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Moreno-Martinez ME, Riba M, García-Cadenas I, Esquirol A, Yusta M, Redondo S, De Dios A, Portos JM, Aso O, Marcos-Fendian A, Font N, Briones J, Martino R, Feliu A. Optimization of a home hospitalization program for hematopoietic stem cell transplantation with ehealth integration and clinical pharmacist involvement. Front Immunol 2024; 15:1397115. [PMID: 38919607 PMCID: PMC11196708 DOI: 10.3389/fimmu.2024.1397115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Home hospitalization represents an alternative to traditional hospitalization, providing comparable clinical safety for hematological patients. At-home therapies can range from the delivery of intravenous antibiotics to more complex scenarios, such as the care during the early period after hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy. Early discharge from conventional hospitalization is feasible and helps reduce hospital resources and waiting lists. The coordinated efforts of multidisciplinary teams, including hematologists, nurses, and pharmacists, ensure patient safety and continuity of care. The traditional model of home hospitalization relies on home visits and telephone consultations with physicians and nurses. However, the use of eHealth technologies, such as MY-Medula, can enhance communication and monitoring, and thereby improve patient outcomes with no additional costs. The active involvement of a clinical pharmacist in home hospitalization programs is essential, not only for the proper logistical management of the medication but also to ensure its appropriateness, optimize treatment, address queries from the team and patients, and promote adherence. In conclusion, the implementation of hematopoietic stem cell transplantation and chimeric antigen receptor T-cell therapy home hospitalization programs that use both an eHealth tool and a multidisciplinary care model can optimize patient care and improve quality of life without increasing healthcare costs.
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Affiliation(s)
- Maria-Estela Moreno-Martinez
- Pharmacy Department, Hospital de la Santa Creu I Sant Pau, IIB Sant Pau, Barcelona, Spain
- School of Health Sciences Blanquerna, University Ramon Llull, Barcelona, Spain
| | - Mireia Riba
- Pharmacy Department, Hospital de la Santa Creu I Sant Pau, IIB Sant Pau, Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau and José Carreras Leukemia Research Institutes, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau and José Carreras Leukemia Research Institutes, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Marta Yusta
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Sara Redondo
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau and José Carreras Leukemia Research Institutes, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Anna De Dios
- Pharmacy Department, Hospital de la Santa Creu I Sant Pau, IIB Sant Pau, Barcelona, Spain
- Digital Health Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jose Manuel Portos
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Olga Aso
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Angel Marcos-Fendian
- Pharmacy Department, Hospital de la Santa Creu I Sant Pau, IIB Sant Pau, Barcelona, Spain
| | - Núria Font
- Hematology Nursing Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau and José Carreras Leukemia Research Institutes, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau and José Carreras Leukemia Research Institutes, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Anna Feliu
- Pharmacy Department, Hospital de la Santa Creu I Sant Pau, IIB Sant Pau, Barcelona, Spain
- School of Health Sciences Blanquerna, University Ramon Llull, Barcelona, Spain
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2
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Chelewski R, Rodriguez K, Peter M, Zuckerman A. Assessing Pharmacist Interventions at an Outpatient Renal Transplant Clinic Under a Collaborative Pharmacy Practice Agreement. J Pharm Pract 2024; 37:593-599. [PMID: 36592136 DOI: 10.1177/08971900221149544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Collaborative pharmacist practice agreements (CPPAs) advance the role of pharmacists by granting prescriptive authority without direct oversight from participating physicians. Objective: To assess the quantity of prescriptions authorized by pharmacists and frequency and types of interventions performed under a CPPA in an outpatient renal transplant clinic. Practice description: Clinical pharmacists in the outpatient renal transplant clinic began prescribing medications under a CPPA in March 2017. Practice innovation: Under the CPPA, pharmacists perform interventions to improve medication management. After identifying gaps in medication therapy, pharmacists tracked their interventions to improve patient care. Methods: An ambispective cohort study evaluated the number of prescriptions and interventions performed under a CPPA. Patients with a prescription generated by pharmacists between January 2019 through June 2019 were included. Pharmacists prospectively collected the number and types of interventions performed; the number of pharmacist-generated prescriptions was retrospectively collected. Interventions were categorized into three groups: medical record assessments, medication counseling, and resolution of barriers to medication continuation. Results: Pharmacists under a CPPA placed 5793 prescriptions and performed 3852 interventions for 1233 patients. The most common intervention categories were medical record assessments, medication counseling, and resolution of barriers to medication continuation. Conclusion: Pharmacists within a CPPA performed medical record assessments to identify untreated or under treated health conditions, eliminate duplicate therapy, and monitor narrow therapeutic drugs. Expanding pharmacists' prescriptive authority within the renal transplant clinic is a successful strategy to ensure patients are taking medications correctly and to avoid barriers to medication persistence.
