 174, 12.85%). This pattern was similar across all subgroups (i.e., gender, age, ward), except for the urgent care unit, where an increase in medication dose was the third highest frequently identified intervention (<i>n</i> = 3, 0.22%). The two medication groups associated with the majority of interventions were the anti-infective and fluid/electrolyte agents. Most of the interventions documented were in the oncology ward (73.19%), while the urgent care unit had the least documented interventions (1.62%).</p><p><strong>Conclusions: </strong>Our analysis showed that clinical pharmacists can effectively identify and prevent DRPs among hospitalized cancer patients.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9766857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2023-08-01DOI: 10.1177/10781552231190009
Taisa R L Machado, Cristiane A M de Pádua, Paula L de Miranda Drummond, Lívia P Silveira, Jéssica S Malta, Roberta M M Dos Santos, Naiane L Costa, Adriano M M Reis
Introduction: Elderly with cancer often have multimorbidity, which determines a higher risk of polypharmacy. This is related to negative clinical results such as adverse drug reaction and emergence service visits. Furthermore, polypharmacy increases the risk of using potentially inappropriate medications.
Objective: To evaluate the use of potentially inappropriate medication in elderly with multiple myeloma and associated factors.
Methods: The study was conducted with older adults with multiple myeloma treated at outpatient oncology and hematology services in a southeastern Brazilian capital. Potentially inappropriate medications were classified using the American Geriatric Society/Beers 2019 Criteria. Variables were described using frequency and proportions, performing multiple logistic regression to identify factors associated with the use of potentially inappropriate medications.
Results: One hundred fifty-three older adults with multiple myeloma were included, with a median age of 70.9 years. The median number of medications was 8, and 63% of patients used polypharmacy. More than half (54%) of the patients used potentially inappropriate medications, and proton pump inhibitors (46%) and benzodiazepines (8%) were the most employed therapeutic classes. Older adults who used potentially inappropriate medications differed from those who did not use them in the following characteristics: income up to three minimum wages, higher schooling level, private service, multimorbidity, hypertension, cardiovascular disease, chronic kidney disease, depression, adverse event, and polypharmacy. Higher schooling levels and polypharmacy were independently associated with the use of potentially inappropriate medications in the multivariate analysis.
Conclusion: Potentially inappropriate medication use was high in patients with multiple myeloma studied. The use of polypharmacy and higher schooling levels were independently and positively associated with the use of potentially inappropriate medications.
{"title":"Factors associated with potentially inappropriate medications in elderly with multiple myeloma.","authors":"Taisa R L Machado, Cristiane A M de Pádua, Paula L de Miranda Drummond, Lívia P Silveira, Jéssica S Malta, Roberta M M Dos Santos, Naiane L Costa, Adriano M M Reis","doi":"10.1177/10781552231190009","DOIUrl":"10.1177/10781552231190009","url":null,"abstract":"<p><strong>Introduction: </strong>Elderly with cancer often have multimorbidity, which determines a higher risk of polypharmacy. This is related to negative clinical results such as adverse drug reaction and emergence service visits. Furthermore, polypharmacy increases the risk of using potentially inappropriate medications.</p><p><strong>Objective: </strong>To evaluate the use of potentially inappropriate medication in elderly with multiple myeloma and associated factors.</p><p><strong>Methods: </strong>The study was conducted with older adults with multiple myeloma treated at outpatient oncology and hematology services in a southeastern Brazilian capital. Potentially inappropriate medications were classified using the American Geriatric Society/Beers 2019 Criteria. Variables were described using frequency and proportions, performing multiple logistic regression to identify factors associated with the use of potentially inappropriate medications.</p><p><strong>Results: </strong>One hundred fifty-three older adults with multiple myeloma were included, with a median age of 70.9 years. The median number of medications was 8, and 63% of patients used polypharmacy. More than half (54%) of the patients used potentially inappropriate medications, and proton pump inhibitors (46%) and benzodiazepines (8%) were the most employed therapeutic classes. Older adults who used potentially inappropriate medications differed from those who did not use them in the following characteristics: income up to three minimum wages, higher schooling level, private service, multimorbidity, hypertension, cardiovascular disease, chronic kidney disease, depression, adverse event, and polypharmacy. Higher schooling levels and polypharmacy were independently associated with the use of potentially inappropriate medications in the multivariate analysis.</p><p><strong>Conclusion: </strong>Potentially inappropriate medication use was high in patients with multiple myeloma studied. The use of polypharmacy and higher schooling levels were independently and positively associated with the use of potentially inappropriate medications.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9908326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2023-08-10DOI: 10.1177/10781552231190005
Steven Gilmore, Melissa Carroll, Elizabeth Koselke, Shannon Hough
Introduction: Single, fixed-dose rasburicase administration has been evaluated as an effective strategy in the management of hyperuricemia in the hospital setting, but this has not yet been described within ambulatory community oncology practices. The objective of this study is to evaluate and optimize the dosing strategy for rasburicase in the management of tumor lysis syndrome (TLS)-associated hyperuricemia in The US Oncology Network (The Network).
