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Herledan C, Falandry C, Huot L, Poletto N, Baudouin A, Cerfon MA, Lorsche L, Bret J, Ranchon F, Rioufol C. Clinical impact and cost-saving analysis of a comprehensive pharmaceutical care intervention in older patients with cancer. J Am Geriatr Soc 2024; 72:567-578. [PMID: 37818698 DOI: 10.1111/jgs.18585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/22/2023] [Accepted: 08/19/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Hospital admission and discharge are at high risk of drug-related problems (DRPs) in older patients with cancer. This study aimed to assess the clinical and economic impact of a comprehensive pharmaceutical care intervention (RECAP) to optimize drug therapy in patients with cancer ≥75 years admitted to oncology or geriatric wards. METHOD RECAP intervention was defined as follows: at admission and discharge, hospital pharmacists conducted comprehensive medication reconciliation and review, identified relevant DRPs and provided optimization recommendations to prescribers; at discharge, pharmacists also provided patient education and shared information with primary care providers. The impact of the intervention was assessed by the rate of implementation of recommendations by the prescribers and the evolution of polypharmacy rate; a peer review of the clinical significance of DRPs was performed by an expert panel of geriatric oncologists and pharmacists. A cost saving analysis compared cost avoided through resolution of DRPs to cost of pharmacist's time. RESULTS From January 2019 and August 2020, 201 patients were included (median age 80 [75-97] years), 68.7% with solid tumors. DRPs requiring optimization were identified in 70.9% of patients at admission (mean 1.7 DRP/patient) and 47.7% at discharge (0.9 DRP/patient). Most pharmacist recommendations (70.8%) were followed by prescribers, allowing the correction of 1.2 DRP/patient at admission and 0.7 DRP/patient at discharge. Half of resolved DRPs were rated as clinically significant. However, polypharmacy rate was not reduced at discharge. Cost comparison showed $7.2 avoided for $1 invested, with an estimated total net benefit of $354,822 (mean $1766 per patient). CONCLUSIONS The RECAP model significantly reduces DRPs in hospitalized older patients with cancer. The model was cost saving, confirming the value of implementing it in routine practice.
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Affiliation(s)
- Chloé Herledan
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1, Oullins, France
| | - Claire Falandry
- Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France
- Laboratoire CarMeN, INSERM U1060/ INRAE U1397/Université Lyon 1, Université de Lyon, Pierre-Bénite, France
| | - Laure Huot
- Hospices Civils de Lyon, Pôle de Santé Publique, Service Evaluation Economique en Santé, Lyon, France
- Inserm U1290 Research on Healthcare Performance (RESHAPE), Université Lyon 1, Lyon, France
| | - Nicolas Poletto
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Amandine Baudouin
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Marie-Anne Cerfon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurie Lorsche
- Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France
| | - Judith Bret
- Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France
| | - Florence Ranchon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1, Oullins, France
| | - Catherine Rioufol
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1, Oullins, France
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Wells JC, Sidhu A, Ding K, Smoragiewicz M, Heng DYC, Shepherd FA, Ellis PM, Bradbury PA, Jonker DJ, Siu LL, Gelmon KA, Karapetis C, Shapiro J, Nott L, O’Callaghan CJ, Parulekar WR, Seymour L, Monzon JG. OUP accepted manuscript. Oncologist 2022; 27:e286-e293. [PMID: 35274718 PMCID: PMC8914495 DOI: 10.1093/oncolo/oyac020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 11/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Complementary medicines (CM) are frequently used by patients with cancer. Controversy exists over the effectiveness and risk that CM may add to conventional cancer therapy. The incidence of CM use among patients enrolled in phase III clinical trials is unknown. Methods Medication lists from 6 international phase III clinical trials were retrospectively reviewed to identify patients using CM. Patients had metastatic breast, colorectal, or lung cancers. Quality of life, adverse events, overall survival, and progression-free survival were compared between CM users and non-users. Baseline differences between groups were adjusted with propensity score matching groups. Results Seven hundred and six of 3446 patients (20.5%) used at least one CM. CM use was highest among patients with breast cancer (35.6%). CM users had more favorable baseline prognostic factors (ECOG 0-1, non-smoking status, younger age, and fewer metastases). CM use was associated with lower rates of adverse events (50% vs. 62%, P = .002) and quality of life was similar between both groups. After adjustment with propensity score matching, CM use was also associated with longer overall survival in patients with lung cancer (adjusted hazard ratio 0.80, 95%CI, 0.68-0.94, P =.0054). However, several key control variables like EGFR status were not available. Conclusion One in 5 patients in phase III clinical trials report using CM. CM was not associated with worse cancer-specific outcomes. However, CM users had more favorable baseline prognostic factors, and likely other confounders that may have contributed to improved outcomes observed in the lung cohort. Physicians should monitor for CM use and potential interactions with clinical trial drugs.