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Affiliation(s)
- Rachel Chelewski
- Transplant Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Keren Rodriguez
- Transplant Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Megan Peter
- Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Autumn Zuckerman
- Specialty Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
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3
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Griffin SP, Signorelli JR, Lasko A, Andrick BJ, Doan D, Hough S, Riebandt G, Harnicar S. Oncology pharmacy practice in the United States: Results of a comprehensive, nationwide survey. J Oncol Pharm Pract 2024; 30:332-341. [PMID: 37194276 PMCID: PMC10943602 DOI: 10.1177/10781552231174858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/18/2023]
Abstract
Introduction: This study was designed to describe the landscape of oncology pharmacy practice at patient facing institutional healthcare organizations throughout the United States. Methods: The Hematology/Oncology Pharmacy Association (HOPA) Practice Outcomes and Professional Benchmarking Committee conducted a multi-organization, voluntary survey of HOPA members between March 2021 and January 2022. Four overarching domains were targeted: institutional description, job function, staffing, and training/certification. Data were evaluated using descriptive statistics. Results: A total of 68 responses were analyzed including 59% and 41% who self-identified their organization as academic and community centers, respectively. The median number of infusion chairs and annual infusion visits were 49 (interquartile range (IQR): 32-92) and 23,500 (IQR: 8300-300,000), respectively. Pharmacy departments reported to a business leader, physician leader, and nursing leader 57%, 24%, and 10% of the time, respectively. The median oncology pharmacy full-time equivalents was 16 (IQR: 5-60). At academic centers, 50% (IQR: 26-60) of inpatient and 30% (IQR: 21-38) of ambulatory pharmacist FTEs were dedicated to clinical activities. At community centers, 45% (IQR: 26-65) of inpatient and 50% (IQR: 42-58) of ambulatory pharmacist FTEs were dedicated to clinical activities. As many as 18% and 65% of organizations required or encouraged certification for oncology pharmacists, respectively. The median number of Board-Certified Oncology Pharmacists was 4 (IQR: 2-15). Conclusion: As the number of patients with cancer rises, the oncology workforce must grow to support this expanding population. These results describe the practice landscape of oncology pharmacy at US healthcare institutions to serve as a foundation for future research evaluating metrics and benchmarks.
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Affiliation(s)
- Shawn P Griffin
- Department of Clinical Pharmacy Practice, School of Pharmacy & Pharmaceutical Sciences, University of California, Irvine, CA, USA
| | | | - Aubrey Lasko
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin J Andrick
- Enterprise Pharmacy, Center for Pharmacy Innovations & Outcomes, Danville, PA, USA
| | - David Doan
- Department of Pharmacy, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Grazyna Riebandt
- Department of Pharmacy, Clinical Pharmacy Services, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Stephen Harnicar
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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4
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Ozturk GS, Ratip S, Umar RM, Tezcan S. Evaluation of the quality of life of adult patients admitted to the bone marrow transplantation unit. J Oncol Pharm Pract 2024; 30:120-126. [PMID: 37069834 DOI: 10.1177/10781552231170017] [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] [Indexed: 04/19/2023]
Abstract
INTRODUCTION The complexity of treatment and extended therapy duration associated with bone marrow transplantation directly affect the psychological well-being of the patients, create anxiety, and reduce their quality of life. The aim of our study was to evaluate the quality of life of patients admitted to the bone marrow transplantation unit. METHODS This prospective and descriptive study was conducted between January and June 2021 in an adult BMT unit in Turkey. The sociodemographic characteristics of the patients were recorded. The patient's quality of life was measured twice using the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) scale at the beginning of the study and 30 days later. SPSS 15 was used for the analysis. RESULTS A total of 40 patients were included in the study. The mean age was 46 years. Most of the patients were diagnosed with multiple myeloma and 58% had at least one comorbid disease. Most of the patients (78%) were receiving myeloablative therapy. High dose melphalan regimen was the most commonly applied regimen (25%). Thrombocytopenia was the most common side effect (14%). Although there was no change in the quality of life, it was found that the social/family well-being scores increased (p < 0.05). CONCLUSIONS In our study, it was observed that the number of comorbid diseases was higher in patients with bone marrow transplantation. The incidence of side effects may be high in these patients. We believe that clinical pharmacists have an important role in monitoring adverse effects and improving the quality of life in bone marrow transplantation units.
