Pattern of adverse drug reactions due to cancer chemotherapy in a tertiary care hospital in South India

Pharmacovigilance Practices by Healthcare Providers in Oncology: A Cross-Sectional Study

Investigating pharmacovigilance (PV) practices among oncology healthcare providers (HCPs) is crucial for patient safety in oncology settings. This study aimed to assess the awareness, attitudes, and practices towards PV and identify barriers to effective adverse drug reaction (ADR) reporting for HCPs working in oncology-related settings. Employing a cross-sectional survey design, we collected data from 65 HCPs, focusing on their experiences with ADR reporting, education on ADR management, and familiarity with PV protocols. The results showed that about half of the responders were pharmacists. Around 58.9% of the respondents reported ADRs internally, and 76.9% had received some form of ADR-related education. However, only 38.5% were aware of formal ADR review procedures. Methotrexate and paclitaxel emerged as the drugs most frequently associated with ADRs. The complexity of cancer treatments was among the common reasons for the low reporting of ADRs by the study participants. The findings highlight the need for enhanced PV education and standardized reporting mechanisms to improve oncology care. We conclude that reinforcing PV training and streamlining ADR-reporting processes are critical to optimizing patient outcomes and safety in oncology, advocating for targeted educational interventions and the development of unified PV guidelines.

Implementation of pharmaceutical care service to elderly cancer patients in a tertiary care hospital in South India

PURPOSE

The goal of this study is to identify drug-related problems (DRPs) for elderly cancer patients receiving chemotherapy by implementing pharmaceutical care services.

METHODS

In this interventional study, patients were followed after each cycle till 12 weeks. The MOATT-MASCC teaching tool was used to educate patients about their therapy. The outcome measures included the occurrences of any DRPs such as inappropriate medication dose, dosage form, route of administration, therapeutic duplication, failure of the patient to adhere to the medication regimen, adverse drug reactions (ADRs), and drug-drug interactions (DDIs) and to resolve it.

RESULTS

On 186 patients, there were 38% ADRs, 16% DDIs, 6% non-adherence to therapy, 4% medical conditions for which no medication was prescribed, and 1% therapeutic duplication and transcribing error was identified. A total of 226 ADRs were documented. Nausea and vomiting were the most frequently occurring ADRs (24%) and platinum compounds caused the highest number of ADRs. Assessments of causality showed that the majority of cases are 'probable' (50%). In evaluating the severity of ADRs, 53% of ADRs were 'moderate' and 51% of ADRs were 'probably' preventable. Upon assessing the DDIs, 35% of the prescriptions had 'monitor therapy'. All of the DRPs, that were identified were notified to the treating oncologists and resolved without any disagreement.

CONCLUSIONS

Pharmaceutical care is essential for elderly cancer patients. Oncologists and pharmacists should work together to identify and manage DRPs as well as educate patients about their disease. This will help in improved patient care and a better therapeutic outcome.

Assessment of adverse events among cervical cancer patients at Kenyatta National Hospital

INTRODUCTION

Due to their cytotoxic nature, anticancer drugs and radiotherapy have the potential to cause toxic adverse events. As a result, they can increase the risk of morbidity and mortality. However, there was a lack of data among cervical cancer patients in our setting. Hence, this study was aimed to assess the prevalence of adverse events among cervical cancer patients at Kenyatta National Hospital.

METHODS

A cross-sectional study design was employed among a consecutive sample of 151 adult cervical cancer patients. The data were collected by reviewing the medical records and interviewing the patients. The data were entered and analyzed using SPSS 27.0 software. The results were presented with frequency tables and graphs.

RESULTS

A total of 214 adverse events (prevalence of 100%) were identified from 151 patients. The most common adverse events identified were ulcerated sores (52.8%), dysuria (7.5%), thrombocytopenia (5.6%), and loss of appetite (5.6%). The majority of the patients (80.8%) who had adverse events were on radiotherapy. As per the Naranjo causality assessment scale, the predominant (80.1%) proportion of the adverse event was a probable adverse event with a total score of 5-8. Besides, 15.9% of the adverse events had a possible causality. The present study also reported that 61.6% of patients with a probable adverse event were treated with radiotherapy.

CONCLUSION

The prevalence of adverse events among cervical patients was high in our setting. The predominant proportion of the adverse event was a probable adverse event and most of them were treated with radiotherapy.

