Abstract
Background Oral chemotherapy is increasingly used for cancer therapy but, without proper practices, creates safety and adherence issues. However, little is known on safety and adherence practices in wide clinical settings. Objective To assess the implementation level of safety and adherence practices in oral chemotherapy in Spanish hospitals. Setting All Pharmacy services from prescription, dispensation, patient education and monitoring hospitals that prescribe oral chemotherapy of Spain. Main outcome measure Level of safety practices regarding oral chemotherapy prescription, dispensation, patient education and adherence. Method An 11 multiple-choice-item questionnaire made in consensus with GEDEFO (Spanish Group of Oncology Pharmacists) was sent to all pharmacy services from hospitals that prescribe oral chemotherapy. This questionnaire comprised prescription, dispensation, education and monitoring. We arbitrarily defined three levels of practices: no sufficient specific practices were reported (we termed this as ‘level I’); performance of an initial visit with a pharmacist providing written patient educational materials and monitoring adherence (termed as ‘level II’); and level II requirements plus electronic chemotherapy ordering system and extra safety practices (termed as ‘level III’). Results Of the 169 targeted health-care settings, 86 (50.9 %) responded to the survey. The majority of responding hospitals were public, general, and teaching hospitals with more than 200 beds. Main discrepancies were in electronic prescription of oral chemotherapy and monitoring adherence. There were 32 hospitals (37.2 %) with level I of safety and adherence practices, 38 hospitals (44.2 %) accomplished level II, 16 (18.6 %) hospitals reached level III. No hospital variables were found to be correlated with each level of safety. Conclusions The majority of responding hospitals have safety and adherences practices for oral chemotherapy. However, the level of these practices varies. There are significant opportunities for improvement, particularly with regard to electronic prescription of oral chemotherapy and monitoring adherence.
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References
O’Neill VJ, Twelves CJ. Oral cancer treatment: developments in chemotherapy and beyond. Br J Cancer. 2002;87:933–7.
Weingart SN, Brown E, Bach PB, Eng K, Johnson SA, Kuzel TM, et al. NCCN Task Force Report: oral chemotherapy. J Natl Compr Canc Netw. 2008;6(Suppl 3):S1–14.
Petrelli NJ, Winer EP, Brahmer J, Dubey S, Smith S, Thomas C, et al. Clinical Cancer Advances 2009: major research advances in cancer treatment, prevention, and screening–a report from the American Society of Clinical Oncology. J Clin Oncol. 2009;27:6052–69.
Liu G, Franssen E, Fitch MI, Warner E. Patient preferences for oral versus intravenous palliative chemotherapy. J Clin Oncol. 1997;15:110–5.
Catania C, Didier F, Leon ME, Sbanotto A, Mariani L, Nole F, et al. Perception that oral anticancer treatments are less efficacious: development of a questionnaire to assess the possible prejudices of patients with cancer. Breast Cancer Res Treat. 2005;92:265–72.
Jensen LH, Osterlind K, Rytter C. Randomized cross-over study of patient preference for oral or intravenous vinorelbine in combination with carboplatin in the treatment of advanced NSCLC. Lung Cancer. 2008;62:85–91.
Weingart SN, Toro J, Spencer J, Duncombe D, Gross A, Bartel S, et al. Medication errors involving oral chemotherapy. Cancer. 2010;116:2455–64.
Font R, Espinas JA, Gil-Gil M, Barnadas A, Ojeda B, Tusquets I, et al. Prescription refill, patient self-report and physician report in assessing adherence to oral endocrine therapy in early breast cancer patients: a retrospective cohort study in Catalonia. Spain. Br J Cancer. 2012;107:1249–56.
Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L, et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011;126:529–37.
Dooley M, Carrington C. Recommendations for managing patients receiving oral chemotherapy and target therapies. Asia Pac J Clin Oncol. 2008;4:122.
ISOPP standards of practice. Safe handling of cytotoxics. J Oncol Pharm Pract. 2007;13(Suppl):1–81.
Jacobson JO, Polovich M, Gilmore TR, Schulmeister L, Esper P, Lefebvre KB, et al. Revisions to the 2009 american society of clinical oncology/oncology nursing society chemotherapy administration safety standards: expanding the scope to include inpatient settings. J Oncol Pract. 2012;8:2–6.