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Affiliation(s)
| | - Aven Sidhu
- Fraser Health and Veralife Health Centre, Surrey, BC, Canada
| | - Keyue Ding
- Canadian Cancer Trials Group, Kingston, ON, Canada
| | | | - Daniel Y C Heng
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter M Ellis
- Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Penelope A Bradbury
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Lillian L Siu
- Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | | | | - Jose G Monzon
- Corresponding author: Jose G. Monzon, Department of Medical Oncology, Tom Baker Cancer Center, University of Calgary, 1331 29 St NW, Calgary, AB, Canada T2N 4N2. Tel: +1 403 521 3688;
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Use of complementary and alternative medicine among patients with cancer in a sub-Himalayan state in India: An exploratory study. J Ayurveda Integr Med 2021; 12:126-130. [PMID: 33637425 PMCID: PMC8039360 DOI: 10.1016/j.jaim.2021.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/21/2020] [Accepted: 01/05/2021] [Indexed: 11/26/2022] Open
Abstract
Background The use of complementary and alternative medicine (CAM) is widespread among cancer patients in India. Objective The present study elucidated usage patterns of CAM and the factors responsible for its adoption among the patients with cancer, and the therapeutic impact of CAM. Materials and methods This was a questionnaire-based study, conducted among patients with cancer in a tertiary care hospital in a sub-Himalayan city. Data were analyzed using statistical methods. Results A total of 2614 patients with cancer were included. Almost half of the patients (n = 1208, 46.2%) reported to have been treated with CAM. Breast cancer (n = 274, 23.0%) was most prevalent with majority at advanced stages. Ayurveda (n = 428, 35.9%) Yoga/Naturopathy (n = 381, 32.0%) Homeopathy (n = 143, 12.0%) and Unani (n = 71, 5.9%) were used commonly. Among CAM users, 85.0% (n = 1012) of patients used CAM as the sole method of treatment, while 58.9% (n = 702) patients reported initial symptomatic benefit. Conclusion Using CAM benefitted a significant number of patients with cancer. However, there is an urgent need to integrate CAM with modern system of medicine. CAM is widely used in India including in cancer patients. Almost half of the patients reported to have been treated with CAM. CAM needs integration with modern system of medicine.
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The influence of polypharmacy, potentially inappropriate medications, and drug interactions on treatment completion and prognosis in older patients with ovarian cancer. J Geriatr Oncol 2020; 11:593-602. [DOI: 10.1016/j.jgo.2019.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/07/2019] [Accepted: 12/16/2019] [Indexed: 12/27/2022]
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Presley CJ, Canavan M, Wang SY, Feder SL, Kapo J, Saphire ML, Sheinfeld E, Kent EE, Davidoff AJ. Severe functional limitation due to pain & emotional distress and subsequent receipt of prescription medications among older adults with cancer. J Geriatr Oncol 2020; 11:960-968. [PMID: 32169548 DOI: 10.1016/j.jgo.2020.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Certain cancer types and subsequent treatment can cause or worsen pain and emotional distress, leading to functional limitation, particularly among a growing population of older adults with cancer. METHODS We constructed a national sample of older adult Medicare beneficiaries with cancer using the 2007-2012 Surveillance, Epidemiology and End Results (SEER)-Medicare Health Outcomes Survey (MHOS) database linked to Medicare Part D enrollment and prescription claims data. MHOS survey responses described functional limitations due to pain and emotional distress. Using multivariable logistic regression, we estimated the association between participant characteristics and patient-reported functional limitation due to pain and emotional distress and subsequent prescription medication use. RESULTS Among 9105 older adults with cancer, aged 66-102 years (y), 68.6% reported moderate to severe functional limitation due to pain, and 48.3% reported moderate to severe functional limitation due to emotional distress. Nearly 10% reported severe functional limitation due to co-occurring symptoms of pain and emotional distress. Significant predictors of severe functional limitation due to co-occurring symptoms included age ≥ 80y (ref: 66-69y, adjusted relative risk (aRR): 1.74; 95% confidence interval (CI) 1.39-2.18, p < .001), stage IV disease at diagnosis (ref: stage I, aRR: 2.08; CI 1.52-2.86, p < .001), and lung cancer (ref: breast cancer, aRR: 1.84; CI 1.30-2.61, p < .001). Among 892 participants reporting co-occurring symptoms, 32.5% received neither pain nor emotional distress prescription medication. CONCLUSIONS Functional limitation due to pain and emotional distress persist among older adults with cancer, particularly octogenarians. Efforts to identify and target unmet supportive care needs to maintain functional independence are needed.