Methods: A network-wide guideline was revised to standardize rasburicase dosing from a previous recommended fixed doses of 4.5 or 7.5 mg to either 3 or 6 mg for outpatient rasburicase use in management and prevention of TLS. The primary outcome evaluated mean dose of rasburicase among all patients before and after guideline revision. A retrospective chart review evaluated secondary endpoints.
Results: The primary analysis included 291 patients (128 pre-revised and 163 post-revised guideline implementation). The primary outcome, mean rasburicase dose, was reduced in the post-revision compared to the pre-revision population (mean 6.2 mg pre vs. 4.5 mg post, p < 0.00001) resulting in a reduced cost per rasburicase dose of $974. Fifty patients were included for the secondary analysis. Guideline concordance was identified in 12 (48%) and 16 patients (64%), and uric acid <8 mg/dL post-rasburicase administration occurred in 14 (56%) and 16 patients (64%) before and after guideline revision, respectively.
Conclusions: Guideline revision and electronic health record modification resulted in a 27% reduction in the mean rasburicase dose and a 50% reduction in repeat rasburicase dosing without a negative impact on clinical efficacy.
{"title":"Rasburicase dose optimization for tumor lysis syndrome management in a network of community oncology practices.","authors":"Steven Gilmore, Melissa Carroll, Elizabeth Koselke, Shannon Hough","doi":"10.1177/10781552231190005","DOIUrl":"10.1177/10781552231190005","url":null,"abstract":"<p><strong>Introduction: </strong>Single, fixed-dose rasburicase administration has been evaluated as an effective strategy in the management of hyperuricemia in the hospital setting, but this has not yet been described within ambulatory community oncology practices. The objective of this study is to evaluate and optimize the dosing strategy for rasburicase in the management of tumor lysis syndrome (TLS)-associated hyperuricemia in The US Oncology Network (The Network).</p><p><strong>Methods: </strong>A network-wide guideline was revised to standardize rasburicase dosing from a previous recommended fixed doses of 4.5 or 7.5 mg to either 3 or 6 mg for outpatient rasburicase use in management and prevention of TLS. The primary outcome evaluated mean dose of rasburicase among all patients before and after guideline revision. A retrospective chart review evaluated secondary endpoints.</p><p><strong>Results: </strong>The primary analysis included 291 patients (128 pre-revised and 163 post-revised guideline implementation). The primary outcome, mean rasburicase dose, was reduced in the post-revision compared to the pre-revision population (mean 6.2 mg pre vs. 4.5 mg post, p < 0.00001) resulting in a reduced cost per rasburicase dose of $974. Fifty patients were included for the secondary analysis. Guideline concordance was identified in 12 (48%) and 16 patients (64%), and uric acid <8 mg/dL post-rasburicase administration occurred in 14 (56%) and 16 patients (64%) before and after guideline revision, respectively.</p><p><strong>Conclusions: </strong>Guideline revision and electronic health record modification resulted in a 27% reduction in the mean rasburicase dose and a 50% reduction in repeat rasburicase dosing without a negative impact on clinical efficacy.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10327485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2023-08-21DOI: 10.1177/10781552231189199
Lindsey Chippendale, Craig W Freyer, Alison Carulli, Daria V Babushok, Noelle V Frey, Saar I Gill, Elizabeth O Hexner, Selina M Luger, Mary Ellen Martin, David L Porter, Edward A Stadtmauer, Alison W Loren
Introduction: Busulfan is a common component of allogeneic hematopoietic cell transplant (alloHCT) conditioning, however interpatient pharmacokinetic variability can result in enhanced toxicity or increased relapse risk. Therapeutic drug monitoring (TDM) can minimize variability, yet the optimal frequency of TDM is unknown. We compared outcomes for patients with one versus two sets of busulfan TDM during myeloablative conditioning (MAC) prior to alloHCT.