An Account of Acute Adverse Drug Reactions Occurring in a Day-Care Chemotherapy Unit of a Tertiary Care Cancer Hospital—A Prospective Observational Study

Introduction Acute adverse drug reactions (ADRs) in day-care chemotherapy are not uncommon and are easily manageable on most occasions. However, sometimes they may lead to untoward events. It is paramount to document and analyze such events in contemporary medical oncology practice for the best utilization and planning of available personnel and resources.

Objective Our objective was to analyze the acute ADRs occurring in day-care cancer chemotherapy settings.

Materials and Methods ADRs reported in a day-care cancer chemotherapy setting, during the administration of chemotherapy, were prospectively observed and analyzed from 01 June 2020 to 31 December 2020. ADRs were classified into anaphylactic, allergic, and gastrointestinal (GI) (nausea/vomiting/heart burns/chest tightness). All ADRs were graded according to the Common Terminology Criteria for Adverse Events Version 5.0. Suspected drugs, time to reaction, and corrective measures were analyzed.

Results During the study period, a total of 10,120 sessions of day-care chemotherapy were administered. ADRs were noticed in 118 cases (1.18%). Among the reported ADRs, the mean and median age of the patients in this study was 52 years (21–88). Women outnumbered men (n = 81, 68.64% vs n = 37, 31.36%). Anaphylactic reactions (50.92%) were the most common followed by allergic (25.15%) and GI reactions (23.93%). No grade IV reaction was observed. Oxaliplatin-induced allergic reactions (n = 28, 23.73%) were noted most frequently. In majority of sessions (n = 93, 78.81%), the same chemotherapy regimen was readministered and completed uneventfully after the administration of antihypersensitivity medications.

Conclusion Serious ADRs are rare in current day-care chemotherapy administration. Most acute ADRs were of mild grade and successfully managed with antihypersensitivity medication.

Pattern of Adverse Drug Reactions Associated with the Use of Anticancer Drugs in an Oncology-Based Hospital of Nepal

INTRODUCTION

Adverse drug reactions (ADRs) are among the leading causes of morbidity and mortality worldwide. ADRs of anticancer drugs are ubiquitous. However, in Nepal, studies on chemotherapy-induced ADRs are scarce. Thus, this study aimed to assess the ADRs associated with the use of anticancer drugs and their management along with causality assessment and severity of ADRs.

METHODS

A prospective cross-sectional observational and single-center study was conducted at Bhaktapur Cancer Hospital, Nepal, for 6 months. All the patients who fulfilled the study criteria were analyzed to identify ADRs occurring daily. In addition, all collected data were recorded and analyzed using descriptive statistics.

RESULTS

A total of 861 ADRs were detected among 102 cancer patients. The mean ± S.D. age of the patients was 49.93 ± 14.27 years, and each enrolled patient experienced one or more ADRs with a mean ± S.D. of 8.44 ± 3.27. The common ADRs observed were fatigue, anorexia, alopecia, constipation, nausea, vomiting, and neuropathy. Cyclophosphamide, either alone or in combination with other chemotherapeutic agents, was responsible for most ADRs. According to Naranjo's causality assessment algorithm, most of the ADRs belonged to the probable (47.1%) category. Majority (54.9%) of the ADRs were moderate in their severity. Proton pump inhibitors, antiemetic, mouth gargle, protein powders, iron tablets, and multivitamin and mineral tablets were commonly used for ADR management.

CONCLUSIONS

The occurrence of chemotherapy-related ADRs in each enrolled patient is a crucial concern. The present study highlights the need for active monitoring of the patients to identify and manage ADRs promptly.

Retrospective Observational Study to Evaluate Causality, Preventability and Severity of Adverse Drug Reaction Associated with Anticancer Drugs in A Tertiary Care Hospital in Northern India

BACKGROUND

Chemotherapy has high efficacy, but it is associated with several adverse drug reactions (ADRs).

OBJECTIVES

A retrospective observational study to explore the prevalence, causality, and preventability of ADRs of anticancer agents was conducted.

METHODS

The study was carried out at Punjab Institute of Medical Sciences Jalandhar, Punjab after obtaining IEC approval. The data was collected from cancer patients undergoing treatment at the hospital. The causality assessment of the collected data was done by using WHO causality assessment criteria. The preventability and severity of the reported ADRs were also assessed.