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Affiliation(s)
- Carolyn J Presley
- The Ohio State University Comprehensive Cancer Center/The James Cancer Hospital & Solove Research Institute, B424 Starling Loving Hall, 320 W. 10th Avenue, Columbus, OH 43214, USA.
| | - Maureen Canavan
- Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, Yale Cancer Center, 333 Cedar Street, New Haven, CT 06510, USA
| | - Shi-Yi Wang
- Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, Yale Cancer Center, 333 Cedar Street, New Haven, CT 06510, USA; Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
| | - Shelli L Feder
- National Clinical Scholars Program, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Jennifer Kapo
- Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, Yale Cancer Center, 333 Cedar Street, New Haven, CT 06510, USA
| | - Maureen L Saphire
- The Ohio State University Wexner Medical Center/The James Cancer Hospital, 410 W 10th Avenue, Columbus, OH 43210, USA
| | - Ella Sheinfeld
- Yale Fox Fellowship, 333 Cedar Street, New Haven, CT 06510, USA
| | - Erin E Kent
- National Cancer Institute, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Amy J Davidoff
- Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, Yale Cancer Center, 333 Cedar Street, New Haven, CT 06510, USA; Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA
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Chun DS, Faso A, Muss HB, Sanoff HK, Valgus J, Lund JL. Oncology pharmacist-led medication reconciliation among cancer patients initiating chemotherapy. J Oncol Pharm Pract 2019; 26:1156-1163. [PMID: 31852349 DOI: 10.1177/1078155219892066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pharmacist-led medication reconciliation (PMR) ensures adequate recording and use of medications by patients. PMR may be important for cancer patients initiating new therapies, as they have a high burden of medication use and are more susceptible to inadvertent medication discrepancies. To describe medication changes (additions, discontinuations, and modifications) made to the electronic health record during a PMR among cancer patients initiating chemotherapy. METHODS From October 2011 to March 2012, 397 cancer patients initiating chemotherapy underwent a PMR at the University of North Carolina Cancer Hospital. Self-reported medications and those in the patients' electronic health record were reviewed. Log-binomial regression models were used to estimate adjusted prevalence ratios and 95% confidence intervals for the associations between patient characteristics and medication changes made to the electronic health record. RESULTS Mean age at time of the PMR was 58. Median number of medications taken prior to the PMR was 10 and median time to PMR completion was 11 min. Vitamins and herbal supplements accounted for the largest proportion of medication additions (38%) and modifications (20%). Antimicrobials accounted for the largest share of discontinuations (15%). After adjustment for all other covariates, patients aged 60-69 years were more likely to have additions than those aged 50 and under (aPR = 1.47, 95%CI: 1.10-1.97). Patients 70 years and over were more likely to have modifications (aPR = 1.74, 95%CI: 1.07-2.82). CONCLUSION Our results show that most cancer patients had a medication change in the electronic health record. A brief oncology PMR can accurately capture and improve medication safety by preventing prescribing and administration errors.
