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Martin T, Rioufol C, Favier B, Martelli N, Madelaine I, Chouaid C, Borget I. Impact of Early Access Reform on Oncology Innovation in France: Approvals, Patients, and Costs. BioDrugs 2024; 38:465-475. [PMID: 38643301 DOI: 10.1007/s40259-024-00658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND An ambitious reform of the early access (EA) process was set up in July 2021 in France, aiming to simplify procedures and accelerate access to innovative drugs. OBJECTIVE This study analyzes the characteristics of oncology drug approvals through the EA process and its impact on real-life data for oncology patients. METHODS The number and characteristics of EA demands concerning oncology drugs submitted to the National Health Authority (HAS, Haute Autorité de Santé) were reviewed until 31 December 2022. A longitudinal retrospective study on patients treated with an EA oncology drug between 1 January 2019 and 31 December 2022 was also performed using the French nationwide claims database (Systeme National des Données de Santé [SNDS]) to assess the impact of the reform on the number of indications and patients, and the costs. RESULTS Among 110 published decisions, the HAS granted 88 (80%) EA indications within 70 days of assessment on average, including 46 (52%) in oncology (67% in solid tumors and 33% in hematological malignancies). Approved indications were mostly supported by randomized phase III trials (67%), whereas refused EA relied more on non-randomized (57%) trials. Overall survival was the primary endpoint of 28% of EA approvals versus none of denied EAs. In the SNDS data, the annual number of patients with cancer treated with an EA drug increased from 3137 patients in 2019 to 18,341 in 2022 (+ 484%), whereas the number of indications rose from 12 to 62, mainly in oncohematology (n = 17), lung (n = 12), digestive (n = 9) and breast cancer (n = 9). Reimbursement costs for EA treatments surged from €42 to €526 million (+ 1159%). CONCLUSION The French EA reform contributed to enabling rapid access to innovations in a wide range of indications for oncology patients. However, the findings highlight ongoing challenges in financial sustainability, warranting continued evaluation and adjustments.
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Affiliation(s)
- Tess Martin
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015, Paris, France.
- GRADES, Faculty of Pharmacy, Paris-Saclay University, 17 Av. des Sciences, 91400, Orsay, France.
| | - Catherine Rioufol
- Pharmacy Department, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
- EA3738, CICLY, UCBL1, Lyon, France
| | - Bertrand Favier
- Pharmacy Department, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France
| | - Nicolas Martelli
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015, Paris, France
- GRADES, Faculty of Pharmacy, Paris-Saclay University, 17 Av. des Sciences, 91400, Orsay, France
| | - Isabelle Madelaine
- Société Française de Pharmacie Oncologique [SFPO], Pharmacy Department, Saint-Louis Hospital, AP-HP, 1 Avenue Vellefaux, 75010, Paris, France
| | - Christos Chouaid
- Service de Pneumologie, CHI Créteil, Créteil, France
- Inserm U955, UPEC, IMRB, Créteil, France
| | - Isabelle Borget
- Biostatistics and Epidemiology Office, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- CESP U1018, Oncostat, Labeled Ligue Contre le Cancer, Inserm, Université Paris-Saclay, Villejuif, France
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Damerval M, Bennani M, Rioufol C, Omrani S, Riboulet M, Etienne-Selloum N, Saint-Ghislain A, Leenhardt F, Schmitt A, Simon N, Clairet AL, Meurisse A, Nerich V. Attributes for a discrete-choice experiment on preferences of patients for oncology pharmacy consultations. Support Care Cancer 2024; 32:318. [PMID: 38687392 DOI: 10.1007/s00520-024-08517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/21/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE To ensure the safe use of oral anticancer drugs, oncology pharmacy consultations (OPCs) have been established in France. They are conditioned by the needs, expectations, and involvement of the patients in their care. Thus, it is essential to elicit their preferences. The discrete-choice experiment (DCE) is a method recommended by the ISPOR for such a task. The "selection and validation of attributes and their values" step is fundamental in this process. In this context, the aim of this study was to present our research approach to identify and validate the attributes that characterize an OPC and their values. METHODS Due to the lack of relevant published data in the literature, the focus-group method was used in accordance with good research practices for the application of conjoint-analysis of the ISPOR. The two-round Delphi method was used to validate the attributes and their values identified by the focus-group method. RESULTS The focus-group method enabled identification of nine attributes. Thirty-seven healthcare professionals at a national level, including 30 pharmacists and seven physicians, were selected to take part in the Delphi procedure. Seven attributes (frequency, planification, operation mode, duration, content, written support, and report) and their values were thus validated. CONCLUSION Based on these results, the next step will be to elicit patient preferences for OPCs and to then shed light on the issues of pharmaceutical support for patients by comparing their preferences with those of informal caregivers and, in particular, those of the healthcare professionals involved in their care.