RESULTS

From 50 medical records, a total of 47 ADRs were recorded among 25 patients out of which 16 were females and the rest were males. The cancer cases observed were breast carcinoma, leukaemia, lung, colon, and ovarian cancer. The highest number of ADRs were observed with alkylating agents, followed by taxanes, antimetabolites, kinase inhibitors, and monoclonal antibodies. The most affected organ systems were the gastrointestinal system, blood, and lymphatic system. According to the causality assessment, the majority of the ADRs were of the "possible" category. Preventability analysis showed that 85.11% of ADRs were unavoidable reactions, while 14.89% of ADRs were possibly avoidable. Severity analysis of ADRs showed that 87.23% of ADRs were mild and 12.77% were of moderate severity. The majority of the ADRs were unavoidable and mild to moderate in severity.

CONCLUSION

Since the majority of the ADRs were of the unavoidable category, indicate that the treatment regimens are acceptable as per the current clinical management of cancer patients.

Adverse Drug Reaction Profile of Anticancer Agents in a Tertiary Care Hospital: An Observational Study

BACKGROUND

Anti-cancer agents are known to be toxic, leading to a number of adverse drug reactions (ADRs). ADRs not only increase the financial burden on patient/healthcare system but also decrease quality of life. Understanding the burden of ADR will help strengthen the knowledge on patient safety and thereby in implementing intervention strategies to reduce it.

OBJECTIVES

1. To study the pattern of Adverse drug reaction of anticancer agents of patients admitted in the oncology ward. 2. To assess the causality, severity, and preventability of the adverse drug reactions observed.

METHODS

This was a cross-sectional, observational study carried out in 200 adult patients in the daycare center for chemotherapy. Details of ADRs noted in the previous and current cycles were noted. Causality assessment was done using Naranjo and WHO scale. For severity and preventability assessment Hartwig Siegel and Modified Schumock Thorton scale were used respectively.

RESULTS

Out of the total 732 ADRs encountered, alopecia was the most common ADR. The average number of ADRs observed per patient was 3.66 + 1.59(mean + SD). The maximum number of ADRs were seen in Paclitaxel-carboplatin 3 weekly regimen. Nausea and alopecia were the most common ADRs reported with most regimens. On causality assessment, 95(12.97%) were definitely related according to Naranjo's Causality scale, while 15.71% were certainly related according to WHO scale. Of all the ADRs recorded,47.81% were of moderate-intensity while 52.18% were of mild intensity. The majority of ADRs were not preventable, 87.59%.

CONCLUSION

Alopecia was the most common ADR reported. Most of the ADRs could be causally related to drugs. These ADRs were mild to moderate in severity and were not preventable. There is need to identify the underlying factors that predispose patients to these ADRs and target them in future research.

Frequency, nature, severity and preventability of adverse drug reactions arising from cancer chemotherapy in a teaching hospital

Background:

An adverse drug reaction (ADR) is defined by the World Health Organization (WHO) as “Any response to a drug which is noxious, unintended and occurs at doses used in man for prophylaxis, diagnosis or therapy”. Cancer chemotherapy is associated with the occurrence of ADRs, which is a worldwide problem. Monitoring and reporting of these ADRs are essential to safeguard the patient and to manage it accordingly. The outcome would create alertness and prevent their recurrence. Hence, we have undertaken a hospital-based study to study the frequency and nature of ADRs due to chemotherapeutic agents.

Methods:

A total of 500 patients developed ADRs due to cancer chemotherapy from 13^th April 2018 to 18^th September 2019. Demographics of the patient, drugs taken, and ADRs encountered were recorded in a predesigned form.

Results:

A total of 665 ADRs were recorded from 500 patients. Anemia was the most common ADR encountered followed by nausea/vomiting and leucopenia. Leukemia (s) were common cancer observed followed by lung and breast cancers. The most common drugs implicated were cisplatin, paclitaxel, carboplatin, and doxorubicin. Naranjo's scale showed 92% of ADRs as probable and 7% as possible. Severity scale showed 80.2% of ADRs were of moderate (level 3 and 4) severity, 11.6% of mild (level 1 and 2) severity, and 8.2% of level 5 severity. A total of 26.8% of ADRs were deemed preventable and 73.2% were not preventable.

Conclusions:

Our study provides safety data regarding the usage of anti-cancer drugs. Hence, it creates alertness among the treating doctors to prevent its recurrence.

