Analysis of the interventions in antineoplastic therapy by a clinical pharmacy service at a tertiary hospital in Brazil

Background Medication errors are avoidable occurrences that can assume clinically significant dimensions and impose relevant costs to the health system, especially in the context of antineoplastic therapy. Objective Assess the clinical significance and economic impacts of a clinical pharmaceutical service. This retrospective study consists of an analysis of pharmacy interventions and drug-related problems found in a review of electronic prescriptions referring to antineoplastic therapy of a public teaching tertiary hospital in Brazil. Method Retrospective descriptive study obtained from electronic records of drug-related problems and pharmaceutical interventions related to antineoplastic therapy for oncological and hematological diseases, obtained through the pharmacotherapy review service. The accepted interventions were analyzed for the financial impact generated, evaluating your direct costs. The perception of clinical significance of a random sample of interventions was ascertained by the experts' opinion, using the Delphi method. Results The most frequent problem was a “lack of information to professionals” (25.06%), “problems as to the frequency and interval of doses” (22.90%), and “medication underdosing” (16.20%). Dose adjustment (31.50%) and clarifications (30.90%) were the most frequent pharmaceutical interventions. In the second round of Delphi, experts rated 77.77% of interventions as extremely significant and very significant. The main drugs reported in the interventions were cyclophosphamide, carboplatin, methotrexate, folinic acid, and monoclonal antibodies. The savings amounted to US$1,193,970.18 and involved mainly bortezomib, dactinomycin, and monoclonal antibodies. Conclusion Clinical pharmacy services contributed to the rational use of medicines presenting clinical significance and avoiding waste of financial resources.

Use of therapeutic outcomes monitoring method for performing of pharmaceutical care in oncology patients

This study aimed to implement pharmaceutical care using the therapeutic outcome monitoring (TOM) method for pharmacotherapeutic follow-up of oncological patients. This was a prospective longitudinal study involving patients undergoing oral chemotherapy. The study environment was an outpatient pharmacy at a tertiary-level oncology hospital. Ninety patients who received oral chemotherapy were evaluated, and 27 patients were followed up in accordance with the exclusion criteria and acceptability of participation in the study. The patients were predominantly diagnosed with gynecological tumors, with a mean age of 57.56 ± 13.06. The average consumption of drugs per patient was 4.63 ± 4.85, and more than 55% of patients had undergone oral antineoplastic therapy for more than a year. The main therapeutic groups used were drugs that acted on the gastrointestinal tract and metabolism (34%). All patients had at least one drug-related problem (DRP). In total, 133 DRP were identified. Approximately 33% of patients had DRPs related to antineoplastic therapy; non-adherence, incorrect administration, and the probability of adverse events were among the frequently reported DRPs. We identified 43 negative outcomes associated with medication (NOM), with untreated health problems (47%) and non-quantitative insecurity (30%) being the most frequently reported. 81 pharmaceutical interventions were performed, and 96% were accepted. The main errors avoided with the interventions were untreated health problems, misuse, and interruptions associated with medication administration. The TOM method effectively achieved the desired results of therapy, improving the use of medicines, and thus increasing patient safety.

ORAL MANIFESTATIONS ARISING FROM ANTINEOPLASTIC THERAPY IN CHILD ONCOLOGICAL PATIENTS

No Brasil, o câncer é a principal causa de morte por doença em crianças e adolescentes. O Instituto Nacional do Câncer (INCA) estima a ocorrência de 8.460 novos casos de câncer em crianças e adolescentes no ano de 2020.O objetivo desse estudo foi identificar as manifestações bucais mais frequentes nos pacientes pediátricos em tratamento antineoplásico. Essa pesquisa incluiu 137 crianças e adolescentes de 0 a 19 anos de idade. Os dados incluíram um questionário semiestruturado para verificar as manifestações bucais mais frequentes decorrentes da terapia antineoplásica. Os testes estatísticos utilizados foram o teste Qui-quadrado de Pearson e para avaliar a força da associação foi obtido o Odds Ratio (OR) ou Razão das Chances (RC) com respectivo intervalo de confiança. Os resultados encontrados demonstram que a idade média dos pacientes pesquisados foi de 6,8 anos; o sexo masculino (57,7%) foi predominante na amostra; a neoplasia maligna mais incidente foi à leucemia (67,9%); 70,1% dos pacientes apresentaram pelo menos uma manifestação oral, sendo a mucositede maior prevalência (56,2%), seguida da xerostomia (46,7%), gengivite (41,6%), disfagia (35,8%), disgeusia (35,8%), candidíase (34,3%) e herpes (21,2%). Encontraram-se 54,7% dos pacientes com saúde bucal favorável e 40,9% deles com saúde bucal desfavorável. Concluímos que o paciente infantil deve ser avaliado por um odontopediatra previamente ao início da quimioterapia para minimizar as complicações bucais durante o tratamento antineoplásico.

Endocrine Toxicities of Antineoplastic Therapy

In recent years, the prognosis of many solid tumors has improved markedly thanks to new treatment strategies, including tyrosine kinase inhibitors (TKIs) and immunotherapy [...]