Skin disorder management in oral anticancer drugs by collaboration of hospital pharmacists and community pharmacists

Pharmacist Intervention in Outpatients With Prostate Cancer Prevents Apalutamide-induced Skin Adverse Events

BACKGROUND/AIM

Apalutamide induces severe skin adverse events (sAEs) in 14.7% of Japanese patients, leading to treatment discontinuation. To maximize the management of sAEs in patients taking apalutamide for prostate cancer, we conducted pharmacist outpatient clinics for patients receiving apalutamide in the outpatient setting. During these sessions, patients were informed about skin care management, including the application of moisturizers to prevent sAEs. This study aimed to evaluate the usefulness of pharmacist-led outpatient services in managing sAEs.

PATIENTS AND METHODS

Patients with castration-resistant prostate cancer without distant metastases or prostate cancer with distant metastases, receiving 240 mg apalutamide once daily, were divided into pharmacist intervention and nonintervention groups and retrospectively investigated. The primary endpoint was the incidence of all sAEs.

RESULTS

The incidence of sAEs of any grade was significantly lower in the intervention group (n=26) than in the nonintervention group (n=16) (30.8% vs. 68.8%, respectively, p=0.03), without a significant difference in the incidence of grade 3 or more sAEs (3.8% vs. 25.0%, respectively, p=0.05). At the pharmacist outpatient clinics, pharmacists gave 84 recommendations to urologists, with 98.8% of them reflected in prescriptions. The most frequently prescribed moisturizers were heparinoid oil-based creams, with a significantly higher prescription rate in the intervention compared to the nonintervention group (30.0 g/28 days vs. 0 g/28 days, p<0.01).

CONCLUSION

As far as we are aware, our study is the first to show that intervention by pharmacist outpatient clinics reduces apalutamide-induced sAEs. Pharmacist outpatient clinics can assist in the appropriate skin management of patients taking apalutamide.

Early follow-up of outpatients with oral anticancer therapy in the ONCORAL multidisciplinary community-hospital program

BACKGROUND

Healthcare professionals are faced with the new challenges of preventing and managing drug-related problems (DRPs) with oral anticancer therapy (OAT): side-effects, drug-drug interactions (DDIs), non-adherence, or medication errors. This study aims to assess the impact of ONCORAL, a real-life multidisciplinary care plan for cancer patients based on community and hospital follow-up, for the first OAT cycle.

METHODS

A prospective cohort study was conducted between October 1, 2021 and October 1, 2022 including all outpatients starting OAT treatment. During the first OAT cycle, the program consists of 6 weekly scheduled face-to-face or phone consultations to prevent and manage DRPs. Nurse and pharmacist interventions (NPIs) are realized to optimize treatments (primary outcomes). Secondary outcomes included the relative dose intensity (RDI) of the first cycle.

RESULTS

A total of 562 NPIs were performed by the ONCORAL team: that is, 87.1% of the 209 patients included, for a mean of 3.1 ± 2.2 NPIs/patient. NPIs-concerned DRPs detected by the nurse and pharmacist (346, 61.6%), symptoms and/or adverse effects reported as PROs by the patient or family (138, 24.6%), or pathway issues (78, 13.9%). Seventy-three DDIs were detected and managed during medication review, in a quarter of patients (n = 54/209), leading to the discontinuation of a daily concomitant medication in 30 cases. The mean RDI at the end of the first cycle, calculated for 209 patients, was 83.1 ± 23.9% (17.56-144.23).

CONCLUSION

In these ambulatory cancer patients, the interest in tailored monitoring of DRPs as a whole, including the prevention and management of drug interactions in addition to symptoms and adverse effects, is highlighted.

Survey of community and hospital pharmacist involvement in outpatient chemotherapy using Japanese health information data

In this study, information on injectable anticancer drug use and additional fee for enhanced collaboration (AEC) and additional fee for specific drug management guidance 2 (ASD2) claims from the NDB Open Data Japan (NODJ) dataset and the number of patients with cancer according to sex and age from the National Cancer Registry (NCR) dataset were integrated and evaluated to determine the current status and challenges in pharmacist interventions for patients receiving cancer treatment. The NODJ data, including receipt data billed from 2020 to 2021, were obtained from the Ministry of Health, Labour and Welfare website. The use of injectable anticancer drugs decreased relative to the number of cancer patients aged ≥ 75 years compared to those aged < 75 years. Regarding injectable anticancer drug use, the number of AEC claims was similar between men and women, but the number of ASD2 claims was lower in men than in women. The number of times community pharmacists claimed their ASD2 was approximately 5% of the number of times hospital pharmacists claimed their AEC. This study revealed that several patients did not receive sufficient guidance from community pharmacists compared to hospital pharmacists, suggesting a potential insufficiency in the collaboration between the two groups.