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Affiliation(s)
- Danielle S Chun
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Aimee Faso
- Department of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Hanna K Sanoff
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Division of Hematology/Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - John Valgus
- Department of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer L Lund
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Sneha SG, Simhadri K, Subeesh VK, Sneha SV. Predictors of adverse drug reactions in geriatric patients: An exploratory study among cancer patients. South Asian J Cancer 2019; 8:130-133. [PMID: 31069198 PMCID: PMC6498717 DOI: 10.4103/sajc.sajc_218_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: The objective of this study was to study the predictors of adverse drug reactions (ADRs) among geriatric patients in the Department of Medical Oncology. Methods: A hospital-based prospective observational study was carried out among 153 inpatients in the Department of Medical Oncology for 6 months. Patients above 60 years of age with a confirmed history of malignancy were included in the study. The potential risk factors for ADR were defined in relation to the patient and chemotherapeutic regimen and relationship between them was assessed by univariate and multivariate logistic regression analysis. Results: Among 153 patients, 94 (64.43%) experienced ADRs. The mean ADR per patient was 0.88 ± 1.2. The common ADRs found were alopecia (30.18%) and diarrhea (28.68%). Risk estimates revealed that there was a significant association between smokers (odds ratio [OR] = 10.326; 95% confidence interval [CI] 2.345–45.47, P = 0.001), alcoholics (OR = 10.897; 95% CI 2.479–47.902, P = 0.001), increasing age (OR = 2.22; 95% CI 1.698–2.909, P = 0.001), overweight (OR = 16.68; 95% CI 2.179–127.741, P = 0.001), and male participants (OR = 0.143; 95% CI 0.05–0.390 P = 0.001) with the development of ADRs. The risk of carboplatin (OR = 13.359; 95% CI 3.056–58.406 P = 0.001) and 5-fluorouracil (OR = 1.938 95% CI 1.266–2.935 P = 0.001) use and occurrence of ADRs were also found to be high. Conclusion: The study findings showed that smoking, alcohol consumption, age more than 70 years, and overweight had a high risk for developing ADRs in geriatric patients who underwent chemotherapy. The independent risk factors identified should be targeted for preventive measures to improve anticancer agent prescription and reduce the risk of ADRs.
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Affiliation(s)
- S George Sneha
- Department of Pharmacy Practice, Faculty of Pharmacy, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Kalpana Simhadri
- Department of Pharmacy Practice, Faculty of Pharmacy, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Viswam K Subeesh
- Department of Pharmacy Practice, Faculty of Pharmacy, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - S Varghese Sneha
- Department of Pharmacy Practice, Faculty of Pharmacy, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
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The prevalence and predictors of using herbal medicines among Iranian cancer patients. Complement Ther Clin Pract 2019; 35:368-373. [DOI: 10.1016/j.ctcp.2019.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 03/05/2019] [Accepted: 03/08/2019] [Indexed: 01/20/2023]
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Nightingale G, Schwartz R, Kachur E, Dixon BN, Cote C, Barlow A, Barlow B, Medina P. Clinical pharmacology of oncology agents in older adults: A comprehensive review of how chronologic and functional age can influence treatment-related effects. J Geriatr Oncol 2018; 10:4-30. [PMID: 30017734 DOI: 10.1016/j.jgo.2018.06.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 05/11/2018] [Accepted: 06/19/2018] [Indexed: 12/22/2022]
Abstract
Unique challenges exist when managing older adults with cancer. Associations between cancer and age-related physiologic changes have a direct impact on pharmacokinetics and pharmacodynamics of cancer therapies and can affect drug dosing, dose intensity, efficacy, safety and quality of life. The breadth and depth of these issues, however, have not been fully evaluated because the majority of clinical trials have focused on a younger and healthier population. As a consequence, little information is available to support clinicians in making evidence-based decisions regarding treatment with cancer therapies in older adults, especially those over age 75. Prior clinical pharmacology reviews summarized the literature on how age-related physiologic changes can influence and affect conventional and targeted anti-cancer treatments. Our article provides an updated review with expanded information that includes small molecule kinase inhibitors, monoclonal antibodies, immunotherapies, hormonal, conventional, and miscellaneous agents. Additionally, our article integrates how functional age, determined by the geriatric assessment (GA), can also influence treatment-related effects and health outcomes. Broadening cancer therapy trials to capture not only chronologic age but also functional age would allow clinicians to better identify subsets of older adults who benefit from treatment versus those most vulnerable to morbidity and/or mortality.