Case report on 5-fluorouracil induced cerebrovascular accident

Introduction

5-Fluorouracil is an antineoplastic agent generally used to treat various types of solid tumors. The common adverse drug reaction associated with 5-fluorouracil are myelosuppression, mucositis, diarrhea, and hand-foot syndrome. Neurological side effects such as headache, dizziness, convulsion, encephalopathy, and acute cerebellar syndrome are rare in nature.

Case presentation

We report a case of 5-fluorouracil induced cerebrovascular accident (CVA) in a patient with no risk factors for CVA before chemotherapy. A 37 years old female patient diagnosed with carcinoma rectum underwent six cycles of chemotherapy with 5- fluorouracil- calcium leucovorin- irinotecan (FOLFIRI regimen). After completing the last cycle, she developed headache, vomiting, and facial deviation along with high blood pressure (260/160 mmHg). MRI brain was done, and it revealed acute non-hemorrhagic lacunar infarct in the left half of pons. 5-fluorouracil induced CVA was suspected and was managed with dual antiplatelet, statin, and antihypertensives.

Conclusion

The clinicians and clinical pharmacists must be aware about the potential of 5-FU to induce rare side effects such as CVA even in low risk patients in order to avoid permanent harm to the patient

Serious adverse effects occurring after chemotherapy: A general cancer registry-based incidence survey

AIMS

Pharmaco-epidemiological surveys enable the frequency of serious adverse effects-and also the determining factors of their occurrence and seriousness-to be quantified. Few studies systematically gathering post-chemotherapy adverse effects data have been conducted. The objective was to assess the incidence of post-chemotherapy serious adverse effects on the basis of cancer registry data.

METHODS

The population was composed of new invasive cancer cases, with the exception of haematopoietic tumours and cutaneous carcinomas. These cancers were identified in 2012 among patients living at the time of diagnosis in a region covered by a general cancer registry and by a French regional pharmacovigilance centre, and treated with neo-adjuvant and/or adjuvant first-intention chemotherapy, followed or not by radiotherapy. The study was based on a sample of 1000 patients from the registry, followed by the collection of serious adverse effects and the required information to constitute a pharmacovigilance file.

RESULTS

Chemotherapy was associated with a particularly high incidence of serious adverse effects, affecting 44.5% (41.4-47.5%) of the patients. The highest incidence rates were observed when patients were exposed to topo-isomerase II inhibitors such as etoposide and bleomycin (69.2%), vinca-alkaloids (66.7%), topo-isomerase I inhibitors (54.5%) and platinum derivatives (52.0%). The clinical context was also linked to incidence, especially in case of metastases (53.3%) and comorbidities (51.3%). Substantial differences were found according to localisation, with a particularly high incidence in bronchial-pulmonary cancers (59.0%).

CONCLUSION

The high overall incidence rate of serious adverse effects should motivate a reinforcement of information about drug toxicities and improve knowledge by drawing on patient reporting.

Improving medication safety in oncology care: impact of clinical pharmacy interventions on optimizing patient safety

Background Adverse drug reactions (ADRs) monitoring in cancer patients is important to ensure early detection, effective management and possible prevention subsequently. Objectives This study was conducted to detect and monitor ADRs to anti-cancer agents, and to assess impact of clinical pharmacists (CPs)' interventions in minimizing ADRs to anti-cancer agents. Setting Private, specialty oncology care hospital in South India. Methods CPs prospectively followed cancer patients admitted to inpatient wards and treated at ambulatory care in order to identify ADRs, for a period of 3 years. Identified/reported ADRs were discussed with concerned oncologists and/or nurses, documented electronically and assessed further for their causality, severity, preventability and grading. Based on study findings during year 1, interventions (educational, therapeutic and system based) were developed by CPs and implemented in order to minimize preventable ADRs. Impact of CPs' interventions was studied during year 2 and year 3. Main outcome measure(s) Preventable factors contributing to ADRs and percentage of preventable ADRs before and after CPs' interventions. Results A total of 1279 ADRs were reported in 1133 patients from a cohort of 1328 patients. Vomiting (23.22%), alopecia (9.53%), diarrhoea (8.67%) and myelosuppression (7.42%) were the common ADRs reported. Inappropriate administration frequency and regimen of anti-emetics (22%), lack of/suboptimal supportive care (18%) and administration errors (16%) were identified as common contributing (preventable) factors for ADRs in year 1. Percentage of preventable ADRs was 81% during year 1 (pre-intervention), and 45% and 34% in year 2 and year 3 respectively (post-interventions). Conclusion Interventions by CPs helped to minimize preventable ADRs to anti-cancer agents.

