Research Article
Influence of Pharmacist Recommendations for Chemotherapy-Related Problems in Diabetic Cancer Patients
Abstract
Drug related-problems pose additional worse outcomes in
cancer patients treated with chemotherapy. A vital role of the
clinical pharmacist is the detection and prevention of drugrelated
problems. The provision of patient education is an
important step to reduce and prevent drug-related problems
during chemotherapy administration. The objective of this
study was to assess the occurrence of drug-related problems
and the importance of effective provision of patient education
and appropriate recommendations by the clinical pharmacist
in reducing and solving of these problems in diabetic patients
suffering from cancer.
A prospective study carried out on 50 diabetic patients as
a single group with new diagnosis of diverse cancer types
eligible for chemotherapy adminitration recruited between
September 2014 and April 2015 at the oncology unit in one
of the Teaching and Research Hospital (Istanbul-Turkey).
Drug-related problems were evaluated, and proper patient
education alongside pharmacist recommendation regarding
chemotherapy was provided during the required chemotherapy
protocol schedule. (n=65) of the drug-related problems were
contributed to inappropriate IV fluid selection; (n=33) were
attributed to low drug dose prescribed, and (n=30) to high
drug dose prescribed. Drug-related problems totally solved
due to clinical pharmacist recommendations were 69.57%
(n=80). There was a significant increase in the occurrence of
paleness (P=0.0001); urinary frequency (P=0.003); loss of
appetite (P=0.0001), nausea (P=0.0001), vomiting (P=0.0001);
and numbness (P=0.0001). A significant decrease in the
occurrence and severity of chemotherapy-related adverse
effects was observed as a mild urinary frequency (P=0.0001)
and mild vomiting (P=0.0001) after the clinical pharmacist
recommendations and provision of patient education.
Results of this study revealed that diabetic cancer patients are
definitly prone to the occurrence of drug-related problems
and adverse drug reactions. Clinical pharmacist is expected to
provide a well-defined education and care to those patients and
the outcomes of pharmacist recommendations may diminish
and prevent many drug-related problems and adverse drug
reactions and by this, influence patients’ desire to complete the
course of chemotherapy.
Keywords
Clinical Pharmacist Recommendations Diabetes Mellitus Drug-Related Problems Adverse Drug Effects
References
- 1. Vigneri P, Frasca F, Sciacca L, Pandini G, Vigneri R. Diabetes and cancer. Endocr Relat Cancer 2009;16:1103-23. 2. Pharmaceutical Care Network Europe. DRP-Classification V6.2. 2010. http://www.pcne.org/upload/files/11_PCNE_ classification_V6.2.pdf. Accessed date: 8 March 2017. 3. Ruths S, Viktil KK, Blix HS. Classification of drug-related problems. Tidsskr Nor Laegeforen 2007; 127: 3073-6. 4. Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM; HARM Study Group. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med 2008;168:1890-6. 5. Stafford AC, Tenni PC, Peterson GM, Jackson SL, Hejlesen A, Villesen C, Rasmussen M. Drug-related problems identified in medication reviews by Australian pharmacists. Pharm World Sci 2009 ;31:216-23. 6. Molokhia M, Tanna S, Bell D. Improving reporting of adverse drug reactions: Systematic review. Clin Epidemiol 2009;1:75- 92. 7. Routledge PA, O’Mahony MS, Woodhouse KW. Adverse drug reactions in elderly patients. Br J Clin Pharmacol 2004;57:121- 6. 