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Banez MT, Atienza S, Butts A, Derba M, Dicke K, Haverstick K, Heron BB, Cimino SK, Loop MS, Hough S, Merten JA, Moore DC, Shah V, Taucher KD, Zhang JM, Mahmoudjafari Z. Oncology stewardship practice in the United States: A Hematology/Oncology Pharmacy Association national survey. J Oncol Pharm Pract 2024:10781552241265280. [PMID: 39091073 DOI: 10.1177/10781552241265280] [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: 08/04/2024]
Abstract
INTRODUCTION The treatment of cancer is associated with high risk for toxicity and high cost. Strategies to enhance the value, quality, and safety of cancer care are often managed independently of one another. Oncology stewardship is a potential framework to unify these efforts and enhance outcomes. This landscape survey establishes baseline information on oncology stewardship in the United States. METHODS The Hematology/Oncology Pharmacy Association (HOPA) distributed a 38-item survey composed of demographic, institutional, clinical decision-making, support staff, metrics, and technology sections to 675 HOPA members between 9 September 2022 and 9 October 2022. RESULTS Most organizations (78%) have adopted general pharmacy stewardship practices; however, only 31% reported having established a formalized oncology stewardship team. More than 70% of respondents reported implementation of biosimilars, formulary management, and dose rounding as oncology stewardship initiatives in both inpatient and outpatient settings. Frequently cited barriers to oncology stewardship included lack of clinical pharmacist availability (74%), lack of oncology stewardship training (62%), lack of physician/provider buy-in (32%), and lack of cost-saving metrics (33%). Only 6.6% of survey respondents reported their organization had defined "value in oncology." Lack of a formalized stewardship program was most often cited (77%) as the rationale for not defining value. CONCLUSIONS Less than one-third of respondents have established oncology stewardship programs; however, most are providing oncology stewardship practices. This manuscript serves as a call to action for stakeholders to work together to formalize oncology stewardship programs that optimize value, quality, and safety for patients with cancer.
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Affiliation(s)
- Marisela Tan Banez
- Department of Pharmaceutical Services, University of California, San Francisco, California, USA
| | - Sol Atienza
- Department of Pharmacy, Advocate Health Midwest, Milwaukee, Wisconsin, USA
| | - Allison Butts
- Department of Pharmacy, UK HealthCare, Lexington, Kentucky, USA
| | - Megan Derba
- Department of Pharmacy, Eastern Maine Medical Center, Bangor, Maine, USA
| | - Katie Dicke
- Department of Pharmacy, OhioHealth, Columbus, Ohio, USA
| | - Kimberly Haverstick
- Pharmacy and Therapeutics Service Line, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Bernadette B Heron
- National Pharmacy Benefits Management, Hematology/Oncology, Department of Veterans Affairs, Hines, Illinois, USA
| | - Sarah K Cimino
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew Shane Loop
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, Alabama, USA
| | - Shannon Hough
- The US Oncology Network, McKesson Specialty Health, The Woodlands, Texas, USA
| | | | - Donald C Moore
- Department of Pharmacy, Atrium Health Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Vishal Shah
- Department of Pharmacy, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Junyu Matt Zhang
- Department of Pharmacy, University of Chicago Medical Center, Chicago, Illinois, USA
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Dean T, Koné A, Martin L, Armstrong J, Sirois C. Understanding the Extent of Polypharmacy and its Association With Health Service Utilization Among Persons With Cancer and Multimorbidity: A Population-Based Retrospective Cohort Study in Ontario, Canada. J Pharm Pract 2024; 37:35-46. [PMID: 35861340 PMCID: PMC10804697 DOI: 10.1177/08971900221117105] [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] [Indexed: 11/15/2022]
Abstract
Background: Cancer often co-occurs with other chronic conditions, which may result in polypharmacy. Polypharmacy is associated with adverse outcomes, including increased health service utilization. Objectives: This study examines the overall prevalence of polypharmacy (5 or more medications) among adults with cancer and multimorbidity, as well as the association of both minor polypharmacy (5-9 medications) and hyper-polypharmacy (10 or more medications) on high use of emergency room visits and hospitalizations, while controlling for age, sex, and type and stage of cancer. Methods: This retrospective longitudinal study used linked health administrative databases and included persons 18 years and older diagnosed with cancer between April 2010 and March 2013 in Ontario, Canada. Data on the number of health service utilizations at or above the 90th percentile (high users), was collected up to March 2014 and multivariate logistic regression was used to determine the impact of polypharmacy. Results: The prevalence of polypharmacy was 46% prior to cancer diagnosis, and 57% one year after diagnosis. Polypharmacy prior to and after cancer diagnosis increased with the level of multimorbidity, increasing age, but did not differ by sex. It was also highest in persons with lung cancer (52.4%) and those diagnosed with stage 4 cancer (51.3%). Minor polypharmacy increased the odds of being a high user of emergency rooms (1.16; 99% CI: 1.09-1.24) and hospitalizations (1.03; 0.98-1.09) and the odds of high use was greater with hyper-polypharmacy (1.41; 1.33-1.51) and (1.23; 1.17-1.29) respectively. Conclusion: Polypharmacy is highly prevalent and is associated with high health service utilization among adults with cancer and multimorbidity.