Predictors of adverse drug reactions in geriatric patients: An exploratory study among cancer patients

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.

Assessment of drug therapy problems among patients with cervical cancer at Kenyatta National Hospital, Kenya

Background

Although cervical cancer is preventable, it is still the second leading cause of cancer deaths among women in the world. Further, it is estimated that around 5–10% of hospital admissions are due to drug related problems (DRPs), of which 50% are avoidable. In cancer therapy, there is an immense potential for DRPs due to the high toxicity of most chemotherapeutic regimens. Hence, this study sought to assess DRPs among patients with cervical cancer at Kenyatta National Hospital (KNH).

Methods

A cross-sectional study was conducted at the oncology units of KNH. A total of 81 study participants were recruited through simple random sampling. Data were collected from medical records and interviewing patients. The appropriateness of medical therapy was evaluated by comparing with National Compressive Cancer Network and European Society for Medical Oncology practice guideline of cervical cancer treatment protocol. The degree of adherence was determined using eight-item Morisky medication adherence scale. The likelihood of drug interaction was assessed using Medscape, Micromedex and Epocrates drug interaction checkers. The data were entered in Microsoft Excel and analysed using statistical software STATA version 13.0. Descriptive statistics such as mean, percent and frequency were used to summarise patients’ characteristics. Univariable and multivariable binary logistic regression were used to investigate the potential predictors of DRPs.

Result

A total of 215 DRPs were identified from 76 patients, translating to a prevalence of 93.8% and a mean of 2.65 ± 1.22 DRPs. The predominant proportion of DRPs (48.2%) was identified in patients who had been treated with chemoradiation regimens. Adverse drug reactions 56(69.1%) and drug interactions 38(46.9%) were the most prevalent DRPs. Majority (67.9%) of the study population were adherent to their treatment regimens. Forgetfulness 18(69.2%), expensive medications 4(15.4%) and side effects of medications 4(15.4%) were the main reasons for medication non-adherence. Patients with advanced stage cervical cancer were 15.4 times (AOR = 15.4, 95% CI = 1.3–185.87, p = 0.031) more likely to have DRPs as compared to patients with early stage disease.

Conclusion

Adverse drug reactions, drug interactions, and need of additional drug therapy were the most common DRPs identified among cervical cancer patients. Advanced stage cervical cancer was the only predictor of DRPs.

Adverse drug reactions due to cancer chemotherapy in a tertiary care teaching hospital

BACKGROUND

An adverse drug reaction (ADR) is defined by World Health Organization (WHO) as 'Any response to a drug which is noxious, unintended and occurs at doses used in man for prophylaxis, diagnosis or therapy'. ADRs associated with cancer chemotherapy warrant analysis on their severity and preventability. The outcome would create awareness among health care providers and prevent their recurrence. We have performed a hospital-based prospective observational study designed to analyze the pattern of ADRs to chemotherapeutic agents in cancer patients of a tertiary care hospital.

METHODS

A total of 119 cancer patients were monitored for suspected ADRs during the course of chemotherapy from November 2014 to December 2015. Clinical events were recorded and analyzed with regard to the demographics and drug details of the patients.

RESULTS

A total of 106 ADRs were recorded from 119 cases. The ADRs commonly encountered included constipation, nausea, vomiting, alopecia and hematological changes. Cisplatin, cyclophosphamide, paclitaxel and 5-FU were used for the treatment of commonly found cancers in this region affecting the lungs, esophagus and lymphomas. Naranjo's causality assessment showed 86.7% possible (score 4) and 13.2% probable (score 5-6). Severity of adverse reactions showed 77.4% mild, 18.9% moderate and 3.8% severe. A total of 45.3% of ADRs were preventable reactions such as nausea, vomiting and constipation.

CONCLUSIONS

This study highlights the role of active monitoring as an important tool for early detection, assessment and timely management of ADRs in patients undergoing cancer chemotherapy. The observed ADRs were preventable although ADRs such as hiccough, anemia, neutropenia and alopecia were not preventable.