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Affiliation(s)
| | | | - Catherine Rioufol
- Department of Pharmacy, Hospices Civils de Lyon, UCBL1, EA3738 CICLY, F-69002, Lyon, France
| | - Selim Omrani
- Department of Pharmacy, Hôpital Nord Franche-Comté, Site de Belfort, 90400, Trévenans, France
| | - Margaux Riboulet
- Assistance Pour Le Traitement des Urémiques en Provence-Corse, Centre de Néphrologie Marseille Borde, 13008, Marseille, France
| | - Nelly Etienne-Selloum
- Department of Pharmacy, Institut de Cancérologie Strasbourg Europe, 67200, Strasbourg, France
- Laboratory of Bioimaging and Pathology, University of Strasbourg, UMR7021 CNRS, 67401, Illkirch, France
| | | | - Fanny Leenhardt
- Department of Pharmacy, Institut du Cancer de Montpellier, 34090, Montpellier, France
| | - Antonin Schmitt
- Department of Pharmacy, Centre Georges-François Leclerc, 21000, Dijon, France
| | - Nicolas Simon
- Department of Pharmacy, Centre Hospitalier Universitaire de Lille, 59000, Lille, France
| | - Anne-Laure Clairet
- CHU Besançon, Pôle Pharmacie, 25030, Besançon, France
- Université de Franche-Comté, INSERM, EFS-BFC, UMR 1098, CHU Besançon, Pôle Pharmacie, 25030, Besançon, France
| | - Aurélia Meurisse
- Methodology and Quality of Life in Oncology Unit, Centre Hospitalier Universitaire de Besançon, 25000, Besançon, France
| | - Virginie Nerich
- CHU Besançon, Pôle Pharmacie, 25030, Besançon, France.
- Université de Franche-Comté, INSERM, EFS-BFC, UMR 1098, CHU Besançon, Pôle Pharmacie, 25030, Besançon, France.
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Tchernonog E, Moignet A, Anota A, Bernard S, Bouguet G, Colin F, Rioufol C, Ysebaert L, Gyan E. Health-related quality of life in patients with hematologic malignancies treated with chimeric antigen receptor T-cell therapy: review and current progress. Haematologica 2024. [PMID: 38450528 DOI: 10.3324/haematol.2022.282363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Indexed: 03/08/2024] Open
Abstract
Chimeric antigen receptor (CAR) T-cell therapy has transformed the care of patients with relapsed/refractory B-cell derived hematologic malignancies. To date, six CAR T-cell therapies, targeting either CD19 or B-cell maturation antigen, have received regulatory approval. Along with the promising survival benefit, CAR T-cell therapy is associated with potentially lifethreatening adverse events (AE), including cytokine release syndrome and immune effector cellassociated neurotoxicity syndrome. While clinical trials evaluating CAR T-cell therapy consistently report the incidence of these AE, most trials do not collect health-related quality of life (HRQoL) data. As such, the impact of CAR T-cell therapy process and related AE on the physical and psychological well-being of patients remains uncertain. HRQoL and other patientreported outcome (PRO) assessments in patients with relapsed or refractory hematologic malignancies are of utmost importance, as individuals may have unmet needs and a high demand for tolerable therapy if a cure is not obtained. In addition, it is important to standardize methods of data collection to better assess the impact of CAR T-cell therapy on quality of life, optimize patient care and costs, and enable comparison between different studies. We conducted a literature search up to June 2023 to identify the HRQoL tools used in clinical trials and in realworld studies investigating CAR T-cell therapy in patients with lymphomas or leukemias. In the present comprehensive review, we summarize the most commonly used CAR T-cell specific and non-specific HRQoL tools and discuss how the use of HRQoL and other PRO tools may be optimized.