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Affiliation(s)
- Gozde Seray Ozturk
- Department of Clinical Pharmacy, Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - Siret Ratip
- Department of Hematology, Acibadem Altunizade Hospital, Istanbul, Turkey
| | - Rashida Muhammad Umar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Medipol University, Istanbul, Turkey
| | - Songül Tezcan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Turkey
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Duncan N, Moreno-Martinez ME, Pires V, Domingos V, Bonnin A, Nezvalova-Henriksen K, Admiraal R, Bauters T, Langebrake C. Role and competencies of the EBMT clinical pharmacists and clinical pharmacologists: a pan-European survey. Bone Marrow Transplant 2023; 58:829-831. [PMID: 37029183 DOI: 10.1038/s41409-023-01983-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Affiliation(s)
| | - Maria-Estela Moreno-Martinez
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- School of Health Sciences Blanquerna, University Ramon Lull, Barcelona, Spain
| | - Vera Pires
- Insituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Vera Domingos
- Insituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Agnes Bonnin
- Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Rick Admiraal
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Claudia Langebrake
- University Medical Centre Hamburg-Eppendorf, Department of Stem Cell Transplantation, Hamburg, Germany
- University Medical Centre Hamburg-Eppendorf, Hospital Pharmacy, Hamburg, Germany
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6
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Fraint E, Abdel-Azim H, Bhatt NS, Broglie L, Chattha A, Kohorst M, Ktena YP, Lee MA, Long S, Qayed M, Sharma A, Stefanski H, Vatsayan A, Wray L, Hamadani M, Carpenter PA. Evaluation of Children with Malignancies for Blood and Marrow Transplantation: A Report from the ASTCT Committee on Practice Guidelines. Transplant Cell Ther 2023; 29:293-301. [PMID: 36775202 DOI: 10.1016/j.jtct.2023.02.003] [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: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
Evaluation of a candidate for hematopoietic cell transplantation (HCT) is a complex process with substantial intercenter variability. Although literature providing guidance for evaluating the eligibility of adults is well established, similar guidance for children is lacking. To address gaps between adult recommendations and the specific needs of children, we convened a panel of pediatric HCT experts from a wide geographic range of American Society of Transplantation and Cellular Therapy (ASTCT) member institutions to offer recommendations for pediatric-focused pre-HCT evaluation. In this report from the ASTCT Committee on Practice Guidelines, we present a practical framework for evaluating children with malignancies who are candidates for HCT. We also highlight key differences from adults and emphasize areas of unmet need that require additional research to delineate best practices.
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Affiliation(s)
- Ellen Fraint
- Division of Pediatric Hematology, Oncology, and Cellular Therapy, Children's Hospital at Montefiore, Bronx, New York.
| | - Hisham Abdel-Azim
- Loma Linda University School of Medicine, Cancer Center, Children's Hospital and Medical Center, Loma Linda, California
| | - Neel S Bhatt
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Larisa Broglie
- Medical College of Wisconsin, Department of Pediatrics, Division of Pediatric Hematology/Oncology/Blood and Marrow Transplantation, Milwaukee, Wisconsin
| | - Asma Chattha
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mira Kohorst
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota
| | - Yiouli P Ktena
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michelle A Lee
- Division of Pediatric Hematology, Oncology, and Cellular Therapy, Children's Hospital at Montefiore, Bronx, New York
| | - Susie Long
- University of Minnesota Masonic Children's Hospital, MHealth Fairview Acute Care Pharmacy Services, Minneapolis, Minnesota
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Anant Vatsayan
- Children's National Medical Center, Washington, District of Columbia
| | - Lisa Wray
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
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7
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Mahmoudjafari Z, Alencar MC, Alexander MD, Johnson DJ, Yeh J, Evans MD. Hematopoietic stem cell transplantation-associated thrombotic microangiopathy and the role of advanced practice providers and pharmacists. Bone Marrow Transplant 2023:10.1038/s41409-023-01951-3. [PMID: 37059738 DOI: 10.1038/s41409-023-01951-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 04/16/2023]
Abstract
Hematopoietic stem cell transplantation-associated thrombotic microangiopathy (HSCT-TMA) is a severe and potentially life-threatening complication. HSCT-TMA is often underdiagnosed due to multifactorial pathophysiology and a historic lack of standard diagnostic criteria. Identification of the multi-hit hypothesis and the key role of the complement system, particularly the lectin pathway of complement, has led to development of treatments targeting the underlying pathogenesis of HSCT-TMA. Additional research is ongoing to investigate the efficacy and safety of these targeted therapies in patients with HSCT-TMA. Advanced practice providers (APPs; nurse practitioners and physician assistants) and pharmacists are critical members of the multidisciplinary HSCT team and ensure management of patients throughout the continuum of care. Additionally, pharmacists and APPs can improve patient care through medication management of complex regimens; transplant education for patients, staff, and trainees; evidence-based protocol and clinical guideline development; assessment and reporting of transplant-related outcomes; and quality improvement initiatives to improve outcomes. Understanding the presentation, prognosis, pathophysiology, and treatment options for HSCT-TMA can improve each of these efforts. Collaborative practice model for monitoring and care of HSCT-TMA. Advanced practice providers and pharmacists contribute to many aspects of patient care in transplant centers, including medication management for complex regimens; transplant education for patients, staff, and trainees; evidence-based protocol and clinical guideline development; assessment and reporting of transplant-related outcomes; and quality improvement initiatives. HSCT-TMA is a severe and potentially life-threatening complication that is often underdiagnosed. The collaboration of a multidisciplinary team of advanced practice providers, pharmacists, and physicians can optimize recognition, diagnosis, management, and monitoring of patients with HSCT-TMA, thereby improving outcomes for these patients.