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Affiliation(s)
- Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, United States.
| | - Rowena Schwartz
- Pharmacy Practice, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, United States
| | - Ekaterina Kachur
- Department of Hematologic Oncology & Blood Disorders, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, United States
| | - Brianne N Dixon
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Ashley Barlow
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Brooke Barlow
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Patrick Medina
- Director of Pharmacy, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States
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Berretta M, Della Pepa C, Tralongo P, Fulvi A, Martellotta F, Lleshi A, Nasti G, Fisichella R, Romano C, De Divitiis C, Taibi R, Fiorica F, Di Francia R, Di Mari A, Del Pup L, Crispo A, De Paoli P, Santorelli A, Quagliariello V, Iaffaioli RV, Tirelli U, Facchini G. Use of Complementary and Alternative Medicine (CAM) in cancer patients: An Italian multicenter survey. Oncotarget 2018; 8:24401-24414. [PMID: 28212560 PMCID: PMC5421857 DOI: 10.18632/oncotarget.14224] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/20/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Complementary and Alternative Medicine (CAM) include a wide range of products (herbs, vitamins, minerals, and probiotics) and medical practices, developed outside of the mainstream Western medicine. Patients with cancer are more likely to resort to CAM first or then in their disease history; the potential side effects as well as the costs of such practices are largely underestimated. Patients and method We conducted a descriptive survey in five Italian hospitals involving 468 patients with different malignancies. The survey consisted of a forty-two question questionnaire, patients were eligible if they were Italian-speaking and receiving an anticancer treatment at the time of the survey or had received an anticancer treatment no more than three years before participating in the survey. RESULTS Of our patients, 48.9% said they use or have recently used CAM. The univariate analysis showed that female gender, high education, receiving treatment in a highly specialized institute and receiving chemotherapy are associated with CAM use; at the multivariate analysis high education (Odds Ratio, (OR): 1.96 95% Confidence Interval, CI, 1.27-3.05) and receiving treatment in a specialized cancer center (OR: 2.75 95% CI, 1.53-4.94) were confirmed as risk factors for CAM use. Conclusion Roughly half of our patients receiving treatment for cancer use CAM. It is necessary that health professional explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision.
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Affiliation(s)
| | - Chiara Della Pepa
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Paolo Tralongo
- Division of Medical Oncology, "Umberto I" Hospital, Syracuse, Italy
| | - Alberto Fulvi
- Department of Medicine and Surgery of Integrated Treatment, Division of Thoracic Oncology, "San Camillo Forlanini" Hospital, Rome, Italy
| | | | - Arben Lleshi
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy
| | - Guglielmo Nasti
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | | | - Carmela Romano
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | - Chiara De Divitiis
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | - Rosaria Taibi
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy
| | - Francesco Fiorica
- Department of Radiation Oncology University Hospital Ferrara, Division of Radiotherapy, "Arcispedale Sant'Anna" Hospital, Ferrara, Italy
| | - Raffaele Di Francia
- Department of Hematology, Istituto Nazionale Tumori 'Fondazione Giovanni Pascale', IRCCS, Naples, Italy.,Gruppo Oncologico Ricercatori Italiani, GORI, Pordenone, Italy
| | - Anna Di Mari
- Division of Medical Oncology, "Umberto I" Hospital, Syracuse, Italy
| | - Lino Del Pup
- Division of Gynaecological Oncology, National Cancer Institute, Aviano (PN), Italy
| | - Anna Crispo
- Unit of Epidemiology, Struttura Complessa di Statistica Medica, Biometria e Bioinformatica, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Paolo De Paoli
- Scientific Directorate, National Cancer Institute, Aviano (PN), Italy
| | - Adriano Santorelli
- Department of Plastic Surgery, Regenerative Medicine, Health Park Hospital, Naples, Italy
| | - Vincenzo Quagliariello
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | - Rosario Vincenzo Iaffaioli
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | - Umberto Tirelli
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy
| | - Gaetano Facchini
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