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Affiliation(s)
- Tamara Dean
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Anna Koné
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Joshua Armstrong
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Caroline Sirois
- Faculté de pharmacie, Université Laval, Quebec City, QC, Canada
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Hennes ER, Reed M, Mably M, Jared J, Bergsbaken JJ, Deming D, Callander N, O’Regan R. Implementation of a chemotherapy stewardship process. Am J Health Syst Pharm 2020; 77:1243-1248. [DOI: 10.1093/ajhp/zxaa157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Purpose
To design and implement a chemotherapy stewardship process to optimize the location of chemotherapy administration in an effort to decrease the number of inappropriate inpatient anticancer regimen administrations and decrease institutional costs associated with inpatient administration.
Summary
As the costs of anticancer agents continue to rise, it is crucial that multidisciplinary efforts are aimed at managing anticancer medication utilization; this is especially important for high-cost medications, medications whose use requires increased monitoring due to safety concerns, and medications that do not exert effects quickly and, as such, can be more appropriately administered in the outpatient setting. It is imperative that pharmacists play a role in managing chemotherapy medication utilization, as pharmacists provide expertise in formulary management, a vast knowledge of financial impact and reimbursement processes, and clinical knowledge that can help predict the expected effectiveness and adverse effects of each anticancer regimen. Our institution sought to develop and implement a multidisciplinary chemotherapy stewardship program targeting the optimization of site of anticancer agent administration with a goal of decreasing both cost and inappropriate utilization of high-cost, high-risk anticancer agents.
Conclusion
Implementation of a chemotherapy stewardship service may decrease the number of inappropriate inpatient anticancer regimen administrations and decrease inpatient resource use, thereby decreasing costs to institutions. The concept of a chemotherapy stewardship process was well received by multidisciplinary healthcare colleagues, and a collaborative approach should be used to design and implement such processes.
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Affiliation(s)
| | | | | | | | | | - Dustin Deming
- Carbone Cancer Center, UW Health, Madison, WI, and University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Natalie Callander
- Carbone Cancer Center, UW Health, Madison, WI, and University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ruth O’Regan
- Division of Hematology and Oncology, Department of Medicine, Carbone Cancer Center, UW Health, Madison, WI
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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Bostelman C. 5-Fluorouracil Infiltrations and Ambulatory Pumps: Education, Prevention, and Management Considerations. Clin J Oncol Nurs 2019; 23:537-539. [PMID: 31538980 DOI: 10.1188/19.cjon.537-539] [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: 11/17/2022]
Abstract
Although uncommon, 5-fluorouracil (5-FU) infiltrations do occur. Two case studies involving 5-FU infiltration from totally implanted venous access devices identified at the conclusion of a 46-hour continuous infusion via an ambulatory infusion pump are presented. These cases highlight the importance of patient and caregiver education, considerations for preventing infiltrations, and challenges associated with managing these cases.
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