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Affiliation(s)
- Zahra Mahmoudjafari
- Department of Pharmacy, University of Kansas Cancer Center, Kansas City, KS, USA.
| | - Maritza C Alencar
- Oncology Service Line, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Maurice D Alexander
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Darren J Johnson
- Pediatric Hematology and Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jason Yeh
- Division of Pharmacy, MD Anderson Cancer Center, Houston, TX, USA
| | - Misty D Evans
- School of Nursing, Vanderbilt University, Nashville, TN, USA
- Sarah Cannon Pediatric Hematology/Oncology & Cellular Therapy at TriStar Centennial, Nashville, TN, USA
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8
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Kim HJ, Lee S, Lee YJ, Kim S, Jo YH, Cho YS, An HY, Hong KT, Choi JY, Kang HJ, Shin HY, Lee JY. Clinical and Economic Impact of Pharmacists' Intervention on Care of Pediatric Hematology and Oncology Patients. J Oncol Pharm Pract 2023; 29:319-325. [PMID: 34931912 DOI: 10.1177/10781552211068139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Children with cancer may be one of the most vulnerable groups to drug-related adverse events because they possess characteristics of patients with cancer as well as pediatric patients. To evaluate the clinical and economic impact of pharmacists' intervention on the care of pediatric hematology and oncology patients in the inpatient and outpatient settings of a children's hospital. METHODS The pharmacist-intervention records from 2017 were retrospectively reviewed. Intervention rate, type of drug-related problems, acceptance rate, and frequently involved drugs in pharmacist interventions were analyzed. One physician and one pharmacist evaluated the clinical significance of each intervention. A cost-benefit analysis was conducted from hospital and patient perspective. The benefit from cost savings by reducing the number of prescribed drugs that are disposed was estimated as the benefit from hospital perspective. The benefit from cost avoidance based on the potential to avoid an adverse drug event (ADE) was estimated as the benefit from patient perspective. The cost of reviewing prescriptions was estimated based on the pharmacists' salary and the time involved. RESULTS In 2017, 2361 interventions were performed in 381 pediatric patients with cancer. The acceptance rate was 97.2%. More than half of the interventions were regarded as clinically "significant" (58.8%) and "very significant" (14.6%). The cost-benefit of US$28,705 was determined from hospital perspective, with a cost-benefit ratio of 1.45:1. The cost-benefit of US$35,611 was calculated from patient perspective, with a cost-benefit ratio of 1.55:1. CONCLUSIONS Pharmacists' intervention in the care of hematology and oncology pediatric patients was effective in preventing clinically significant ADEs and had a positive economic impact on the health-care budget from both hospital and patient perspective.
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Affiliation(s)
- Hyun Jee Kim
- Department of Pharmacy, 58927Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Sunghee Lee
- Department of Pharmacy, 58927Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yu Jin Lee
- Department of Pharmacy, 58927Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Sunghwan Kim
- Department of Pharmacy, 58927Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yun Hee Jo
- Department of Pharmacy, 58927Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yoon-Sook Cho
- Department of Pharmacy, 58927Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hong Yul An
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, 37990Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon 25159, Korea
| | - Kyung Taek Hong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, 37990Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon 25159, Korea
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, 37990Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon 25159, Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, 37990Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon 25159, Korea
| | - Hee Young Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Cancer Research Institute, 37990Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon 25159, Korea
| | - Ju-Yeun Lee
- Department of Pharmacy, 58927Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Korea
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9
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Zanetti MOB, Rodrigues JPV, Varallo FR, Cunha RLG, Simões BP, Pereira LRL. Impact of the insertion of the clinical pharmacist in the Allogeneic Hematopoietic Stem Cells Transplantation team. J Oncol Pharm Pract 2023; 29:375-385. [PMID: 35037789 DOI: 10.1177/10781552211073797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Allogeneic Hematopoietic Stem Cells Transplantation (allo-HSCT) is capable of curing patients with neoplastic or non-neoplastic hematologic disorders or of prolonging their survival. This study assessed if the insertion of the clinical pharmacist in the allo-HSCT team modified the outcomes: transplantation-related mortality, grafting failure, incidence of Graft versus Host Disease, hospitalization time, time for grafting, number of readmissions, number of drug-related problems (DRPs), adherence and knowledge about pharmacotherapy. METHODS Interventional study with historical control carried out in an allo-HSCT unit, in which the intervention group (IG) included 33 individuals who received pharmacotherapy follow-up. Control Group (CG) consisted of 28 individuals. RESULTS A total of 250 DRPs were identified, 59 team's doubts were clarified, and 309 interventions were conducted in the IG. The DRPs mainly arose from safety (51.60%) and effectiveness (38.40%) problems. A mean of 9.36 (SD = 6.97) interventions per patient was obtained, mainly including dose reductions (19.09%), adjustments in administration time (18.12%), educational activities (15.21%) and drug removal (10.68%). Clinical significance of the interventions was considered high (75.7% extremely significant, very significant or significant), as well as their acceptability (89.7% accepted). Each patient attended a mean of 4.68 pharmaceutical consultations (SD = 1.91) after hospital discharge, presenting increase in knowledge (p = 0.0001) and in adherence (p = 0.0115). There was no evidence of differences between the groups in the other outcomes analyzed. CONCLUSIONS The pharmacotherapy follow-up allowed detecting several DRPs and performing interventions of high clinical relevance and acceptability, in addition to improving adherence and individualizing the pharmacotherapy.