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Varlı M, Bahşi R, Doğan Ş, Uysal H, Subaşı Ş, Toper M, Peksarı S, Keskin S, Mut Sürmeli D, Turgut T, Öztorun HS, Aras S. Nonprescription Product Use Among Geriatric Outpatients. ANKARA MEDICAL JOURNAL 2017. [DOI: 10.17098/amj.364163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Soto-Perez-de-Celis E, de Glas NA, Hsu T, Kanesvaran R, Steer C, Navarrete-Reyes AP, Battisti NML, Chavarri-Guerra Y, O’Donovan A, Avila-Funes JA, Hurria A. Global geriatric oncology: Achievements and challenges. J Geriatr Oncol 2017. [DOI: 10.1016/j.jgo.2017.06.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Fan Y, He L, Zhang R. Classification of Use Status for Dietary Supplements in Clinical Notes. PROCEEDINGS. IEEE INTERNATIONAL CONFERENCE ON BIOINFORMATICS AND BIOMEDICINE 2017; 2016:1054-1061. [PMID: 28824824 DOI: 10.1109/bibm.2016.7822668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Clinical notes contain rich information about dietary supplements, which are critical for detecting signals of dietary supplement side effects and interactions between drugs and supplements. One of the important factors of supplement documentation is usage status, such as started and discontinuation. Such information is usually stored in the unstructured clinical notes. We developed a rule-based classifier to identify supplement usage status in clinical notes. The categories referring to the patient's status of supplement use were classified into four classes: Continuing (C), Discontinued (D), Started (S), and Unclassified (U). Clinical notes containing 10 of the most commonly consumed supplements (i.e., alfalfa, echinacea, fish oil, garlic, ginger, ginkgo, ginseng, melatonin, St. John's Wort, and Vitamin E) were retrieved from the University of Minnesota Clinical Data Repository. The gold standard was defined by manually annotating 1000 randomly selected sentences or statements mentioning at least one of these 10 supplements. The rules in the classifier was initially developed on two-thirds of the set of 7 supplements (i.e., alfalfa, garlic, ginger, ginkgo, ginseng, St. John's Wort, and Vitamin E); the performance was evaluated on the remaining one-third of this set. To evaluate the generalizability of rules, we further validated the second testing set on other 3 supplements (i.e., echinacea, fish oil, and melatonin). The performance of the classifier achieved F-measures of 0.95, 0.97, 0.96, and 0.96 for status C, D, S, and U on 7 supplements, respectively. The classifier also showed good generalizability when it was applied to the other 3 supplements with F-measures of 0.96 for C, 0.96 for D, 0.95 for S, and 0.89 for U. This study demonstrated that the classifier can accurately classify supplement usage status, which can be further integrated as a module into the existing natural language processing pipeline for supporting dietary supplement knowledge discovery.
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Affiliation(s)
- Yadan Fan
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Lu He
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Rui Zhang
- Institute for Health Informatics, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Turkmenoglu FP, Kutsal YG, Dolgun AB, Diker Y, Baydar T. Evaluation of herbal product use and possible herb–drug interactions in Turkish elderly. Complement Ther Clin Pract 2016; 23:46-51. [DOI: 10.1016/j.ctcp.2016.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/16/2016] [Indexed: 12/13/2022]
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Singh JC, Lichtman SM. Effect of age on drug metabolism in women with breast cancer. Expert Opin Drug Metab Toxicol 2016; 11:757-66. [PMID: 25940027 DOI: 10.1517/17425255.2015.1037277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The aging of the population will increase the number of breast cancer patients requiring treatment in both the adjuvant and metastatic setting. Hormones, chemotherapy and targeted drugs all have a role in treatment. Older patients have been underrepresented in clinical trials making evidence-based decisions difficult. The increase in comorbidity and aging, polypharmacy and changes in function make pharmacotherapy decisions more complicated. Knowledge of the issues is critical in the prescribing of effective and safe therapy. There are factors associated with advancing age that can result in pharmacokinetic and pharmacodynamic variations in processing of hormonal agents, chemotherapy and targeted drugs. AREAS COVERED A review of the literature pertaining to pharmacokinetic changes in aging in breast cancer was untaken. Studies are reviewed involving single agents and some combinations. EXPERT OPINION Older patients should be considered for standard therapies. Their specific problems need to be evaluated by geriatric-specific assessment including functional status, end organ dysfunction and polypharmacy. There are few instances for age-related changes in pharmacokinetics and when present are usually not clinically significant. When changes are present, they are often the result of comorbidity, drug interactions and drug scheduling issues. The older patients may be more sensitive to certain toxicities such as cardiac toxicity, neuropathy and myelosuppression.