Methods: We analyzed the impact of busulfan TDM frequency and dose adjustments, with the primary outcome being relapse-free survival (RFS). Other outcomes included the incidence of acute and chronic graft versus host disease (GVHD), oral mucositis, pulmonary toxicity, sinusoidal obstruction syndrome (SOS), the cumulative incidence of relapse (CIR), and overall survival (OS).
Results: Twenty-two patients underwent one set of sampling while 53 patients underwent two sets. Similar baseline characteristics were observed between the groups. There were no significant differences observed in RFS by day +180 (77.3% vs. 79.2%, p = 1.0), CIR by day +180 (18.2% vs. 17.8%, p = 0.74), or OS (p = 0.73). The incidences of acute GVHD, chronic GVHD, SOS, and severe mucositis were also similar. In each group, 63% received busulfan dose adjustments after one set, with 52.8% receiving further dose adjustments following the second set.
Conclusion: We observed no significant difference in alloHCT outcomes between patients who underwent one versus two sets of busulfan TDM sampling, suggesting that a single-time TDM and dose adjustment may be adequate to maximize outcomes after MAC alloHCT.
{"title":"One versus two sets of busulfan therapeutic drug monitoring in myeloablative allogeneic hematopoietic cell transplant.","authors":"Lindsey Chippendale, Craig W Freyer, Alison Carulli, Daria V Babushok, Noelle V Frey, Saar I Gill, Elizabeth O Hexner, Selina M Luger, Mary Ellen Martin, David L Porter, Edward A Stadtmauer, Alison W Loren","doi":"10.1177/10781552231189199","DOIUrl":"10.1177/10781552231189199","url":null,"abstract":"<p><strong>Introduction: </strong>Busulfan is a common component of allogeneic hematopoietic cell transplant (alloHCT) conditioning, however interpatient pharmacokinetic variability can result in enhanced toxicity or increased relapse risk. Therapeutic drug monitoring (TDM) can minimize variability, yet the optimal frequency of TDM is unknown. We compared outcomes for patients with one versus two sets of busulfan TDM during myeloablative conditioning (MAC) prior to alloHCT.</p><p><strong>Methods: </strong>We analyzed the impact of busulfan TDM frequency and dose adjustments, with the primary outcome being relapse-free survival (RFS). Other outcomes included the incidence of acute and chronic graft versus host disease (GVHD), oral mucositis, pulmonary toxicity, sinusoidal obstruction syndrome (SOS), the cumulative incidence of relapse (CIR), and overall survival (OS).</p><p><strong>Results: </strong>Twenty-two patients underwent one set of sampling while 53 patients underwent two sets. Similar baseline characteristics were observed between the groups. There were no significant differences observed in RFS by day +180 (77.3% vs. 79.2%, <i>p</i> = 1.0), CIR by day +180 (18.2% vs. 17.8%, <i>p</i> = 0.74), or OS (<i>p</i> = 0.73). The incidences of acute GVHD, chronic GVHD, SOS, and severe mucositis were also similar. In each group, 63% received busulfan dose adjustments after one set, with 52.8% receiving further dose adjustments following the second set.</p><p><strong>Conclusion: </strong>We observed no significant difference in alloHCT outcomes between patients who underwent one versus two sets of busulfan TDM sampling, suggesting that a single-time TDM and dose adjustment may be adequate to maximize outcomes after MAC alloHCT.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10395510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2023-09-25DOI: 10.1177/10781552231196130
Betel Del Rosario García, María Micaela Viña Romero, Virginia González Rosa, Carolina Alarcón Payer, Leonor Oliva Oliva, Francisco Javier Merino Alonso, Gloria Julia Nazco Casariego, Fernando Gutiérrez Nicolás
Objective: Tyrosine kinase inhibitors (TKIs) have successfully changed the natural course of chronic myeloid leukaemia (CML). Although they are highly effective drugs, their clinical benefit is conditioned by adherence. This study aims to analyse the adherence of CML patients treated with TKIs and to identify the main factors influencing their adherence to TKIs treatment.