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Affiliation(s)
| | - João Paulo Vilela Rodrigues
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Fabiana Rossi Varallo
- School of Pharmaceutical Sciences of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | | | - Belinda Pinto Simões
- Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
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10
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Mahmoudjafari Z, Hough S. Expanding oncology pharmacist teams: Justifying the return on investment. J Oncol Pharm Pract 2022; 28:1381-1387. [PMID: 35274995 DOI: 10.1177/10781552221086292] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Oncology pharmacists are an integral member of the cancer care multi-disciplinary team. Despite the role being previously well defined, responsibilities continue to expand. Position justification for pharmacists is a challenge with prerequisites to optimize efficient processes, promote quality and reduce overall costs. Initiation and implementation of new oncology pharmacist services requires a clear description of value to the organization and a strong understanding of workflows. Position justifications must be data-driven and unique to the organization's need and should include physician or key stakeholder support, quality initiatives, cost-savings initiatives, and revenue-generating roles. The cases and examples described serve as a reference for individuals, teams, or organizations pursuing the value of a financial investment of an oncology pharmacist to expand or initiate new pharmacy services.
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Affiliation(s)
| | - Shannon Hough
- McKesson/US Oncology Network.,1259University of Michigan College of Pharmacy
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11
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Andrick B, Tusing L, Jones LK, Hu Y, Sneidman R, Gregor C, Basu S, Lynch JP, Vadakara J. The impact of a hematopoietic cellular therapy pharmacist on clinical and humanistic outcomes: A RE-AIM framework analysis. Transplant Cell Ther 2022; 28:334.e1-334.e9. [PMID: 35189400 DOI: 10.1016/j.jtct.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/31/2022] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The hematopoietic cellular therapy (HCT) pharmacist is an essential member of the multidisciplinary care team. Yet, standardized incorporation of a pharmacist at transplant centers remains challenging. Implementation science uses theory-driven and systematic approaches to integrate interventions into clinical practice. We describe our experience implementing an HCT pharmacist at our center and conducted a program evaluation using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. OBJECTIVE To evaluate the impact of HCT pharmacist medication management services on allogeneic stem cell transplant patients utilizing the RE-AIM framework. STUDY DESIGN We implemented one full-time equivalent pharmacist to provide medication management services through a collaborative practice agreement (CPA) to the allogeneic transplant population at a medium-sized center in rural Pennsylvania over a two-year period. The HCT pharmacist documented all in-person and telephonic care encounters in the electronic medical record. A pharmacist intervention tool was developed to document identified medication related problems (MRPs) with corresponding interventions and magnitude of intervention. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was utilized to evaluate the impact of the HCT pharmacist. Summary statistics including frequency and percentages were presented for categorical variables in RE-AIM domain. RESULTS Over the 2-year period, the HCT pharmacist followed 40 allogeneic patients at our institution accounting for 1531 patient encounters. The average duration of follow-up was 299 days. The HCT pharmacist medication therapy services were able to reach all allogeneic transplants at our institute. The HCT pharmacist managed 388 medications and identified 2156 medication related problems for which the pharmacist provided 2959 interventions. Time in therapeutic range of immunosuppression was 74% when managed by the HCT pharmacist through a CPA. Of the 24 patients and 9 caregivers who completed the patient satisfaction survey, 25 (76%) were strongly satisfied with their care. Pharmacy services were gradually adopted and expanded to incorporate additional populations, including 121 autologous transplant and 272 hematology patient encounters. The role of the HCT pharmacist was justified with hospital administration and sustained as a designated pharmacist role at our center. CONCLUSION The implementation of an HCT pharmacist service can positively impact patient care. The RE-AIM framework provides a methodological approach for programmatic evaluation and generalizability.
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Affiliation(s)
- Benjamin Andrick
- Enterprise Pharmacy, Geisinger, Danville, PA; Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA.
