Prevention and treatment of venous thromboembolism in patients with cancer

Adherence to Oral Anticancer Medications: Evolving Interprofessional Roles and Pharmacist Workforce Considerations

Interprofessional care is exhibited in outpatient oncology practices where practitioners from a myriad of specialties (e.g., oncology, nursing, pharmacy, health informatics and others) work collectively with patients to enhance therapeutic outcomes and minimize adverse effects. Historically, most ambulatory-based anticancer medication therapies have been administrated in infusion clinics or physician offices. Oral anticancer medications (OAMs) have become increasingly prevalent and preferred by patients for use in residential or other non-clinic settings. Self-administration of OAMs represents a significant shift in the management of cancer care and role responsibilities for patients and clinicians. While patients have a greater sense of empowerment and convenience when taking OAMs, adherence is a greater challenge than with intravenous therapies. This paper proposes use of a qualitative systems evaluation, based on theoretical frameworks for interdisciplinary team collaboration and systems science, to examine the social interactionism involved with the use of intravenous anticancer treatments and OAMs (as treatment technologies) by describing patient, organizational, and social systems considerations in communication, care, control, and context (i.e., Kaplan’s 4Cs). This conceptualization can help the healthcare system prepare for substantial workforce changes in cancer management, including increased utilization of oncology pharmacists.

A scoping review of research on the prescribing practice of Canadian pharmacists

BACKGROUND

Pharmacists in Canada have been prescribing since 2007. This review aims to explore the volume, array and nature of research activity on Canadian pharmacist prescribing and to identify gaps in the existing literature.

METHODS

We conducted a scoping review to examine the literature on prescribing by pharmacists in Canada according to methodological trends, research areas and key findings. We searched for peer-reviewed research articles and abstracts in the Ovid MEDLINE, Ovid EMBASE and International Pharmaceutical Abstracts databases without any date limitations. A standardized form was used to extract information.

RESULTS

We identified 156 articles; of these, 26 articles and 12 abstracts met inclusion criteria. One-half of the research studies (20) used quantitative methods, including surveys, trials and experimental designs; 11 studies used qualitative methods and 7 used other methods. Research on pharmacist prescribing demonstrated an improvement in patient outcomes (13 studies), varied stakeholder perceptions (10 studies) and factors that influence this practice change (11 studies). Pharmacist prescribing was adopted when pharmacists practised patient-centred care. Stakeholders held contrasting perceptions of pharmacist prescribing.

DISCUSSION

Canadian research has demonstrated the benefit of pharmacist prescribing on patient outcomes, which is not present in the international literature. Future research may consider a meta-analysis addressing the impact on patient health. Gaps in research include comparisons between provinces, effects on physicians' services, overall patient safety and access to health care systems and economic implications for society.

CONCLUSION

A growing body of research on pharmacist prescribing has captured the early impact of prescribing on patient outcomes, perceptions of practice and practice change. Opportunities exist for pan-Canadian research that examines the system impact.

The association of deep vein thrombosis with cancer treatment modality: chemotherapy or surgery?

Background:

Deep vein thrombosis (DVT) is a well-recognized complication in patients with cancer. Chemotherapy and cancer surgery increase the risk of DVT in these patients. There are a few reports about the prevalence of DVT in patients with cancer regarding different managing modalities.

Objectives:

This study aimed to assess the prevalence of DVT in patients with cancer, who were hospitalized in teaching hospitals, according to their treatment intervention.

Patients and Methods:

A cross-sectional retrospective study was conducted on 602 patients with cancer in Kerman, Iran, during years 2006-2007. Among the subjects, 301 had been operated and the rest had received chemotherapy. The prevalence of DVT was determined based on patients’ variables, cancer factors, and therapeutic modalities.

Results:

Totally, 349 subjects (58%) were male. DVT incidence was 19.9%, most of the cases were over 40 years of age (82.2%), and 21.2% of males and 18.2% of females had developed DVT. The prevalence of DVT in chemotherapy group was higher than that in surgery group (21.9% and 17.9%, respectively); however, this difference was statistically insignificant. DVT developed more frequently in lung cancer (42%) with small cell carcinoma being the most common pathologic finding (42.9%) in those with lung cancer (P = 0.0001).

Conclusions:

DVT occurs frequently in patients with malignancies. In this study, there was no association between DVT prevalence and age as well as sex; nonetheless, the prevalence was significantly higher in some sites and in patients with certain pathologies. Although DVT prevalence was higher in chemotherapy than in surgery, the difference was insignificant. Informing patients with cancer about symptoms of DVT and prophylactic interventions are warranted.