Influence of Pharmacist Recommendations for Chemotherapy-Related Problems in Diabetic Cancer Patients

Year 2017, Volume: 21 Issue: 3, 603 - 611, 23.06.2017

Fikret V. Izzettin Anmar Al-taie , Mesut Sancar Mehmet Aliustaoğlu

https://doi.org/10.12991/marupj.323286

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

Diyabetli Kanser Hastalarında Kemoterapiyle İlişkili Problemler Üzerine Eczacı Önerilerinin Etkisi

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.

Keywords

Klinik eczacı önerileri, diabetes mellitus, ilaç kaynaklı problemler, ilaç yan etkileri

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.