Journal of Oncology Pharmacy Practice最新文献

PurposeThe time to complete oncology pharmacist tasks is needed to determine workload and productivity. The Hematology/Oncology Pharmacy Association (HOPA) and the Hematology/Oncology Practice and Research Network (PRN) of the American College of Clinical Pharmacy (ACCP) partnered with the aim of establishing consensus on the time required to complete oncology pharmacy tasks.MethodsFifteen patient care tasks and 9 non-patient care tasks, commonly completed by oncology pharmacists were each assigned an average amount of time to be completed. This list was then converted into 24 statements and the Delphi survey method was utilized with an expert panel to arrive at consensus between December 2023 and February 2024. Consensus was defined as at least 75% agreement. The complete manuscript was endorsed by HOPA and ACCP Hematology/Oncology PRN.ResultsThirty-three pharmacist-experts agreed to participate in this survey with all participating in round 1, and 29 (87.9%) participating in round 2. In round 1, 9 tasks achieved consensus, with 7 of these being classified as patient care associated. Seven statements reaching 65% but less than 75% agreement were deemed to reach borderline consensus. Eight statements failed to achieve at least 65% agreement and were modified based on respondent feedback. In round 2, 15 statements were included with all achieving consensus. At the completion of round 2, all 24 statements reached consensus, and the survey was deemed complete.ConclusionThis project produced the first comprehensive consensus statements for the average time for a US-based oncology pharmacist to complete common patient and non-patient care-related tasks.

IntroductionCapecitabine-induced hand-foot syndrome (HFS) is a frequent and clinically relevant toxicity that may impair quality of life and lead to chemotherapy dose reduction or interruption. This study aimed to evaluate the effectiveness, safety, and clinical predictors of response to topical recombinant human epidermal growth factor (rhEGF) gel combined with urea ointment in patients with capecitabine-induced HFS.MethodsThis retrospective case series included a total of 83 patients with colorectal adenocarcinoma who developed Grade II-III capecitabine-induced HFS and received topical rhEGF gel plus urea ointment between January 2022 and December 2025.ResultsThe median age was 61 years, and 49 patients (59.0%) were male. At baseline, 48 patients (57.8%) had Grade II HFS and 35 (42.2%) had Grade III HFS. After 3 weeks of treatment, 67 patients (80.7%) achieved at least a one-grade reduction in HFS severity. The median HFS grade significantly decreased after treatment (Wilcoxon, signed-rank, p < 0.001), with no cases of worsening. Improvements were observed in pain (70/70 affected patients; 100.0%), erythema (73/76; 96.1%), desquamation (60/60; 100.0%), and ulceration (18/24; 75.0% among affected patients). The median time to first documented improvement was 10 days. In an exploratory adjusted model, early treatment initiation within 7 days was associated with higher odds of response, whereas baseline Grade III HFS was associated with lower odds of response. No serious adverse events considered related to treatment were documented.ConclusionsTopical rhEGF gel plus urea ointment was associated with rapid, well-tolerated improvement in capecitabine-induced HFS.

IntroductionHigh-dose methotrexate (HD-MTX) is a cornerstone in the treatment of acute lymphoblastic leukemia but carries a risk of severe toxicity. Toxic epidermal necrolysis (TEN) is a rare life-threatening adverse reaction.Case reportWe report the case of a 15-year-old male with high-risk T-cell acute lymphoblastic leukemia who developed fatal TEN following HD-MTX therapy during induction chemotherapy. Ten days after methotrexate administration, the patient developed rapidly progressive epidermal detachment with mucosal involvement.Management & outcomeThe clinical course was complicated by tumor lysis syndrome and acute renal failure requiring intensified leucovorin rescue. Skin biopsy confirmed drug-induced TEN, and pharmacovigilance analysis using the ALDEN score strongly implicated methotrexate. Despite intensive supportive care and broad-spectrum antimicrobial therapy, the patient deteriorated and died of multiorgan failure.DiscussionThis case highlights the importance of early recognition of methotrexate toxicity, strict renal monitoring, and awareness of drug interactions to prevent fatal outcomes.

IntroductionCancer poses a major challenge to global health, impacting individuals, communities and societies worldwide. A significant proportion of global morbidity and mortality from neoplasms is accounted for by gastrointestinal tumors, due to their high incidence and lethality. Capecitabine, an oral antineoplastic agent, has brought advances in treatment, but requires caution regarding adherence and adverse events. In this context, it is believed that pharmaceutical care can significantly contribute to optimizing therapy and promoting better clinical outcomes.ObjectiveThe aim of this study is to assess the advantages of pharmaceutical care for patients with gastric cancer who are being treated with capecitabine.MethodsA multicentre, prospective, longitudinal study was conducted with patients with gastric cancer using capecitabine. Patients were randomised into two groups, namely control (pharmaceutical guidance) and intervention (pharmaceutical care). Sociodemographic, clinical, and therapeutic data were collected, and adverse events were identified, classified and analysed, with impacts such as dose suspension or reduction, emergencies, hospitalisations and use of additional drugs being considered. Quality of life was assessed before and after treatment.ResultsThirty-one patients were selected, 16 of whom were in the intervention group. This group completed more treatment cycles, although it had a higher number of adverse events, with less severity. All patients who received pharmaceutical care were adherent to their treatment. In contrast, patients who did not receive pharmaceutical care had more suspensions and dose reductions. They also had a significant worsening of overall functional capacity. In addition, their symptoms such as nausea, vomiting, and diarrhea were aggravated. In the intervention group, however, there was an improvement in these symptoms.ConclusionThe study highlights the importance of pharmaceutical care in capecitabine treatment, especially in the management of adverse events, treatment adherence and promotion of quality of life. Despite the small sample size, the results reinforce the role of the pharmacist in the care of these patients and indicate the need for further studies with larger samples.