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Affiliation(s)
- Jasmeet C Singh
- Memorial Sloan Kettering Cancer Center , 650 Commack Road, Commack, NY 11725 , USA +1 631 623 4100 ; +1 631 864 3827 ;
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Ben-Arye E, Samuels N, Goldstein LH, Mutafoglu K, Omran S, Schiff E, Charalambous H, Dweikat T, Ghrayeb I, Bar-Sela G, Turker I, Hassan A, Hassan E, Saad B, Nimri O, Kebudi R, Silbermann M. Potential risks associated with traditional herbal medicine use in cancer care: A study of Middle Eastern oncology health care professionals. Cancer 2015; 122:598-610. [DOI: 10.1002/cncr.29796] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/09/2015] [Accepted: 10/19/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services; Haifa and Western Galilee District Israel
- Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology; Haifa Israel
| | - Noah Samuels
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services; Haifa and Western Galilee District Israel
- Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center; Tel Hashomer Israel
| | | | - Kamer Mutafoglu
- Center for Palliative Care Research and Education, Dokuz Eylul University; Inciralti Izmir Turkey
| | - Suha Omran
- Faculty of Nursing; Jordan University of Science and Technology; Irbid Jordan
| | - Elad Schiff
- Department of Internal Medicine and Integrative Medicine Service; Bnai-Zion Hospital; Haifa Israel
- Department for Complementary Medicine, Law and Ethics, The International Center for Health, Law and Ethics; Haifa University; Israel
| | | | - Tahani Dweikat
- Sheikh Khalifa Medical City; Abu Dhabi United Arab Emirates
| | | | - Gil Bar-Sela
- Division of Oncology, Rambam Health Care Campus; Haifa Israel
| | - Ibrahim Turker
- Dr. A.Y Ankara Oncology Training and Research Hospital; Ankara Turkey
| | - Azza Hassan
- National Center for Cancer Care and Research; Doha Qatar
| | - Esmat Hassan
- Botany Department; National Research Centre; Dokki Giza Egypt
| | - Bashar Saad
- Qasemi Research Center, Al-Qasemi Academy; Baqa El-Gharbia Israel
- Faculty of Arts and Sciences; Arab American University; Jenin Palestinian Authority
| | - Omar Nimri
- Department of Cancer Prevention; Ministry of Health; Amman Jordan
| | - Rejin Kebudi
- Cerrahpasa Medical Faculty; Istanbul University; Istanbul Turkey
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A pharmacist-led medication assessment used to determine a more precise estimation of the prevalence of complementary and alternative medication (CAM) use among ambulatory senior adults with cancer. J Geriatr Oncol 2015; 6:411-7. [DOI: 10.1016/j.jgo.2015.07.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 07/02/2015] [Accepted: 07/23/2015] [Indexed: 11/18/2022]
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Bauml J, Langer CJ, Evans T, Garland SN, Desai K, Mao JJ. Does perceived control predict Complementary and Alternative Medicine (CAM) use among patients with lung cancer? A cross-sectional survey. Support Care Cancer 2014; 22:2465-72. [PMID: 24715092 DOI: 10.1007/s00520-014-2220-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 03/12/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE Scant literature exists on the use of complementary and alternative medicine (CAM) among patients with lung cancer. Preliminary data indicates that perceived control is an important factor leading patients to CAM. This study aimed to evaluate the relationship between perceived control and CAM use in patients with lung cancer. METHODS We performed a cross-sectional survey in patients with lung cancer under active treatment and follow-up at the oncology clinic of an academic medical center. Self-reported CAM use was the primary outcome. Multivariate logistic regression was performed to determine the relationship between perceived control and CAM use, controlling for other factors. RESULTS Among 296 participants, 54.4 % were female, 83.5 % were Caucasian, 57.6 % were ≤65 years old, 52.4 % were in stage IV, and 86.4 % had non-small cell lung cancer; 50.9 % of patients had used CAM, most commonly vitamins (31.5 %), herbs (19.3 %), relaxation techniques (16 %), and special diets (15.7 %). In multivariate analysis, CAM use was associated with having greater perceived control over the cause of cancer (adjusted odds ratio (AOR) 2.27, 95 % confidence interval (CI) 1.35-3.80), age ≤ 65 (AOR 1.64, 95 % CI 1.01-2.67), higher education (AOR 2.17, 95 % CI 1.29-3.64), and never having smoked tobacco (AOR 2.39, 95 % CI 1.25-4.54). Nearly 60 % of patients who used CAM were receiving active treatment. CONCLUSION Over half of lung cancer patients have used CAM since diagnosis. Greater perceived control over the cause of cancer was associated with CAM use. Given the high prevalence of CAM, it is essential that oncologists caring for patients with lung cancer discuss its use.