Material and methods: An 8-month prospective, observational, multicentre study which included patients diagnosed with CML on treatment with TKIs attending the outpatient departments (OPD) of the Pharmacy Services of the participating hospitals. Adherence was assessed using two methods: the Simplified Medication Adherence Questionnaire (SMAQ) and the register of treatment dispensations from the OPDs. To analyse the predictors of adherence, a questionnaire was developed to report demographic and socio-economic information on the patients.
Results: A total of 130 patients enrolled in this study. Adherence rate was 56.9% (n = 74) among individuals, not conditioned by the type of drug used: imatinib (54.8%), nilotinib (63.6%) or dasatinib (54.3%) (p = 0.67). The patient educational level (p = 0.047) and employment status (p = 0.028) were predictors of non-adherence to treatment.
Conclusions: Adherence is one of the most relevant parameters affecting the effectiveness of highly effective chronic treatments. Approximately half of our patients showed inadequate adherence to treatment with TKIs, with employment status and the individual's level of education emerging as the determining factors.
{"title":"Risk factors determining adherence to tyrosine kinase inhibitors in chronic myeloid leukaemia.","authors":"Betel Del Rosario García, María Micaela Viña Romero, Virginia González Rosa, Carolina Alarcón Payer, Leonor Oliva Oliva, Francisco Javier Merino Alonso, Gloria Julia Nazco Casariego, Fernando Gutiérrez Nicolás","doi":"10.1177/10781552231196130","DOIUrl":"10.1177/10781552231196130","url":null,"abstract":"<p><strong>Objective: </strong>Tyrosine kinase inhibitors (TKIs) have successfully changed the natural course of chronic myeloid leukaemia (CML). Although they are highly effective drugs, their clinical benefit is conditioned by adherence. This study aims to analyse the adherence of CML patients treated with TKIs and to identify the main factors influencing their adherence to TKIs treatment.</p><p><strong>Material and methods: </strong>An 8-month prospective, observational, multicentre study which included patients diagnosed with CML on treatment with TKIs attending the outpatient departments (OPD) of the Pharmacy Services of the participating hospitals. Adherence was assessed using two methods: the Simplified Medication Adherence Questionnaire (SMAQ) and the register of treatment dispensations from the OPDs. To analyse the predictors of adherence, a questionnaire was developed to report demographic and socio-economic information on the patients.</p><p><strong>Results: </strong>A total of 130 patients enrolled in this study. Adherence rate was 56.9% (n = 74) among individuals, not conditioned by the type of drug used: imatinib (54.8%), nilotinib (63.6%) or dasatinib (54.3%) (<i>p</i> = <i>0.67</i>). The patient educational level (<i>p</i> = <i>0.047</i>) and employment status (<i>p</i> = <i>0.028</i>) were predictors of non-adherence to treatment.</p><p><strong>Conclusions: </strong>Adherence is one of the most relevant parameters affecting the effectiveness of highly effective chronic treatments. Approximately half of our patients showed inadequate adherence to treatment with TKIs, with employment status and the individual's level of education emerging as the determining factors.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41115638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2023-08-03DOI: 10.1177/10781552231189706
Manjula Gudhoor, Aneetta Thankam Mathew, Akul Madiwalayya Ganachari, Gayathri Baiju, Sushrut Sachchidanand Kulkarni, M S Ganachari
Background: In this new era of cancer management, the quality of life (QOL) is given more importance than the quantity of life. QOL evaluation studies are widely used in oncology to assess the patient's performance in different cancer types and treatment modalities.
Objective: To evaluate cancer patients' QOL after various chemotherapy cycles.
Methods: An observational study was performed on cancer patients receiving chemotherapy in the daycare setting of a South Indian Tertiary Care Hospital for 6 months. European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) questionnaire was employed to study the QOL.