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Affiliation(s)
| | - Aline Moignet
- Hematology department, Pontchaillou University Hospital, Rennes
| | - Amélie Anota
- Department of Clinical Research and Innovation and Department of Human and Social Sciences, Centre Léon Bérard, Lyon
| | - Sophie Bernard
- Hematology department, Centre Hospitalier de la Côte Basque, Bayonne
| | - Guy Bouguet
- Ensemble Leucémie Lymphomes Espoir (ELLyE), Paris
| | - Fanny Colin
- Hematology department, Pontchaillou University Hospital, Rennes
| | - Catherine Rioufol
- Clinical Oncology Pharmacy Department, University Lyon I, France - EA 3738 CICLY, University Hospital, Lyon
| | - Loïc Ysebaert
- Toulouse Cancer Research Center (CRCT), INSERM, CNRS, Toulouse III Paul Sabatier University, Toulouse, France; Clinical Hematology, IUCT Oncopole, Toulouse University Hospital, Toulouse.
| | - Emmanuel Gyan
- Hematology and cell therapy department, University Hospital, Tours, France; Clinical investigation center, INSERM U1415, University Hospital, Tours
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Huot L, Guerre P, Descotes G, Caffin AG, Herledan C, Ranchon F, Rioufol C. Cost-effectiveness of the ONCORAL multidisciplinary programme for the management of outpatients taking oral anticancer agents at risk of drug-related event: protocol for a pragmatic randomised controlled study. BMJ Open 2024; 14:e074956. [PMID: 38367968 PMCID: PMC10875583 DOI: 10.1136/bmjopen-2023-074956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION The development of oral anticancer agents (OAA) has profoundly changed cancer care, leading patients to manage their chemotherapy treatment on an outpatient basis. The prevention of iatrogenic effects of OAA remains a major concern, especially since their side effects are not less serious than those of intravenous chemotherapy. The ONCORAL programme was set up to secure the management of OAA in cancer patients followed at the Lyon University Hospital. This multidisciplinary programme involves hospital pharmacists, nurses, oncologists, and haematologists, as well as community health professionals. Given the economic stakes that this programme entails for the health system, a medico-economic study was designed. METHODS AND ANALYSIS This is a prospective controlled study, with individual open-label randomisation. A total of 216 outpatients treated with OAA and at risk of developing a drug-related iatrogenic event, will be randomised (2:1) to undergo follow-up in the ONCORAL programme or usual care. The primary outcome will be the estimation of the incremental cost-effectiveness ratio (difference in total costs per quality adjusted life years gained) at 12 months between the two groups. The secondary outcomes will be evaluation of OAA management consequences (relative-dose intensity, adherence, adverse drug events, drug-drug interactions, and proven medication errors), evaluation of overall survival and cancer-related quality of life, and patient-reported outcomes in relation to the treatment. A budget impact analysis will be implemented. Patient and health professional satisfaction regarding the ONCORAL programme will be measured. ETHICS AND DISSEMINATION Approval to conduct this study was obtained from an Ethics Committee (Comité de Protection des Personnes Ile-de-France VI) in October 2019, and from the French data protection agency (Commission Nationale de l'Informatique et des Libertés), according to the French Law. Trial results will be disseminated at clinical conferences and published in peer-reviewed journals. TRIAL REGISTRATION NCT03660670.
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Affiliation(s)
- Laure Huot
- Hospices Civils de Lyon, Pôle de Santé Publique, Service Evaluation Economique en Santé, Lyon, France
- Université Lyon 1, Inserm U1290 Research on Healthcare Performance (RESHAPE), Lyon, France
| | - Pascale Guerre
- Hospices Civils de Lyon, Pôle de Santé Publique, Service Evaluation Economique en Santé, Lyon, France
- Université Lyon 1, Health Systemic Process, EA 4129 Research Unit, Lyon, France
| | - Guillaume Descotes
- Hospices Civils de Lyon, Hôpital Lyon Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Anne-Gaëlle Caffin
- Hospices Civils de Lyon, Hôpital Lyon Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Chloé Herledan
- Hospices Civils de Lyon, Hôpital Lyon Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1, CICLY Centre pour l'Innovation et la Cancérologie de Lyon 1-EA3738, Lyon, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Hôpital Lyon Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1, CICLY Centre pour l'Innovation et la Cancérologie de Lyon 1-EA3738, Lyon, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Hôpital Lyon Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1, CICLY Centre pour l'Innovation et la Cancérologie de Lyon 1-EA3738, Lyon, France