Carrington C, Stone L, Koczwara B, Searle C, Siderov J, Stevenson B, et al. The Clinical Oncological Society of Australia (COSA) guidelines for the safe prescribing, dispensing and administration of cancer chemotherapy. Asia Pac J Clin Oncol. 2010;6:220–37.
Gandhi TK, Bartel SB, Shulman LN, Verrier D, Burdick E, Cleary A, et al. Medication safety in the ambulatory chemotherapy setting. Cancer. 2005;104:2477–83.
Beney J, Bero LA, Bond C. Expanding the roles of outpatient pharmacists: effects on health services utilisation, costs, and patient outcomes. Cochrane Database Syst Rev. 2000:CD000336.
SHPA Standards of Practice for the Provision of Oral Chemotherapy for the Treatment of Cancer. J Pharm Pract Res. 2007; 37:149–52.
Weingart SN, Flug J, Brouillard D, Morway L, Partridge A, Bartel S, et al. Oral chemotherapy safety practices at US cancer centres: questionnaire survey. BMJ. 2007;334:407.
Bonal J, Castro I, Duran J. Trends in clinical pharmacy in Spain. Ann Pharmacother. 1980;14:259–65.
Colomer R, Alba E, Gonzalez-Martin A, Paz-Ares L, Martin M, Llombart A, et al. Treatment of cancer with oral drugs: a position statement by the Spanish Society of Medical Oncology (SEOM). Ann Oncol. 2010;21:195–8.
Collins CM, Elsaid KA. Using an enhanced oral chemotherapy computerized provider order entry system to reduce prescribing errors and improve safety. Int J Qual Health Care. 2011;23:36–43.
Keely JL. American College of Physicians-American Society of Internal M. Pharmacist scope of practice. Ann Intern Med. 2002;136:79–85.
Alminana M. Mangues Bafalluy MA, Santos Ramos B [Spanish presence in BPS accreditation]. Farm Hosp. 2010;34:314–6.
Aisner J. Overview of the changing paradigm in cancer treatment: oral chemotherapy. Am J Health-Syst Pharm. 2007;64:S4–7.
Simchowitz B, Shiman L, Spencer J, Brouillard D, Gross A, Connor M, et al. Perceptions and experiences of patients receiving oral chemotherapy. Clin J Oncol Nurs. 2010;14:447–53.
Ruddy K, Mayer E, Partridge A. Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin. 2009;59:56–66.
Partridge AH, Avorn J, Wang PS, Winer EP. Adherence to therapy with oral antineoplastic agents. J Natl Cancer Inst. 2002;94:652–61.
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487–97.
Voeffray M, Pannatier A, Stupp R, Fucina N, Leyvraz S, Wasserfallen JB. Effect of computerisation on the quality and safety of chemotherapy prescription. Qual Saf Health Care. 2006;15:418–21.
Acknowledgments
The authors thank Marta Pulido, MD; for editing the manuscript and editorial assistance. The following pharmacists have participated in this study. Inmaculada Vallejo Rodríguez (Granada), Juan Francisco Marín Pozo (Jaén), José Antonio Marcos Rodríguez (Sevilla), Silvia Artacho Criado (Sevilla), Carmen Blanco Bermejo (Málaga) Begoña Muros de Fuentes (Málaga), Margarita Garrido Siles (Marbella), Carmen Martínez Díaz (Cádiz), MªJosé Martínez Bautista (Cádiz)., MªCarmen Marín Guzmán (Granada), Natalia Allué Fantova (Barbastro, Huesca), Mercedes Gimeno Gracia (Zaragoza), Reyes Abad Sazatornil (Zaragoza), Clara Martorell Puigserver (Palma de Mallorca), Mónica Cholvi Llovell (Palma de Mallorca), Sonia González Ponsjoan (Tenerife), Pilar Díaz Ruiz (Santa Cruz de Tenerife), Rosa Seisdedos Elcuaz (Alcázar de San Juan, Ciudad Real), Lidia Martinez Valdivieso (Cuenca) Beatriz González Joga (Talavera de la Reina, Toledo), Paula de Juan-García Torres (Guadalajara), Ana Mª Moreno Gómez (Aranda de Duero, Burgos), Mª Paz Espinosa