Automated reconstitution or preparation of systemic anticancer therapy has gained traction in the past decade. Transitioning from traditional manual workflows to fully automated production offers multiple benefits: decreased pharmacy staff workload, reduced risk of repetitive strain injuries, minimized medication errors, and lower risk of occupational exposure to hazardous medicinal products, especially when the robotic preparation areas are fully enclosed. Several elements can facilitate efficient implementation and improve productivity and safety in the use of robotic systems. The purpose of this study was to aggregate insights from an international expert group of early adopters on optimizing both productivity and safety in robotic drug preparation. Eight best practices regarding workflow, quality management, software integration, cleaning protocols, staff training, and safety measures during drug shortages have been identified and agreed upon. Application of these recommendations will enhance the robotic system efficiency, accelerate product turnaround times, and improve oncology pharmacy services.

BackgroundIbrutinib exposure is strongly affected by cytochrome P450 3A4 (CYP3A4) activity. Drug-drug interactions (DDIs) can substantially increase ibrutinib plasma concentrations, requiring major dose reductions in DDI management. This study aimed to assess whether splitting ibrutinib 140 mg tablets is a practical and feasible strategy to adjust ibrutinib dosing in case of DDIs.MethodsIbrutinib 140 mg tablets were split into quarters using a tablet splitter aiming at 35 mg dose units. The obtained quarters were evaluated according to the European Pharmacopoeia requirements for Uniformity of Dosage Units. In addition, Uniformity of Mass, Uniformity of Content, loss of mass, stability of quartered tablets, reproducibility of splitting, usability of the splitting device, and patient instructions were assessed. The expected effects of tablet splitting on ibrutinib exposure were calculated.ResultsA strong correlation between tablet mass and ibrutinib content was observed (r = 0.896; p < 0.0001), indicating uniform distribution of ibrutinib throughout the tablets. Loss of mass was <3% for all tablets, indicating that quartering did not lead to substantial material loss. The mean ibrutinib content was 34.4 mg (range 28.2-40.3 mg). Uniformity of Dosage Units of ibrutinib quarters complied with the European Pharmacopoeia requirements, with an acceptance value of 7.5% against a requirement of ≤15%. Split tablets were stable for at least two weeks under outpatient storage conditions. Patient instructions were considered sufficient and the splitting device was rated user-friendly. The impact of splitting variation on exposure is within the range of interindividual variation in ibrutinib exposure.ConclusionSplitting ibrutinib 140 mg tablets may provide a practical, clinically feasible and patient-friendly strategy to obtain 35 or 70 mg doses of ibrutinib when dose reduction is required in the management of DDIs. The expected exposure variation due to dose variations introduced by tablet splitting is unlikely to be of clinical relevance.

BackgroundCancer chemotherapy is associated with significant deterioration in quality of life (QoL) and challenges in treatment adherence. Mobile health (mHealth) applications represent a promising digital intervention for supporting patients throughout the chemotherapy trajectory.ObjectiveTo systematically evaluate the effectiveness of patient-facing mHealth applications in improving QoL and treatment adherence among adult cancer patients actively undergoing chemotherapy, and to quantify the pooled effect size through meta-analysis.MethodsA systematic search was conducted across seven databases from January 2014 to June 2026. Randomised controlled trials (RCTs), quasi-experimental, and cohort studies enrolling adults receiving chemotherapy with a patient-facing mHealth intervention reporting QoL or adherence outcomes were included.ResultsTwenty-two studies (n = 3505 participants; 14 RCTs, 5 quasi-experimental, 1 cluster-RCT, 1 protocol) across 11 countries were included. Of 19 studies reporting QoL outcomes, 17 (89%) demonstrated statistically significant improvements in favour of the mHealth intervention. The pooled random-effects estimate demonstrated a large, statistically significant effect on QoL (Hedges' g = 0.981, 95% CI: 0.336 to 1.626, P = 0.003; k = 9, n = 939). Medication adherence was significantly improved in five studies. Overall certainty of evidence was rated as moderate (GRADE).ConclusionsPatient-facing mHealth applications produce large, significant improvements in QoL during cancer chemotherapy. Interventions grounded in nursing theory and incorporating real-time clinician feedback yield the largest effects. Integration of mHealth into oncology pharmacy practice models is warranted. Standardised outcome reporting and head-to-head comparative trials are needed.