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Herledan C, Falandry C, Huot L, Poletto N, Baudouin A, Cerfon MA, Lorsche L, Bret J, Ranchon F, Rioufol C. Clinical impact and cost-saving analysis of a comprehensive pharmaceutical care intervention in older patients with cancer. J Am Geriatr Soc 2024; 72:567-578. [PMID: 37818698 DOI: 10.1111/jgs.18585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/22/2023] [Accepted: 08/19/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Hospital admission and discharge are at high risk of drug-related problems (DRPs) in older patients with cancer. This study aimed to assess the clinical and economic impact of a comprehensive pharmaceutical care intervention (RECAP) to optimize drug therapy in patients with cancer ≥75 years admitted to oncology or geriatric wards. METHOD RECAP intervention was defined as follows: at admission and discharge, hospital pharmacists conducted comprehensive medication reconciliation and review, identified relevant DRPs and provided optimization recommendations to prescribers; at discharge, pharmacists also provided patient education and shared information with primary care providers. The impact of the intervention was assessed by the rate of implementation of recommendations by the prescribers and the evolution of polypharmacy rate; a peer review of the clinical significance of DRPs was performed by an expert panel of geriatric oncologists and pharmacists. A cost saving analysis compared cost avoided through resolution of DRPs to cost of pharmacist's time. RESULTS From January 2019 and August 2020, 201 patients were included (median age 80 [75-97] years), 68.7% with solid tumors. DRPs requiring optimization were identified in 70.9% of patients at admission (mean 1.7 DRP/patient) and 47.7% at discharge (0.9 DRP/patient). Most pharmacist recommendations (70.8%) were followed by prescribers, allowing the correction of 1.2 DRP/patient at admission and 0.7 DRP/patient at discharge. Half of resolved DRPs were rated as clinically significant. However, polypharmacy rate was not reduced at discharge. Cost comparison showed $7.2 avoided for $1 invested, with an estimated total net benefit of $354,822 (mean $1766 per patient). CONCLUSIONS The RECAP model significantly reduces DRPs in hospitalized older patients with cancer. The model was cost saving, confirming the value of implementing it in routine practice.
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Affiliation(s)
- Chloé Herledan
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1, Oullins, France
| | - Claire Falandry
- Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France
- Laboratoire CarMeN, INSERM U1060/ INRAE U1397/Université Lyon 1, Université de Lyon, Pierre-Bénite, France
| | - Laure Huot
- Hospices Civils de Lyon, Pôle de Santé Publique, Service Evaluation Economique en Santé, Lyon, France
- Inserm U1290 Research on Healthcare Performance (RESHAPE), Université Lyon 1, Lyon, France
| | - Nicolas Poletto
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Amandine Baudouin
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Marie-Anne Cerfon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurie Lorsche
- Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France
| | - Judith Bret
- Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France
| | - Florence Ranchon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1, Oullins, France
| | - Catherine Rioufol
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1, Oullins, France
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Vachez E, Kefleyesus A, Bakrin N, Ranchon F, Rioufol C, Vassal O, Al-Hadeedi O, Kepenekian V, Glehen O. Eliminating the need for preoperative intravenous hyperhydration: Sodium thiosulfate as nephrotoxicity prevention in HIPEC-treated patients - A retrospective analysis. Eur J Surg Oncol 2024; 50:107955. [PMID: 38219699 DOI: 10.1016/j.ejso.2024.107955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for peritoneal metastases. However, HIPEC with cisplatin is associated with renal toxicity. Sodium thiosulfate (ST) has been shown to prevent cisplatin-induced toxicity. METHODS A retrospective, single-center analysis of patients treated curatively for peritoneal surface malignancy, who underwent cytoreductive surgery with cisplatin-based HIPEC between 2015 and 2020. Patients were categorized into three groups based on the management of cisplatin-induced renal toxicity: preoperative hyperhydration alone (PHH), preoperative hyperhydration with ST (PHH + ST), and ST alone. Renal function and complications, in terms of Acute (AKI) and chronic kidney injury (CKI), were monitored and analyzed during 3 postoperative months. RESULTS This study included 220 consecutive patients. Mean serum creatinine levels were 95, 57 and 61 mmol/L, for PHH, PHH + ST and ST groups, respectively (p < 0.001). Glomerular Filtration Rate (GFR) were 96, 94 and 78 ml/min/1.73 m2, respectively (p < 0.001). AKI and CKI are respectively for PHH, PHH + ST and ST groups were 21 % (n = 46), 1 % (n = 2) and 0 % vs 19 % (n = 42), 0 % and 0 % (p < 0.001), for pairwise analysis did not show any difference between PHH + ST and ST alone combination, regarding nephrological outcomes. All patients were followed 3 months postoperatively. CONCLUSION There is no need for preoperative hyperhydration when sodium-thiosulfate is used to prevent cisplatin-induced nephrotoxicity in patients undergoing cytoreductive surgery with HIPEC. These findings have implications for improving and simplifying the management of patients with peritoneal metastases undergoing HIPEC with cisplatin.