| | - Lorraine Tusing
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA
| | - Laney K Jones
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA; Genomic Medicine Institute, Geisinger, Danville, PA
| | - Yirui Hu
- Center for Population Health Research, Geisinger, Danville, PA
| | | | - Christina Gregor
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA
| | - Soumit Basu
- The Christ Hospital Cancer Center, Cincinnati, OH
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12
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Faraci M, Lorenzi I, Martino M, Mammoliti S, Iurilli V, Serra N, Giardino S, Cannici C, Ciceri F, Botti S. The role of pharmacies in haematopoietic stem cell transplantation process: A nationwide survey by Gruppo Italiano Trapianto di Midollo Osseo. J Clin Pharm Ther 2021; 46:1665-1679. [PMID: 34397108 DOI: 10.1111/jcpt.13498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/13/2021] [Accepted: 07/23/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The aim of this survey, conducted by the Gruppo Italiano per il Trapianto di Midollo Osseo (GITMO), was to evaluate the involvement of pharmacists in the haematopoietic stem cell transplant (HSCT) program in Italian adult and paediatric centres. METHODS A 63-item online questionnaire was developed and sent to the Italian Transplant Programs on behalf of GITMO. RESULTS AND DISCUSSION Overall, 54.7% of the Italian HSCT centres participated in the survey (88.5% adult, 7.7% paediatric, 3.8% mixed), of which 50% were in public hospitals and 50% affiliated with public universities. Just over 80% declared that a pharmacist is involved in the HSCT centre, and 86.5% reported the presence of a documentation system to signal of adverse events, accessible by physicians, nurses and pharmacists in 57.7%. Chemotherapy drugs were centralized in the pharmacy in 98.1% of HSCT centres, while parenteral nutrition was centralized in 55.8%. The use of off-label drugs was authorized by an internal committee and by the regional health authorities in 88.5% of the centres. On univariate analysis, few statistically significant differences were found on response frequencies between public hospitals and university centres or between HSCT centres performing only autologous stem cell transplantation versus other centres performing autologous and allogeneic stem cell transplantation. WHAT IS NEW AND CONCLUSION This survey suggests that there is good collaboration between pharmacists and physicians and nurses in Italian HSCT transplantation centres. The enhancement of pharmacists dedicated to HSCT programs could improve some problems, for example, the centralization of parenteral nutrition.
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Affiliation(s)
- Maura Faraci
- Hematopoietic stem Cell Transplantation Unit, Department of Hematology Oncology, Istituto G. Gaslini, Genova, Italy
| | - Ines Lorenzi
- Pharmacy Unit, Istituto G. Gaslini, Genova, Italy
| | - Massimo Martino
- Stem Cell Transplant and Cellular Therapies Unit, Hemato-Oncology and Radiotherapy Department, "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Sonia Mammoliti
- Trials Office GITMO, Gruppo Italiano per il Trapianto di Midollo Osseo, Cellule Staminali Emopoietiche e Terapia Cellulare, Genova, Italy
| | | | - Nicola Serra
- Department of Molecular Medicine and Medical Biotechnology, University Federico II of Naples, Naples, Italy
| | - Stefano Giardino
- Hematopoietic stem Cell Transplantation Unit, Department of Hematology Oncology, Istituto G. Gaslini, Genova, Italy
| | - Chiara Cannici
- Hematology Unit, AO SS Antonio e Biagio e Cesare Arrigo di Alessandria, Alessandria, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,San Raffaele Hospital, University Vita-Salute San Raffaele, Milan, Italy
| | - Stefano Botti
- Hematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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13
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Marzal-Alfaro MB, Escudero-Vilaplana V, Revuelta-Herrero JL, Collado-Borrell R, Herranz-Alonso A, Sanjurjo-Saez M. Chimeric Antigen Receptor T Cell Therapy Management and Safety: A Practical Tool From a Multidisciplinary Team Perspective. Front Oncol 2021; 11:636068. [PMID: 33777790 PMCID: PMC7992774 DOI: 10.3389/fonc.2021.636068] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/01/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose The use process for chimeric antigen receptor T (CAR-T) cell drugs is complex and has been associated with a number of potentially severe complications, which requires management by a multidisciplinary team. Pharmacists are a key element in the team and have roles and responsibilities. Our objective was to develop a structured and practical guide that supports hospital pharmacist responsibilities and defines specific activities in a CAR-T cell therapy program, specifically in Europe. Methods A literature review was performed, and the recommendations related to pharmacy practice in CAR-T therapy programs were analyzed. A multidisciplinary team was assembled, and meetings were held to address the key tasks in the CAR-T cells’ management process and to create the guide, based on national and international recommendations and in expert’s opinions. Results The multidisciplinary team defined the following key tasks and issued recommendations to improve patient safety, treatment efficacy, and quality: patient selection and evaluation, CAR-T cell drug order to manufacturer, apheresis and material shipment, reception of CAR-T cell drug and storing, CAR-T cell drug prescription and pharmacy verification, CAR-T cell drug thawing and dispensing, CAR-T cell drug administration, patient education, pharmacovigilance and monitoring and outcomes’ record and evaluation. In each task the pharmacist’s role and how it can improve patient care are defined. A checklist was created to guarantee the compliance of standard operating procedures approved in the institution to manage CAR-T cell therapy and as a tool to collect required data for outcomes’ record and evaluation. Conclusion This article provides a consensus set of safety recommendations regarding CAR-T therapy management in clinical practice, easily implementable by other institutions in the European setting. The guide identifies key steps where the involvement of hospital pharmacists would improve the safety and quality of the process and is a support guide to standardize hospital pharmacists’ responsibilities within the multidisciplinary team.