8. Jamali AN, Aqil M, Alam MS, Pillai KK, Kapur P. A pharmacovigilance study on patients of bronchial asthma in a teaching hospital. J Pharm Bioallied Sci 2010;2:333-6. 9. Ouyang Z, Peng D, Dhakal DP. Risk factors for hematological toxicity of chemotherapy for bone and soft tissue sarcoma. Oncol Lett 2013;5:1736-1740. 10. Cosentino M, Leoni O, Oria C, Michielotto D, Massimo E, Lecchini S, Frigo G. Hospital-based survey of doctors’ attitudes to adverse drug reactions and perception of drug-related risk for adverse reaction occurrence. Pharmacoepidemiol Drug Saf 1999;8 Suppl 1:S27-35. 11. van Grootheest K, de Jong-van den Berg L. Patients’ role in reporting adverse drug reactions. Expert Opin Drug Saf 2004;3:363-8. 12. Aranda S, Jefford M, Yates P, Gough K, Seymour J, Francis P, Baravelli C, Breen S, Schofield P. Impact of a novel nurseled prechemotherapy education intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs: results from a randomised, controlled trial. Ann Oncol 2012;23:222-31. 13. Carelle N, Piotto E, Bellanger A, Germanaud J, Thuillier A, Khayat D. Changing patient perceptions of the side effects of cancer chemotherapy. Cancer 2002;95:155-63. 14. Kayl AE, Meyers CA. Side-effects of chemotherapy and quality of life in ovarian and breast cancer patients. Curr Opin Obstet Gynecol 2006;18: 24-8. 15. Hadder Akram AbdulRazzaq. Prediction of uncontrolled dyslipidemia of cardiac patients and the adverse effect od pharmaceutical excipients. Universiti Sains Malaysia (USM), doctor of Philosophy (PhD) Thesis, 2013, Penang, Malaysia (Supervisor; Syed Azhar Syed Sulaiman). 16. Sisay EA, Engidawork E, Yesuf TA, Ketema EB. Drug Related Problems in Chemotherapy of Cancer Patients. J Cancer Sci Ther 2015; 7: 055-9. 17. Ogbonna BO, Ezenduka CC, Opara CA, Ahara LG. Drug therapy problems in patients with Type-2 Diabetes in a tertiary hospital in Nigeria. IJIRD 2014; 3: 494-502. 18. Hamza NA, Abdou Sallam S, El-Nimr NA. Rates and types of prescribing errors and related ınterventions in oncology. Int J Curr Microbiol App Sci 2013; 2: 435-45. 19. Kuo G, Touchette D, Marinac J. Drug errors and related interventions reported by United States clinical pharmacists: The American college of clinical pharmacy practice-based research network medication error detection, amelioration and prevention study. Pharmacother 2013;33: 253-65. 20. Jaehde U, Liekweg A, Simons S, Westfeld M. Minimising treatment-associated risks in systemic cancer therapy. Pharm World Sci 2008;30:161-8. 21. Slama C, Jerome J, Jacquot C, Bonan B. Prescription errors with cytotoxic drugs and the inadequacy of existing classifications. Pharm World Sci 2005 ;27:339-43. 22. Chan DC, Chen JH, Kuo HK, We CJ, Lu IS, Chiu LS, Wu SC. Drug-related problems (DRPs) identified from geriatric medication safety review clinics. Arch Gerontol Geriatr 2012;54:168-74. 23. Bob W, Ines K. Development of an evidence-based checklist for the detection of drug-related problems in type 2 diabetes mellitus. Pharm World Sci 2009; 31:580–95. 24. Viktil KK, Blix HS, Moger TA, Reikvam A.Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 2007; 63:187-95. 25. Feyer P, Kleeberg UR, Steingräber M, Günther W, Behrens M.Frequency of side effects in outpatient cancer care and their influence on patient satisfaction—a prospective survey using the PASQOC questionnaire. Support Care Cancer 2008; 16:567–75. 26. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M; Medical Research Council Guidance. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008;337:a1655. 