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Affiliation(s)
- Elea Vachez
- Department of Gynecology, Lyon-Sud University Hospital, Lyon, France
| | - Amaniel Kefleyesus
- Department of Surgical Oncology, Lyon-Sud University Hospital, Lyon, France; Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Naoual Bakrin
- Department of Surgical Oncology, Lyon-Sud University Hospital, Lyon, France; CICLY Research Team, University Lyon 1, Lyon, France
| | - Florence Ranchon
- Unit of Oncologic Clinical Pharmacy Unit, Lyon-Sud University Hospital, Lyon, France
| | - Catherine Rioufol
- CICLY Research Team, University Lyon 1, Lyon, France; Unit of Oncologic Clinical Pharmacy Unit, Lyon-Sud University Hospital, Lyon, France
| | - Olivia Vassal
- Department of Intensive Care, Lyon-Sud University Hospital, Lyon, France
| | - Omar Al-Hadeedi
- Department of Surgical Oncology, Lyon-Sud University Hospital, Lyon, France
| | - Vahan Kepenekian
- Department of Surgical Oncology, Lyon-Sud University Hospital, Lyon, France; CICLY Research Team, University Lyon 1, Lyon, France
| | - Olivier Glehen
- Department of Surgical Oncology, Lyon-Sud University Hospital, Lyon, France; CICLY Research Team, University Lyon 1, Lyon, France
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Favrelle L, Masson JB, Parat S, Carre E, Fessy M, Rioufol C, Lienhart A, Chamouard V, Besse JL. A single-centre experience of 29 total ankle replacement in haemophiliac patients: Therapeutic management, factor consumption and cost. Haemophilia 2024; 30:204-213. [PMID: 38082545 DOI: 10.1111/hae.14909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION In patients with haemophilia, repeated bleeding in large joints leads to chronic haemophilic arthropathy, a rare disease that can be managed surgically with ankle arthrodesis or with total ankle replacement (TAR). TAR has been reported to provide good surgical results in the medium/long-term and allow preservation of joint mobility but the medical therapeutic management of the patients has not been described. AIM To describe the medical therapeutic management of TAR. METHODS All patients with haemophilia A/B, with haemophilic ankle arthropathy, and who underwent TAR between April 2006 and October 2019 were retrospectively included. Factor consumption, perioperative and early complications, volume of blood lost, and orthopaedic data were collected. RESULTS A total of 25 patients underwent 29 TAR (mean age was 44.7 years [range: 26-65]). In the 17 patients with HA without history of anti-FVIII inhibitor, the mean ± SD consumption the day of surgery was 116 ± 16 UI/kg when clotting factors were administered by continuous infusion, 106 ± 13 UI/kg when SHL factors were administered by bolus infusion, and 75 ± 22 UI/kg when EHL factors were administered by bolus infusion. During hospitalisation, the mean factor cost was €38,073 (83.7% of the total cost of surgery). Mean blood loss was significantly lower in patients treated with tranexamic acid (164 mL, range: 40-300) than in those not (300 mL, range: 70-800; p = .01). Six patients had haematoma. The 10-year survival free of any prosthesis removal/arthrodesis was estimated to be 92.2% (95% CI [83; 100]). CONCLUSION The medical therapeutic management of TAR is complex, carried out by a multidisciplinary team but effective in avoiding the occurrence of complications.
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Affiliation(s)
- Louise Favrelle
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de pharmacie, Pierre-Bénite, France
| | - Jean-Baptiste Masson
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite, France
| | - Stéphanie Parat
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de pharmacie, Pierre-Bénite, France
| | - Emmanuelle Carre
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de pharmacie, Pierre-Bénite, France
| | - Michel Fessy
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite, France
- Université Lyon 1, IFSTTAR, LBMC UMR-T 9406 - Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de pharmacie, Pierre-Bénite, France
| | - Anne Lienhart
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service d'Hémostase clinique, Bron, France
| | - Valérie Chamouard
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service d'Hémostase clinique, Bron, France
