Pharmacists Contribute to Safe Management in Outpatient Cancer Chemotherapy

Abstract

Background: A great number of new drugs for cancer treatment have been developed during recent years. Thus, multidisciplinary care to patients is essential in cancer chemotherapy. In our hospital, 3 pharmacists have participated in patient care team in outpatient cancer chemotherapy clinic since 2008, where they are in charge of the provision of pharmaceutical care services to all patients. Recently, pharmaceutical counseling to patients has been carried out before clinical examination. We show here our approach to cancer chemotherapy and the clinical outcomes. Methods: A computer system supporting pharmaceutical care practices in coordination with electronic medical record system was developed. Pharmaceutical practices include verification of chemotherapy regimen, modifications of dose and dosing interval, checking premedication, monitoring adverse drug reactions (ADRs), reporting patient information obtained during interview by means of electronic medical record, and proposal of prescription for prophylaxis or cure of ADRs. The severity of ADRs was assessed by CTCAE v4.0. Results: The number of proposals on prescription increased dramatically after introduction of patient interview before clinical examination. The most frequent item was prevention of chemotherapy-induced nausea and vomiting (CINV), followed by treatments for oral mucositis, peripheral neuropathy, and skin rash. For CINV, the rate of adherence to guideline-recommended antiemetic regimens was over 90% as assessed in all patients (532 patients, 2,600 chemotherapy courses) receiving chemotherapy during a year of 2013. Complete protection (without nausea, vomiting and rescue) was 68% for high emetic risk chemotherapy and 74% for moderate emetic risk regimen. Conclusions: Implementation of multidisciplinary care including pharmaceutical care by oncology pharmacists is particularly important during cancer chemotherapy.