27. Aslam MS, Naveed S, Ahmed A, Abbas Z, Gull I, Athar MA. Side effects of chemotherapy in cancer patients and evaluation of patients opinion about starvation based differential chemotherapy. J Cancer Ther 2014; 5: 817-22. 28. Atkin PA, Veitch PC, Veitch EM, Ogle SJ. The epidemiology of serious adverse drug reactions among the elderly. Drugs Aging 1999;14:141-52. 29. Roughead EE, Barratt JD, Gilbert AL. Medication-related problems commonly occurring in an Australian community setting. Pharmacoepidemiol Drug Saf 2004; 13: 83-7. 30. Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc 2006;54:1516-23. 31. Chan H-K, Ismail S. Side effects of chemotherapy among cancer patients in a Malaysian General Hospital: Experiences, perceptions and ınformational needs from clinical pharmacists. Asian Pac J Cancer Prev 2014; 15: 5305-9. 32. Baniasadi S, Habibi M, Haghgoo R, Karimi Gamishan M, Dabaghzadeh F, Farasatinasab M, Farsaei S, Gharekhani A, Kafi H, Karimzadeh I, Kharazmkia A, Najmeddin F, Nikvarz N, Oghazian MB, Rezaee H, Sadeghi K, Tafazzoli A, Shahsavari N, Fahimi F. Increasing the number of adverse drug reactions reporting: the role of clinical pharmacy residents. Iran J Pharm Res 2014;13:291-7. 33. Carelle N, Piotto E, Bellanger A, Germanaud J, Thuillier A, Khayat D. Changing patient perceptions of the side effects of cancer chemotherapy. Cancer 2002;95:155-63.
Year 2017,
Volume: 21 Issue: 3, 603 - 611, 23.06.2017
Abstract
Kemoterapi alan kanser hastalarında ilaç kaynaklı problemler,
normalden daha şiddetli sonuçlar gösterir. Klinik eczacının en
önemli rollerinden biri ilaç kaynaklı problemlerin belirlenmesi
ve önlenmesidir. Hasta eğitiminin sağlanması, kemoterapi
uygulanırken ortaya çıkabilecek ilaç kaynaklı problemlerin
önlenmesi veya şiddetlerinin azaltılması adına önemli bir
adımdır. Bu çalışmanın amacı, diyabetli kanser hastalarına
ait bu problemlerin azaltılması ve çözülmesinde klinik eczacı
tarafından verilen etkili hasta eğitimi ve yapılan uygun
önerilerin öneminin anlaşılması ve ilaç kaynaklı problemlerin
ortaya çıkış sıklığının belirlenmesidir. Çeşitli kanser tiplerine
ait yeni teşhis konmuş ve kemoterapi alması uygun görülmüş
olan 50 diyabetli hasta üzerinde prospektif ve tek grup olarak
yürütülen çalışma, Eylül 2014 ve Nisan 2015 tarihleri arasında
İstanbul, Türkiye’deki bir eğitim ve araştırma hastanesinde
gerçekleştirilmiştir. Uygun görülen kemoterapi protokol
takvimi sırasında, ilaç kaynaklı problemler değerlendirilmiş ve
kemoterapiye dair eczacı önerileriyle, hastalara uygun eğitim
verilmiştir. İlaç kaynaklı problemlerin n=65’i uygunsuz IV
sıvı seçiminden, n=33’ü reçete edilen ilacın dozunun düşük
olmasından, n=30’u da reçete edilen ilacın dozunun yüksek
olmasından dolayı ortaya çıkmıştır. Klinik eczacı önerileriyle
tamamen çözülen ilaç kaynaklı problem yüzdesi %69.57’dir
(n=80). Solgunluk (p=0,0001), idrar sıklığı (p=0,003), iştahta
azalma (p=0,0001), bulantı (p=0,0001), kusma (p=0,0001)
ve uyuşukluk (p=0,0001) belirtilerinde anlamlı bir artış
görülmüştür. Klinik eczacı önerilerinden ve hasta eğitiminden
sonra kemoterapiye bağlı yan etkilerden idrar sıklığı (p=0,0001)
ve kusmanın (p=0,0001) şiddeti ve sıklığında anlamlı azalma
gözlenmiştir. Bu çalışma, diyabetli kanser hastalarının ilaç
kaynaklı problemlere ve ilaç yan etkilerine açık olduklarını
ortaya koymuştur. Klinik eczacının bu tür hastalara anlaşılabilir
bir eğitim ve bakım sağlaması beklenir. Eczacı önerilerinin
sonucunda birçok ilaç kaynaklı problemin ve yan etkinin
önlenmesi ve ortadan kaldırılması sağlanarak hastaların
kemoterapi kürlerine devam etme isteği artırılabilir.