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service de pharmacie, Bron, France
| | - Jean-Luc Besse
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite, France
- Université Lyon 1, IFSTTAR, LBMC UMR-T 9406 - Laboratoire de Biomécanique et Mécanique des Chocs, Bron, France
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Ranchon F, Chatelut É, Lambert J, Sesques P, Thibault C, Madelaine I, Rioufol C, Diéras V, Cazin JL. [Antibody drug conjugates (ADC) and bispecific antibodies in oncology - report of the 2022 Saint Louis day]. Bull Cancer 2023; 110:1343-1351. [PMID: 37827964 DOI: 10.1016/j.bulcan.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 10/14/2023]
Abstract
Antibody Drug Conjugates (ADC) and bispecific antibodies are booming and were the subject of the scientific event proposed by the French Society of Oncological Pharmacy, October 13, 2022. An ADC is composed of the antibody targeting a receptor expressed on the tumor cell, the spacer making it possible to attach the cytotoxic to the antibody and to control its distribution in the body, and the cytotoxic. Therapeutic antibodies, monoclonal and conjugated, have particular pharmacokinetics. Unlike monoclonal antibodies for which the standard dose is most often fixed, this is expressed in mg/m2 (or mg/kg) and capped at 2m2 (or 100kg) for conjugates. The linked cytotoxics are powerful cytotoxics: mitotic spindle poisons (emtansine, monomethyl auristatin E or vedotin), topoisomerase I inhibitors (deruxtecan, SN 38) or antibiotics (ozogamicin). In senology, trastuzumab deruxtecan (anti-HER2) and sacituzumab govitecan (anti-Trop 2) are now modifying treatment standards for patients with metastatic breast cancer, respectively HER2 3X or HER2 low and triple negative. In metastatic bladder cancer, enfortumab vedotin (anti-nectin 4) is positioned as the 2nd line of treatment. Bispecific antibodies, on the other hand, are able to target two epitopes, an antigen specific to a tumor cell and one to an immune cell, allowing a bridge between the killer immune cells and the tumor cells. For lymphoma proliferation, many bispecific antibodies are in development. The most advanced are glofitamab, epcoritamab and mosunetuzumab, which target the CD20 of B lymphocytes and the CD3 of T lymphocytes. Bispecific antibodies are also emerging in the treatment of myeloma with teclistamab and elranatamab (anti-CD3 and anti-BCMA) or talquetamab (anti-GPRC5D and anti-CD3). Conjugated antibodies, and more recently bispecific antibodies, are potential game changers in cancer treatment and researchs are needed to improve their efficacy and safety.
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Affiliation(s)
- Florence Ranchon
- Hospices civils de Lyon, groupement hospitalier Sud, unité de pharmacie clinique oncologique, Pierre-Bénite, France; Université Lyon 1, EA 3738, CICLY centre pour l'innovation en cancérologie de Lyon, 69921 Lyon, Oullins cedex, France; Société française de pharmacie oncologique (SFPO), Paris, France
| | - Étienne Chatelut
- Université Paul Sabatier, institut Claudius-Regaud, institut universitaire du cancer Toulouse - Oncopole ; CRCT, centre de recherche en cancérologie de Toulouse, Inserm U1037, Toulouse, France
| | - Juliette Lambert
- Centre hospitalier de Versailles, service d'hématologie, Le Chesnay, France
| | - Pierre Sesques
- Hospices civils de Lyon, groupement hospitalier Sud, unité d'hématologie clinique, Pierre-Bénite, France
| | - Constance Thibault
- AP-HP, hôpital européen Georges-Pompidou, institut du cancer Paris CARPEM, centre, service d'oncologie médicale, Paris, France
| | - Isabelle Madelaine
- AP-HP, hôpital Saint-Louis, pharmacie, Paris, France; Société française de pharmacie oncologique (SFPO), Paris, France
| | - Catherine Rioufol
- Hospices civils de Lyon, groupement hospitalier Sud, unité de pharmacie clinique oncologique, Pierre-Bénite, France; Université Lyon 1, EA 3738, CICLY centre pour l'innovation en cancérologie de Lyon, 69921 Lyon, Oullins cedex, France; Société française de pharmacie oncologique (SFPO), Paris, France
| | - Véronique Diéras
- Centre Eugène-Marquis, département d'oncologie médicale, Rennes, France
| | - Jean-Louis Cazin
- UFR 3S (université de Lille), centre Oscar-Lambret, faculté de pharmacie, Lille, France; Société française de pharmacie oncologique (SFPO), Paris, France.