Results: Precisely, 102 patients participated in the study, out of which the majority were in the 51 to 60 age group (24%). Female participants (65%) were more. Functional scale domains especially physical ability (P = 0.004), role (P = 0.033), and emotional functioning (P = 0.01) were significantly decreased in patients treated with 4 to 6 chemotherapy cycles. Cognitive ability (P = 0.043) significantly improved in patients treated with more than 6 chemotherapy cycles. Dyspnea (P = 0.036) was significantly increased in patients treated with 4 to 6 chemotherapy cycles and decreased significantly with the further addition of chemotherapy cycles.
Conclusion: Dyspnea is a commonly observed symptom among cancer patients and is often neglected by physicians. Chronic dyspnea can negatively impact a patient's functional ability. Cancer symptoms such as dyspnea should also be given priority and need appropriate treatment. Based on the findings, further interventions can be made to improve the functional ability of cancer patients. Also, studies can be conducted to correlate with cancer rehabilitation programs to improve functional ability and complete the entire chemotherapy cycle.
{"title":"Utilization of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 scale for evaluation of quality of life among cancer patients treated with chemotherapy: A hospital-based observational study.","authors":"Manjula Gudhoor, Aneetta Thankam Mathew, Akul Madiwalayya Ganachari, Gayathri Baiju, Sushrut Sachchidanand Kulkarni, M S Ganachari","doi":"10.1177/10781552231189706","DOIUrl":"10.1177/10781552231189706","url":null,"abstract":"<p><strong>Background: </strong>In this new era of cancer management, the quality of life (QOL) is given more importance than the quantity of life. QOL evaluation studies are widely used in oncology to assess the patient's performance in different cancer types and treatment modalities.</p><p><strong>Objective: </strong>To evaluate cancer patients' QOL after various chemotherapy cycles.</p><p><strong>Methods: </strong>An observational study was performed on cancer patients receiving chemotherapy in the daycare setting of a South Indian Tertiary Care Hospital for 6 months. European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) questionnaire was employed to study the QOL.</p><p><strong>Results: </strong>Precisely, 102 patients participated in the study, out of which the majority were in the 51 to 60 age group (24%). Female participants (65%) were more. Functional scale domains especially physical ability (<i>P</i> = 0.004), role (<i>P</i> = 0.033), and emotional functioning (<i>P</i> = 0.01) were significantly decreased in patients treated with 4 to 6 chemotherapy cycles. Cognitive ability (<i>P</i> = 0.043) significantly improved in patients treated with more than 6 chemotherapy cycles. Dyspnea (<i>P</i> = 0.036) was significantly increased in patients treated with 4 to 6 chemotherapy cycles and decreased significantly with the further addition of chemotherapy cycles.</p><p><strong>Conclusion: </strong>Dyspnea is a commonly observed symptom among cancer patients and is often neglected by physicians. Chronic dyspnea can negatively impact a patient's functional ability. Cancer symptoms such as dyspnea should also be given priority and need appropriate treatment. Based on the findings, further interventions can be made to improve the functional ability of cancer patients. Also, studies can be conducted to correlate with cancer rehabilitation programs to improve functional ability and complete the entire chemotherapy cycle.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9937010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2023-07-18DOI: 10.1177/10781552231184779
Wasfa Farooq, Natasha Baig, Bashir Ahmed Khan, Faran Ahmed Butt, Ayesha Hanif, Arif Ali, Muhammad Rafie Raza
The development of a successful oncology pharmacy system includes competency training, cost-efficient procurement, proper storage, preparation and administration of chemotherapy, and appropriate waste disposal. Low-middle-income countries such as Pakistan face several challenges within the realm of oncology pharmacy such as the unavailability of training programmes, resources and financial support, and inconsistencies in the safe handling of cytotoxic drugs. The Indus Hospital and Health Network (IHHN) is among the pioneers of oncology pharmacy practices in Pakistan, with a well-established Oncology Pharmacy Team and chemotherapy preparation in accordance with the United States Pharmacopeia 797 and 800 safety guidelines. The My Child Matters Grant was awarded by the Sanofi Espoir Foundation to the Department of Paediatric Hematology and Oncology at IHHN for holistic improvement in childhood cancer care through teaching, training and capacity building. Partnerships were formed with five public-sector paediatric oncology units nationwide. Initiatives were taken to improve oncology pharmacy practices including teaching and training courses, in-person assessment visits, and mentorship and liaison efforts. Despite prevailing challenges, promising improvements were noted at each centre. However, Pakistan needs to establish a national plan for childhood cancer with the creation of regional organisations for the training and monitoring of oncology pharmacists. Centralisation of pharmacy operations within hospitals is essential to maintain the availability, storage, preparation and administration standards of chemotherapy.