References
- 1. Vigneri P, Frasca F, Sciacca L, Pandini G, Vigneri R. Diabetes and cancer. Endocr Relat Cancer 2009;16:1103-23. 2. Pharmaceutical Care Network Europe. DRP-Classification V6.2. 2010. http://www.pcne.org/upload/files/11_PCNE_ classification_V6.2.pdf. Accessed date: 8 March 2017. 3. Ruths S, Viktil KK, Blix HS. Classification of drug-related problems. Tidsskr Nor Laegeforen 2007; 127: 3073-6. 4. Leendertse AJ, Egberts AC, Stoker LJ, van den Bemt PM; HARM Study Group. Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands. Arch Intern Med 2008;168:1890-6. 5. Stafford AC, Tenni PC, Peterson GM, Jackson SL, Hejlesen A, Villesen C, Rasmussen M. Drug-related problems identified in medication reviews by Australian pharmacists. Pharm World Sci 2009 ;31:216-23. 6. Molokhia M, Tanna S, Bell D. Improving reporting of adverse drug reactions: Systematic review. Clin Epidemiol 2009;1:75- 92. 7. Routledge PA, O’Mahony MS, Woodhouse KW. Adverse drug reactions in elderly patients. Br J Clin Pharmacol 2004;57:121- 6. 8. Jamali AN, Aqil M, Alam MS, Pillai KK, Kapur P. A pharmacovigilance study on patients of bronchial asthma in a teaching hospital. J Pharm Bioallied Sci 2010;2:333-6. 9. Ouyang Z, Peng D, Dhakal DP. Risk factors for hematological toxicity of chemotherapy for bone and soft tissue sarcoma. Oncol Lett 2013;5:1736-1740. 10. Cosentino M, Leoni O, Oria C, Michielotto D, Massimo E, Lecchini S, Frigo G. Hospital-based survey of doctors’ attitudes to adverse drug reactions and perception of drug-related risk for adverse reaction occurrence. Pharmacoepidemiol Drug Saf 1999;8 Suppl 1:S27-35. 11. van Grootheest K, de Jong-van den Berg L. Patients’ role in reporting adverse drug reactions. Expert Opin Drug Saf 2004;3:363-8. 12. Aranda S, Jefford M, Yates P, Gough K, Seymour J, Francis P, Baravelli C, Breen S, Schofield P. Impact of a novel nurseled prechemotherapy education intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs: results from a randomised, controlled trial. Ann Oncol 2012;23:222-31. 13. Carelle N, Piotto E, Bellanger A, Germanaud J, Thuillier A, Khayat D. Changing patient perceptions of the side effects of cancer chemotherapy. Cancer 2002;95:155-63. 14. Kayl AE, Meyers CA. Side-effects of chemotherapy and quality of life in ovarian and breast cancer patients. Curr Opin Obstet Gynecol 2006;18: 24-8. 15. Hadder Akram AbdulRazzaq. Prediction of uncontrolled dyslipidemia of cardiac patients and the adverse effect od pharmaceutical excipients. Universiti Sains Malaysia (USM), doctor of Philosophy (PhD) Thesis, 2013, Penang, Malaysia (Supervisor; Syed Azhar Syed Sulaiman). 16. Sisay EA, Engidawork E, Yesuf TA, Ketema EB. Drug Related Problems in Chemotherapy of Cancer Patients. J Cancer Sci Ther 2015; 7: 055-9. 17. Ogbonna BO, Ezenduka CC, Opara CA, Ahara LG. Drug therapy problems in patients with Type-2 Diabetes in a tertiary hospital in Nigeria. IJIRD 2014; 3: 494-502. 18. Hamza NA, Abdou Sallam S, El-Nimr NA. Rates and types of prescribing errors and related ınterventions in oncology. Int J Curr Microbiol App Sci 2013; 2: 435-45. 