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Affiliation(s)
- Joshua Bauml
- Department of Medicine, Division of Hematology/Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Huiart L, Bouhnik AD, Rey D, Rousseau F, Retornaz F, Meresse M, Bendiane MK, Viens P, Giorgi R. Complementary or alternative medicine as possible determinant of decreased persistence to aromatase inhibitor therapy among older women with non-metastatic breast cancer. PLoS One 2013; 8:e81677. [PMID: 24367488 PMCID: PMC3867346 DOI: 10.1371/journal.pone.0081677] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 10/15/2013] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Aromatase inhibitor therapy (AI) significantly improves survival in breast cancer patients. Little is known about adherence and persistence to aromatase inhibitors and about the causes of treatment discontinuation among older women. METHODS We constituted a cohort of women over 65 receiving a first AI therapy for breast cancer between 2006 and 2008, and followed them until June 2011. Women were selected in the population-based French National Health Insurance databases, and data was collected on the basis of pharmacy refills, medical records and face-to-face interviews. Non-persistence to treatment was defined as the first treatment discontinuation lasting more than 3 consecutive months. Time to treatment discontinuation was studied using survival analysis techniques. RESULTS Overall among the 382 selected women, non-persistence to treatment went from 8.7% (95%CI: 6.2-12.1) at 1 year, to 15.6% (95%CI: 12.2-19.8) at 2 years, 20.8% (95%CI: 16.7-25.6) at 3 years, and 24.7% (95%CI: 19.5-31.0) at 4 years. In the multivariate analysis on a sub-sample of 233 women with available data, women using complementary or alternative medicine (CAM) (HR = 3.2; 95%CI: 1.5-6.9) or suffering from comorbidities (HR = 2.2; 95%CI: 1.0-4.8) were more likely to discontinue their treatment, whereas women with polypharmacy (HR = 0.4; 95%CI: 0.2-0.91) were less likely to discontinue. In addition, 13% of the women with positive hormonal receptor status did not fill any prescription for anti-hormonal therapy. CONCLUSION AI therapy is discontinued prematurely in a substantial portion of older patients. Some patients may use CAM not as a complementary treatment, but as an alternative to conventional medicine. Improving patient-physician communication on the use of CAM may improve hormonal therapy adherence.
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Affiliation(s)
- Laetitia Huiart
- Unité de Soutien Méthodologique, CHU La Réunion, Saint-Denis, France
- U912 (SESSTIM), INSERM, Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
| | - Anne-Deborah Bouhnik
- U912 (SESSTIM), INSERM, Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
| | - Dominique Rey
- U912 (SESSTIM), INSERM, Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | | | | | - Mégane Meresse
- U912 (SESSTIM), INSERM, Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
| | - Marc Karim Bendiane
- U912 (SESSTIM), INSERM, Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Patrice Viens
- Medical Oncology Department, Institut Paoli-Calmettes, Marseille, France
- Université Aix Marseille, Centre de Recherche en Cancérologie de Marseille, INSERM U891, Marseille, France
| | - Roch Giorgi
- U912 (SESSTIM), INSERM, Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- Service Biostatistique et Technologies de l'Information et de la Communication, Hôpital de la Timone, Assistance Publique – Hopitaux de Marseille, Marseille, France
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