BackgroundBody mass index (BMI) has been associated with improved outcomes in several malignancies, including prostate cancer. However, the impact of BMI on treatment efficacy, particularly with androgen receptor pathway inhibitors (ARPIs), in metastatic hormone-sensitive prostate cancer (mHSPC) remains insufficiently characterized. This study aimed to evaluate the association between BMI and radiographic progression-free survival (rPFS) in patients with mHSPC receiving first-line therapies.MethodsWe retrospectively analyzed 330 patients with newly diagnosed mHSPC. Patients were stratified by their treatment regime and baseline BMI. rPFS was assessed using Kaplan-Meier analysis and Cox proportional hazards models. Multivariate analyses included clinically relevant covariates and factors significant in univariate analyses.ResultsWith a median follow-up of 47 months, median rPFS for the entire cohort was 34 months. Patients with BMI≥25 kg/m² demonstrated significantly longer median rPFS. Higher BMI was associated with favorable baseline characteristics, including better ECOG performance status and higher hemoglobin levels. In multivariate analysis, liver metastases, high-volume disease, low hemoglobin, elevated alkaline phosphatase, and treatment modality remained independent predictors of rPFS, whereas BMI did not retain independent significance. Among overweight patients receiving ARPIs, enzalutamide showed a numerically longer rPFS compared with abiraterone, although this difference was not statistically significant.ConclusionHigher BMI was associated with prolonged rPFS in patients with mHSPC, supporting a potential obesity paradox in this population. While BMI was not an independent predictor in multivariate analysis, it may reflect underlying patient fitness and disease biology. These findings warrant prospective validation into metabolic factors influencing ARPI efficacy.

PurposeProton pump inhibitors (PPIs) are often overprescribed in cancer care, leading to unnecessary side effects and increasing healthcare costs. Pharmacists can optimize and improve the rational prescribing of PPIs particularly in low/middle income countries, where such data is limited. We aimed to evaluate how a pharmacist-led education program affects PPIs rational prescribing and deprescribing in cancer patients through adhering to American Gastroenterological Association (AGA) guidelines, documentation of indication, and reducing costs.MethodsThis quasi-experimental study was conducted at a tertiary care cancer hospital in Peshawar, Pakistan from November 2024 to January 2025. Intervention included physician education via CME sessions and weekly AGA guidelines pamphlet. Data related to patient age, type of cancer, PPI prescriptions, indications for use, documentation, other co-prescribed medicines, and costs were collected. Outcomes included guidelines adherence in terms of changes in PPI prescribing, inappropriate PPI use, and the total costs of therapy.ResultsA total of 400 prescriptions (200 pre- and 200 -post intervention) were analyzed. Inappropriate use without proper indication decreased from 34.3% to 14%. Long-term use without a valid reason also declined from 7.3% to 1.8%. The average cost of treatment dropped from PKR 530 ± 428.6 to 336.4 ± 250.8, with p < 0.001. Significant improvements in adherence to multiple AGA Best Practice Advise (BPA) categories were observed, especially in deprescribing PPIs without definitive indications and step-down dosing. The documentation of indications for PPI use improved from 39.3% to 60.7%, with p < 0.001.ConclusionPharmacist-led interventions greatly improved rational PPIs prescribing, enhanced documentation, reduced inappropriate PPI use, and reduced therapy costs in cancer patients. These results support the pharmacist's integration into oncology healthcare team to improve medicine safety, rational use and resource utilization.

BackgroundTriple-negative breast cancer (TNBC) is an aggressive subtype with limited targeted treatment options. Platinum agents, particularly carboplatin's DNA damaging properties suggest efficacy, its impact on survival outcomes and toxicity remains uncertain.MethodsPubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov were searched from inception to February 2026. Phase II/III RCTs comparing carboplatin plus standard chemotherapy with standard therapy alone in TNBC were included. Primary outcomes were disease-free survival (DFS), overall survival (OS), and pathological complete response (pCR). Pooled hazard ratios (HRs) and risk ratios (RRs) were calculated using random-effects models.ResultsTwenty-three trials (n = 8797) were included. Carboplatin significantly improved DFS (HR 0.68, 95% CI 0.60-0.76), OS (HR 0.65, 95% CI 0.53-0.80), and pCR (RR 1.46, 95% CI 1.30-1.64). Improvements were also observed in distant disease-free survival and recurrence-free survival. However, carboplatin was associated with increased hematological toxicities, including anemia, neutropenia, and thrombocytopenia, and higher rates of dose reduction and treatment discontinuation, though treatment-related mortality was not significant.ConclusionCarboplatin-containing chemotherapy improves survival outcomes and pCR in TNBC. Despite increased toxicity, adverse effects are generally manageable. These findings support the incorporation of carboplatin into TNBC treatment, with careful patient selection to balance efficacy and safety.