建立一个成功的肿瘤药学系统包括能力培训、具有成本效益的采购、化疗的适当储存、准备和管理以及适当的废物处理。巴基斯坦等中低收入国家在肿瘤药学领域面临着一些挑战,如缺乏培训计划、资源和财政支持,以及在安全处理细胞毒性药物方面的不一致。印度河医院与健康网络(Indus Hospital and Health Network,IHHN)是巴基斯坦肿瘤药学实践的先驱之一,它拥有一个完善的肿瘤药学团队,并按照美国药典 797 和 800 安全指南进行化疗准备。赛诺菲 Espoir 基金会向 IHHN 儿童血液学和肿瘤学部门提供了 "我的孩子很重要 "赠款,用于通过教学、培训和能力建设全面改善儿童癌症护理。与全国五个公共部门的儿童肿瘤科建立了合作伙伴关系。为改善肿瘤药学实践采取了多项举措,包括教学和培训课程、亲自评估访问以及指导和联络工作。尽管普遍存在挑战,但每个中心都取得了可喜的进步。不过,巴基斯坦需要制定一项儿童癌症国家计划,并建立地区组织,对肿瘤药剂师进行培训和监督。医院内药房业务的集中化对于保持化疗药物的供应、储存、制备和管理标准至关重要。
{"title":"Enhancement of paediatric oncology pharmacy practices in a low-middle-income country through teaching and training using the My Child Matters Grant.","authors":"Wasfa Farooq, Natasha Baig, Bashir Ahmed Khan, Faran Ahmed Butt, Ayesha Hanif, Arif Ali, Muhammad Rafie Raza","doi":"10.1177/10781552231184779","DOIUrl":"10.1177/10781552231184779","url":null,"abstract":"<p><p>The development of a successful oncology pharmacy system includes competency training, cost-efficient procurement, proper storage, preparation and administration of chemotherapy, and appropriate waste disposal. Low-middle-income countries such as Pakistan face several challenges within the realm of oncology pharmacy such as the unavailability of training programmes, resources and financial support, and inconsistencies in the safe handling of cytotoxic drugs. The Indus Hospital and Health Network (IHHN) is among the pioneers of oncology pharmacy practices in Pakistan, with a well-established Oncology Pharmacy Team and chemotherapy preparation in accordance with the United States Pharmacopeia 797 and 800 safety guidelines. The My Child Matters Grant was awarded by the Sanofi Espoir Foundation to the Department of Paediatric Hematology and Oncology at IHHN for holistic improvement in childhood cancer care through teaching, training and capacity building. Partnerships were formed with five public-sector paediatric oncology units nationwide. Initiatives were taken to improve oncology pharmacy practices including teaching and training courses, in-person assessment visits, and mentorship and liaison efforts. Despite prevailing challenges, promising improvements were noted at each centre. However, Pakistan needs to establish a national plan for childhood cancer with the creation of regional organisations for the training and monitoring of oncology pharmacists. Centralisation of pharmacy operations within hospitals is essential to maintain the availability, storage, preparation and administration standards of chemotherapy.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9827171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01Epub Date: 2023-07-24DOI: 10.1177/10781552231190015
Akimitsu Maeda, Kyoko Hori, Yumiko Sone, Naoya Hashimoto, Kosaku Uchida
Introduction: This study investigated the extent of contamination with antineoplastic agents on floor surfaces of the ward and the outpatient chemotherapy center of a Japanese cancer center to evaluate healthcare workers' risk of occupational exposure to antineoplastic agents outside of the designated drug preparation areas.