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Affiliation(s)
- María Belen Marzal-Alfaro
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Vicente Escudero-Vilaplana
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Jose Luis Revuelta-Herrero
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Roberto Collado-Borrell
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Herranz-Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Maria Sanjurjo-Saez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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14
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Charra F, Philippe M, Herledan C, Caffin AG, Larbre V, Baudouin A, Schwiertz V, Vantard N, Labussiere-Wallet H, Ducastelle-Leprêtre S, Barraco F, Balsat M, Larcher MV, Salles G, Rioufol C, Ranchon F. Immunosuppression medication adherence after allogeneic hematopoietic stem cell transplant: Impact of a specialized clinical pharmacy program. J Oncol Pharm Pract 2021:10781552211000115. [PMID: 33683151 DOI: 10.1177/10781552211000115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aims to evaluate the impact of implementing a specialized clinical pharmacy program in patients with allogeneic hematopoietic stem cell transplant (HSCT) on their adherence to the immunosuppression treatment after discharge. A prospective open interventional design using a retrospective control group was used. The intervention was based on pharmaceutical consultations: the first was performed the day before discharge of HSCT unit and the next consultations during day-care follow-up (weeks 2 and 4 after discharge). Proactive medication reconciliation was implemented with a complete list of medications before the discharge prescription. The discharge prescription summarized on a personalized drug schedule was explained to the patient. The importance of optimal adherence and the potential problems related to self-medication were explained to the patient. Immunosuppression drug adherence was assessed by a direct method using serum levels of calcineurin inhibitors. The potential impact on acute GvHD, and infection was investigated. Twenty-six patients were included in the specialized clinical pharmacy program and 35 patients were in the control group. Seventy-nine pharmaceutical consultations were conducted in the intervention group, lasting a mean 25 min and 16 min for the first and following consultations, respectively. Serum levels in the therapeutic target range were higher in the intervention group (61.5% versus 53.0%, p = 0.07), with greater intra-individual variation (p = 0.005). There was no significant intergroup difference in acute GvHD (53.8% versus 50.3%, p = 0.85) or infection (26.9 versus 22.8%, p = 0.72). The implementation of a specialized clinical pharmacy program for patients who have received allogeneic HSCT seems to be beneficial for immunosuppression drug adherence; this now needs to be confirmed in a multicenter study involving a larger number of patients.
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Affiliation(s)
- Florent Charra
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Michael Philippe
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Chloé Herledan
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
- University Lyon 1, EA CICLY Centre pour l'innovation en cancérologie, Lyon, France
| | - Anne-Gaëlle Caffin
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Virginie Larbre
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
- University Lyon 1, EA CICLY Centre pour l'innovation en cancérologie, Lyon, France
| | - Amandine Baudouin
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Vérane Schwiertz
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Hélène Labussiere-Wallet
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Sophie Ducastelle-Leprêtre
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Fiorenza Barraco
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Marie Balsat
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Marie Virginie Larcher
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Gilles Salles
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
- University Lyon 1, EA CICLY Centre pour l'innovation en cancérologie, Lyon, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
- University Lyon 1, EA CICLY Centre pour l'innovation en cancérologie, Lyon, France
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15
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Coutsouvelis J, Adams J, Bortz H, Chau M, Chiang K, Foo J, Ibrahim K, Kerr K, O'Connor S, Powell M, Rowan G, Siderov J, Tey A, Tran J, Vasileff H, Munro C. Standard of practice in oncology and haematology for pharmacy services. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- John Coutsouvelis
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Alfred Health Melbourne Australia
- Centre Medication Use and Safety Monash University Parkville Australia
| | - Julie Adams
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- View Health Pty Ltd; chemo@home Pty Ltd West Perth Australia
| | - Hadley Bortz
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Alfred Health Melbourne Australia
| | - Maggie Chau
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Melbourne Health Parkville Australia
| | - Karen Chiang
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Melbourne Health Parkville Australia
- St Vincent's Hospital Fitzroy Australia
| | - Josephine Foo
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Eastern Health Melbourne Australia
| | - Karim Ibrahim
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- St Vincent's Hospital Darlinghurst Australia
- St Vincent's Clinical School University of NSW Sydney Australia
| | - Kimberley‐Ann Kerr
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- SA Pharmacy Lyell McEwin Hospital Elizabeth Vale Australia
| | - Shaun O'Connor
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- St Vincent's Hospital Fitzroy Australia
| | - Michael Powell
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Gold Coast Health Gold Coast University Hospital Southport Australia
| | - Gail Rowan
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Peter MacCallum Cancer Centre Melbourne Australia
| | - Jim Siderov
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Austin Health Heidelberg Australia
| | - Amanda Tey
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Monash Health Clayton Australia
| | - Jenny Tran
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- Cancer Institute NSW Eveleigh Australia
| | - Hayley Vasileff
- Oncology and Haematology Standard of Practice Working Group The Society of Hospital Pharmacists of Australia Collingwood Australia
- SA Pharmacy Women's and Children's Hospital North Adelaide Australia
| | - Courtney Munro
- The Society of Hospital Pharmacists of Australia Collingwood Australia
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16
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Booth JP, Kusoski CL, Kennerly-Shah JM. The pharmacist's role in chimeric antigen receptor T cell therapy. J Oncol Pharm Pract 2020; 26:1725-1731. [PMID: 32819199 DOI: 10.1177/1078155220948940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The emergence and efficacy of chimeric antigen receptor (CAR) T cell therapy in previously incurable malignancies represents a promising paradigm shift in cancer care. However, it is not without significant clinical, operational, and financial considerations. Pharmacists should be prepared to fulfill the various roles in CAR T cell therapy provision including: policy development; electronic medical record build; patient and staff education; patient selection; procurement, storage, and handling; medication administration and supportive care; management of adverse reactions; and quality tracking. Our commentary provides an overview of the opportunities for pharmacy involvement in the implementation and maintenance of a CAR T cell therapy program with an emphasis on the importance of pharmacy involvement as part of a multidisciplinary approach to care. Although some institutions have dedicated a CAR T cell pharmacist to meet the demands of emerging CAR T cell therapy, we believe that clinical pharmacists practicing in hematopoietic stem cell transplant and hematology/oncology have the skills and training to fulfill the pharmacist's role in CAR T cell therapy.