Gómez (Burgos), Mercedes Godoy Diez (Valladolid), Natalia Creus Baró (Barcelona), MªJosep Carreras (Barcelona), Estela Moreno Martínez (Barcelona), David Conde Estévez (Barcelona), Montserrat Pons Busom (Barcelona), Gemma Segrelles Bellmunt (Barcelona), Clara Lezcano Rubio (Badalona, Barcelona), Mª Ángeles Parada Aradilla (Barcelona), Joan Lluís Vinent Genestar (Esplugues de Llobregat, Barcelona), Eduard Fort Casamartina (L′Hospitalet de Llobregat, Barcelona), Joan Serraïs Benavente y Daniel Ferrandez Martí (Igualada, Barcelona), MªAntonia Planas Font (Manresa, Barcelona), Mónica Estelrich Rossi (Martorell, Barcelona), Teresa Gurrera Roig (Mataró, Barcelona), MªCarmen Frias (Sabadell, Barcelona), Eva Fernández Cañabete (Santa Coloma de Gramenet, Barcelona), Mª Rosa Garriga Biosca (Terrassa, Barcelona), Cristina Cardells Palau (Villafranca del Penedés, Barcelona), Meritxell Pujal Herranz (Terrassa, Barcelona), Gemma Basagaña Colomer (Vic, Barcelona), Irene Mangues Bafalluy (Lleida), Eva María Martínez Bernabé (Girona), Núria Quer Margall (Girona), Virginia Gol Vallés (Figueres, Girona), María López Brunsó (Palamós, Girona), María Vuelta Arce (Tarragona), Begoña Rodríguez (Tarragona), Fernando Busto Fernández (A Coruña), Beatriz Bernárdez Ferran y María Jesús Lamas Díaz (Santiago de Compostela, A Coruña), Isabel Rodríguez Losada (Lugo), MªAngeles Faraldo Vallés (Verín, Ourense), Rosario Olivera Fernández (Pontevedra), Sonia González Costas (Vigo, Pontevedra), Paloma Sánchez López (Madrid), Ainoa Arenaza Peña (Madrid), Nelida Barrueco Fernández (Madrid), Eva González Haba-Peña (Madrid), Mª Esther Gómez de Salazar López de Silanes y Cristina Pueyo López (Madrid), Amelia Sánchez Guerrero (Madrid), Isabel Eva Castillo Bazán (Madrid), Sonia Cruz Pardos (Madrid), María Fernández Pacheco (Alcalá de Henares, Madrid), Patricia Sanmartín Fenollera (Alcorcón, Madrid), Ana María Iglesias Bolaños (Arganda del Rey, Madrid), Laura Delgado Téllez de Cepeda (Coslada, Madrid), Mª Amparo Lucena Campillo (Leganés, Madrid), Javier Sánchez Rubio (Parla, Madrid), Belén García (San Sebastián de los Reyes, Madrid), Mª Sacramento Díaz Carrasco (Murcia), Mónica Martínez Penell (Cartagena, Murcia), José Javier Elizondo Armendáriz (Pamplona), Ana Iruin Sanz (Pamplona), Marian García del Barrio (Pamplona), Garbiñe Liceaga Cundin (San Sebastián, Guipúzcoa), María José Tamés and Gerardo Cajaraville Ordoñana (San Sebastián, Guipúzcoa), Ana Aguirrezabal Arredondo (Bilbao, Vizcaya), Ana María de Juan Arroyo (Galdakao, Vizcaya), Josefa Polache Vengud (Alicante), Amparo Talens Bolós (Alicante), Ana-Cristina Cercós Lleti (Alcoi, Alicante), Mª Teresa Beltrán Segarra (Castellón), Mª Dolores Pérez Serrano (Valencia).
Funding
This study is the result of the initiative born of a consolidated group of hospital pharmacists who work to improve the quality of oncohematological care, the Spanish Group for the Development of Oncological Pharmacy (GEDEFO, Grupo Español para el Desarrollo de la Farmacia Oncológica).
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This study was conducted on behalf of GEDEFO group.
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Conde-Estévez, D., Salas, E. & Albanell, J. Survey of oral chemotherapy safety and adherence practices of hospitals in Spain. Int J Clin Pharm 35, 1236–1244 (2013). https://doi.org/10.1007/s11096-013-9858-9
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DOI: https://doi.org/10.1007/s11096-013-9858-9