19. Kuo G, Touchette D, Marinac J. Drug errors and related interventions reported by United States clinical pharmacists: The American college of clinical pharmacy practice-based research network medication error detection, amelioration and prevention study. Pharmacother 2013;33: 253-65. 20. Jaehde U, Liekweg A, Simons S, Westfeld M. Minimising treatment-associated risks in systemic cancer therapy. Pharm World Sci 2008;30:161-8. 21. Slama C, Jerome J, Jacquot C, Bonan B. Prescription errors with cytotoxic drugs and the inadequacy of existing classifications. Pharm World Sci 2005 ;27:339-43. 22. Chan DC, Chen JH, Kuo HK, We CJ, Lu IS, Chiu LS, Wu SC. Drug-related problems (DRPs) identified from geriatric medication safety review clinics. Arch Gerontol Geriatr 2012;54:168-74. 23. Bob W, Ines K. Development of an evidence-based checklist for the detection of drug-related problems in type 2 diabetes mellitus. Pharm World Sci 2009; 31:580–95. 24. Viktil KK, Blix HS, Moger TA, Reikvam A.Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol 2007; 63:187-95. 25. Feyer P, Kleeberg UR, Steingräber M, Günther W, Behrens M.Frequency of side effects in outpatient cancer care and their influence on patient satisfaction—a prospective survey using the PASQOC questionnaire. Support Care Cancer 2008; 16:567–75. 26. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M; Medical Research Council Guidance. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008;337:a1655. 27. Aslam MS, Naveed S, Ahmed A, Abbas Z, Gull I, Athar MA. Side effects of chemotherapy in cancer patients and evaluation of patients opinion about starvation based differential chemotherapy. J Cancer Ther 2014; 5: 817-22. 28. Atkin PA, Veitch PC, Veitch EM, Ogle SJ. The epidemiology of serious adverse drug reactions among the elderly. Drugs Aging 1999;14:141-52. 29. Roughead EE, Barratt JD, Gilbert AL. Medication-related problems commonly occurring in an Australian community setting. Pharmacoepidemiol Drug Saf 2004; 13: 83-7. 30. Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc 2006;54:1516-23. 31. Chan H-K, Ismail S. Side effects of chemotherapy among cancer patients in a Malaysian General Hospital: Experiences, perceptions and ınformational needs from clinical pharmacists. Asian Pac J Cancer Prev 2014; 15: 5305-9. 32. Baniasadi S, Habibi M, Haghgoo R, Karimi Gamishan M, Dabaghzadeh F, Farasatinasab M, Farsaei S, Gharekhani A, Kafi H, Karimzadeh I, Kharazmkia A, Najmeddin F, Nikvarz N, Oghazian MB, Rezaee H, Sadeghi K, Tafazzoli A, Shahsavari N, Fahimi F. Increasing the number of adverse drug reactions reporting: the role of clinical pharmacy residents. Iran J Pharm Res 2014;13:291-7. 33. Carelle N, Piotto E, Bellanger A, Germanaud J, Thuillier A, Khayat D. Changing patient perceptions of the side effects of cancer chemotherapy. Cancer 2002;95:155-63.
There are 1 citations in total.
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | Articles |
| Authors | |
| Publication Date | June 23, 2017 |
| Published in Issue | Year 2017 Volume: 21 Issue: 3 |