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Affiliation(s)
- Jennifer P Booth
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center - James, Columbus, OH, USA
| | - Carolyn L Kusoski
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center - James, Columbus, OH, USA
| | - Julie M Kennerly-Shah
- Department of Pharmacy, The Ohio State University Comprehensive Cancer Center - James, Columbus, OH, USA
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17
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Saunders IM, Tan M, Koura D, Young R. Long-term Follow-up of Hematopoietic Stem Cell Transplant Survivors: A Focus on Screening, Monitoring, and Therapeutics. Pharmacotherapy 2020; 40:808-841. [PMID: 32652612 DOI: 10.1002/phar.2443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/19/2023]
Abstract
Annually, ~50,000 patients undergo hematopoietic stem cell transplantation (HCT) worldwide with almost 22,000 of these patients receiving HCT in the United States. HCT is a curative option for a wide range of hematologic malignancies, and advances in transplantation medicine have resulted in an increase in HCT survivors. It is anticipated that the number of HCT survivors will more than double from 242,000 in 2020 to ~500,000 in 2030. Survivors of HCT are at an increased risk of developing late complications due to exposure to chemotherapy and/or radiation in the pre-, peri-, and post-HCT phases and these cumulative exposures have the potential to damage normal tissue. This tissue damage leads to the early onset of chronic health conditions resulting in premature mortality in HCT survivors, who have a 15-year cumulative incidence of severe or life-threatening chronic health conditions exceeding 40%. Due to the significant burden of morbidity in HCT survivors and the delay in the development of long-term complications, this delicate patient population requires life-long monitoring due to the risk for neuropsychological, cardiac, pulmonary, renal, hepatic, ocular, skeletal, cardiac, endocrine, fertility, and sexual health complications, as well as secondary neoplasms. This review will focus on recent advances in screening, monitoring, and therapeutics for late-occurring or long-term complications in HCT survivors.
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Affiliation(s)
- Ila M Saunders
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
| | - Marisela Tan
- Department of Pharmaceutical Services, San Francisco Medical Center, University of California, San Francisco, California, USA
| | - Divya Koura
- Division of Blood and Marrow Transplantation, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Rebecca Young
- Department of Pharmaceutical Services, San Francisco Medical Center, University of California, San Francisco, California, USA
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Clemmons A. The Hematopoietic Cell Transplant Pharmacist: A Call to Action. PHARMACY 2020; 8:E3. [PMID: 31906486 PMCID: PMC7151652 DOI: 10.3390/pharmacy8010003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/20/2019] [Accepted: 12/31/2019] [Indexed: 01/28/2023] Open
Abstract
Recently, the required training and credentials for as well as the various roles of the hematopoietic cell transplant (HCT) pharmacist have been endorsed by the leading organizations in cellular therapy, the American Society of Transplant and Cellular Therapy and the European Society of Blood and Bone Marrow Transplantation. While these documents establish the roles a HCT pharmacist can fulfill within the multi-disciplinary team, few reports have evaluated the impact of the HCT pharmacist on clinical, financial, or quality outcomes. Further, a paucity of information has been reported on types of practice models, such as the use of collaborative practice agreements, or described effective methods to overcome the barriers to the increased utilization of HCT pharmacists. Herein, a brief summary of available information is provided to aid readers in understanding the state of the science for pharmacists practicing in this specialty with the goal to stimulate further research to justify the roles of HCT pharmacists and the correlation of such research to various outcome measures. Practitioners are encouraged to build upon this existing knowledge to create the novel integration and elevation of pharmacy practice to improve outcomes for patients, providers, and payors.
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Affiliation(s)
- Amber Clemmons
- College of Pharmacy, Department of Clinical and Administrative Pharmacy, University of Georgia, Augusta, GA 30912, USA;
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA 30912, USA
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19
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Consensus recommendations for the role and competencies of the EBMT clinical pharmacist and clinical pharmacologist involved in hematopoietic stem cell transplantation. Bone Marrow Transplant 2019; 55:62-69. [PMID: 31101890 DOI: 10.1038/s41409-019-0538-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 11/09/2022]
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