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9
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Grange C, Rioufol C, Souquet PJ, Assaad S. Anti-coagulant Treatment of Cancer-Associated Thrombosis in Frail Patients: Impact of Frailties on the Management of Drug-Drug Interactions. Clin Pharmacokinet 2023; 62:1523-1531. [PMID: 37824026 PMCID: PMC10582124 DOI: 10.1007/s40262-023-01298-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 10/13/2023]
Abstract
Low molecular weight heparins (LMWH) and anti-Xa direct oral anti-coagulants (DOACs) are recommended for the long-term treatment of cancer-associated thrombosis (CAT) based on well-documented randomised controlled trials. Anti-Xa DOACs are viewed as a first choice for the treatment of patients with CAT. A large number of drug-drug interactions have been reported between DOACs and chemotherapy drugs, modifying circulating levels of DOAC leading to fears of increased bleeding risks or thrombotic recurrence. Progresses in anti-neoplastic therapies have improved the prognosis and the survival, thus increasing the prevalence of frail patients with cancer. However, since frailties tend to be excluded from large trials due to multiple co-morbidities, current guidelines are not fully applicable to this population. The management of these frail patients with CAT is particularly complex and requires a risk assessment on a case-by-case basis with specific focus on cancer, patient-related risk factors and drug-drug interactions. In this brief review we have identified age, co-morbidities and co-medications as key factors of frailty that require careful attention and we have developed a therapeutic decision algorithm to help clinicians optimising the use of anti-coagulants in patients with cancer with CAT, especially in case of anti-Xa DOACs concomitant medications. With the evaluation of the bleeding risk according to the type of cancer, and anticipating drug-drug interactions intensity, taking into account patient frailties allows the optimisation of the anti-coagulant choice. A systematic collaboration between oncologists, vascular pathology specialists and pharmacists is warranted to ensure an optimal patient management. Clinical studies are needed to determine the real impact of these interactions.
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Affiliation(s)
- Claire Grange
- Service de Médecine Interne-Médecine Vasculaire, Hospices Civils de Lyon, CH Lyon Sud, Lyon, France.
| | - Catherine Rioufol
- Hospices Civils de Lyon, CH Lyon Sud, Service de Pharmacie, UCBL1-EA 3738 CICLY, Lyon, France
| | - Pierre-Jean Souquet
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, CH Lyon Sud, Lyon, France
| | - Souad Assaad
- Département d'Oncologie Médicale, Centre Léon Bérard, Lyon, France
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10
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Larbre V, Romain-Scelle N, Reymond P, Ladjouzi Y, Herledan C, Caffin AG, Baudouin A, Maire M, Maucort-Boulch D, Ranchon F, Rioufol C. Cancer outpatients during the COVID-19 pandemic: what Oncoral has to teach us about medical drug use and the perception of telemedicine. J Cancer Res Clin Oncol 2023; 149:13301-13310. [PMID: 37482585 DOI: 10.1007/s00432-023-04971-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/03/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE The COVID-19 pandemic has disrupted healthcare access and telemedicine has been widely deployed. The aim of this study is to assess the impact of this health crisis on treatment consumption and telemedicine development in outpatients treated by oral anti-cancer agents and followed by the Oncoral hospital/community multidisciplinary program where continuity care is maintained by a pharmacist/nurse pair. METHODS A prospective monocentric study was conducted among cancer patients who received Oncoral telephone follow-up during the 1st lockdown in France using a 56-item questionnaire which covered sociodemographic data, patient medication management, and telehealth. RESULTS 178 patients received Oncoral follow-up during the 1st lockdown and 67.4% responded to the questionnaire. During lockdown, 9.2% of patients took medication or CAM for fatigue, 6.7% for mood alteration, 10.8% for sleep disorder, 11.7% for stress and anxiety, and 12.5% to get more energy. Homeopathy consumption was triggered by the pandemic. Habits about getting drugs from the pharmacy changed significantly (p < 0.001), while other treatment habits did not. 83% of patients were satisfied by the telephone follow-up established, 69% would be in favor of repeating this in case of a new epidemic wave. Those most in favor of using telemedicine seemed to be the youngest (p < 0.001), with several dependent children (p < 0.007), high school degree or higher education (p = 0.023), and in work (p < 0.001). CONCLUSION Health system reorganization enables to limit the impact of the crisis on patients' drug use in oncology care. Telemedicine is a promising public health tool.
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Affiliation(s)
- V Larbre
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
- Université Lyon 1-EA 3738, CICLY, Lyon, France
| | - N Romain-Scelle
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Pierre-Bénite, France
- Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, CNRS, UMR 5558, Villeurbanne, France
| | - P Reymond
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
| | - Y Ladjouzi
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
| | - C Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
- Université Lyon 1-EA 3738, CICLY, Lyon, France
| | - A G Caffin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
| | - A Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
| | - M Maire
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
| | - D Maucort-Boulch
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Biostatistique-Bioinformatique, Pôle Santé Publique, Pierre-Bénite, France
| | - F Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France
- Université Lyon 1-EA 3738, CICLY, Lyon, France
| | - C Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite Cedex, France.
- Université Lyon 1-EA 3738, CICLY, Lyon, France.