Methods: In this study conducted at Aichi Cancer Center, the amount of fluorouracil detected on various floor surfaces was measured using liquid chromatography-tandem quadrupole mass spectrometry. Areas around the toilets were cleaned with a surfactant two or three times a day, whereas other floor surfaces were cleaned only with dry and wet mops.
Results: Fluorouracil was detected on all surveyed floor surfaces, with particularly high amounts detected around the toilet areas in the ward. Additionally, areas with more human traffic tended to have higher fluorouracil contamination.
Conclusions: This survey suggested that antineoplastic agent contamination occurring through patient excretions might spread throughout the hospital with human traffic. Therefore, controlling the spread of antineoplastic agent contamination in hospitals should include the review of measures to mitigate contamination around toilets and to implement effective cleaning methods for floor surfaces.
{"title":"Assessing floor contamination by antineoplastic agents in a Japanese medical institution specializing in cancer treatment.","authors":"Akimitsu Maeda, Kyoko Hori, Yumiko Sone, Naoya Hashimoto, Kosaku Uchida","doi":"10.1177/10781552231190015","DOIUrl":"10.1177/10781552231190015","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigated the extent of contamination with antineoplastic agents on floor surfaces of the ward and the outpatient chemotherapy center of a Japanese cancer center to evaluate healthcare workers' risk of occupational exposure to antineoplastic agents outside of the designated drug preparation areas.</p><p><strong>Methods: </strong>In this study conducted at Aichi Cancer Center, the amount of fluorouracil detected on various floor surfaces was measured using liquid chromatography-tandem quadrupole mass spectrometry. Areas around the toilets were cleaned with a surfactant two or three times a day, whereas other floor surfaces were cleaned only with dry and wet mops.</p><p><strong>Results: </strong>Fluorouracil was detected on all surveyed floor surfaces, with particularly high amounts detected around the toilet areas in the ward. Additionally, areas with more human traffic tended to have higher fluorouracil contamination.</p><p><strong>Conclusions: </strong>This survey suggested that antineoplastic agent contamination occurring through patient excretions might spread throughout the hospital with human traffic. Therefore, controlling the spread of antineoplastic agent contamination in hospitals should include the review of measures to mitigate contamination around toilets and to implement effective cleaning methods for floor surfaces.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9865426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Enfortumab vedotin (EV) is a novel treatment option for patients with advanced/metastatic urothelial carcinoma who have progressed after chemotherapy and immunotherapy. Two patients at two different New England tertiary cancer care centers were treated with EV while concurrently receiving hemodialysis (HD), where a complete response to EV in both patients was noted. The use of EV in patients requiring HD is extrapolated from the available pharmacokinetic and pharmacodynamic literature on monoclonal antibodies in patients requiring HD. There is a paucity of data for the use of antibody-drug conjugates like EV in patients needing dialysis.
恩福单抗维多汀(EV)是化疗和免疫疗法后病情进展的晚期/转移性尿路上皮癌患者的一种新型治疗选择。在新英格兰两个不同的三级癌症治疗中心,两名患者在接受EV治疗的同时还接受了血液透析(HD)治疗,两名患者均对EV产生了完全反应。在需要接受血液透析的患者中使用 EV 是根据现有的单克隆抗体在需要接受血液透析的患者中的药代动力学和药效学文献推断出来的。在需要透析的患者中使用 EV 等抗体药物结合物的数据很少。
{"title":"Enfortumab-vedotin use for urothelial carcinoma in two patients on hemodialysis.","authors":"Harshit Khosla, Sita Bhatt, Ming-Jin Wang, Gretchen Gignac, Kriti Mittal, Jasmine Patel","doi":"10.1177/10781552241237752","DOIUrl":"10.1177/10781552241237752","url":null,"abstract":"<p><p>Enfortumab vedotin (EV) is a novel treatment option for patients with advanced/metastatic urothelial carcinoma who have progressed after chemotherapy and immunotherapy. Two patients at two different New England tertiary cancer care centers were treated with EV while concurrently receiving hemodialysis (HD), where a complete response to EV in both patients was noted. The use of EV in patients requiring HD is extrapolated from the available pharmacokinetic and pharmacodynamic literature on monoclonal antibodies in patients requiring HD. There is a paucity of data for the use of antibody-drug conjugates like EV in patients needing dialysis.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140101834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}