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11
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Herledan C, Toulemonde A, Clairet AL, Boulin M, Falandry C, Decker LD, Rioufol C, Bayle A, Bertrand N. Enhancing collaboration between geriatricians, oncologists, and pharmacists to optimize medication therapy in older adults with cancer: A position paper from SOFOG-SFPO. Crit Rev Oncol Hematol 2023; 190:104117. [PMID: 37660933 DOI: 10.1016/j.critrevonc.2023.104117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/05/2023] Open
Abstract
Optimizing anticancer treatment and medication therapy in older patients with cancer requires a multidisciplinary approach, with a strong collaboration between geriatricians, oncologists and pharmacists. While all patients can benefit, some clinical situations seem to be high-priority. Careful attention should be given to patients with cardiovascular comorbidities and/or diabetes, which are prone to decompensate during anticancer treatment and often involve multiple medications. Another great concern is the risk of falls, closely related to polypharmacy, hence the need for a comprehensive medication review. Managing the pharmacological treatment of depression is also challenging and require shared expertise. Finally, pharmacists can prove valuable in situations of adherence difficulties or use of complementary medicines. Collaborative practice should begin at initiation of anticancer treatment and continue throughout the care pathway, as continuous reassessment is essential. Although the integration of pharmacists in multidisciplinary teams is often challenged by funding, collaborative should still be strongly encouraged.
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Affiliation(s)
- Chloé Herledan
- Société Française de Pharmacie Oncologique (SFPO), France; Department of Pharmacy, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France and EA 3738 CICLY, Lyon 1 University, Oullins, France.
| | - Anne Toulemonde
- Société Française de Pharmacie Oncologique (SFPO), France; Department of Pharmacy, Lille University Hospital, Lille, France
| | - Anne-Laure Clairet
- Société Française de Pharmacie Oncologique (SFPO), France; Department of Pharmacy, Centre Hospitalier Universitaire de Besançon, Besançon, France and INSERM, EFS BFC, UMR 1098, Interaction Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, University of Bourgogne Franche-Comté, Besançon, France
| | - Mathieu Boulin
- Société Française de Pharmacie Oncologique (SFPO), France; Department of Pharmacy, Dijon University Hospital and EPICAD LNC UMR 1231, University of Burgundy & Franche Comte, Dijon, France
| | - Claire Falandry
- Société Francophone d'Oncogériatrie (SoFOG), France; Institut du Vieillissement, Hospices Civils de Lyon, Lyon, France and Laboratoire CarMeN, INSERM U1060/ INRAE U1397/ Université Lyon 1, Université de Lyon, Pierre-Bénite, France
| | - Laure De Decker
- Société Francophone d'Oncogériatrie (SoFOG), France; Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 44000 Nantes, France
| | - Catherine Rioufol
- Société Française de Pharmacie Oncologique (SFPO), France; Department of Pharmacy, Lyon Sud University Hospital, Hospices Civils de Lyon, Pierre-Bénite, France and EA 3738 CICLY, Lyon 1 University, Oullins, France
| | - Arnaud Bayle
- Société Francophone d'Oncogériatrie (SoFOG), France; Université Paris Saclay, Université Paris-Sud, Faculté de médecine, Le Kremlin Bicêtre, Paris, France and Bureau biostatistique et épidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Nicolas Bertrand
- Société Francophone d'Oncogériatrie (SoFOG), France; Université de Lille, CHU Lille, ULR 2694 METRICS, Lille, France
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12
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Cerutti A, Ledoux T, Vantard N, Cerfon MA, Kimbidima R, Larbre V, Herledan C, Lattard C, Baudouin A, Caffin AG, Schwiertz V, Ranchon F, Rioufol C. Comparing different robots available in the European market for the preparation of injectable chemotherapy and recommendations to users. J Oncol Pharm Pract 2023; 29:1599-1612. [PMID: 36999226 DOI: 10.1177/10781552221143786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Recent advances in technology have made it possible to develop robots for preparing injectable anticancer drugs. This study aims to compare characteristics between robots available in the European market in 2022 and to help future pharmacy users in their choices. METHODS Three sources of data were used: (1) a review of published articles in the MEDLINE database from November 2017 to end of June 2021 on chemotherapy-compounding robots used in hospital; (2) all manufacturers' documentation, and (3) demonstrations of robot operations in real hospital conditions and discussions with users and manufacturers. Robot characteristics included number of robots installed, general technical characteristics, type of injectable chemotherapy produced and compatible materials, productivity data, preparation control methods, residual manual tasks, chemical and microbiological risk management, cleaning method, software, and implementation time. RESULTS Seven robots commercialized were studied. Several technical characteristics have to be taken into account in selecting the robot whose match the specific needs of a particular hospital, and which often require rethinking the current production workflow as well as the organization of the pharmacy unit. In addition to increasing productivity, the robots improve the quality of production thanks to better traceability, reproducibility, and precision of sampling. They also improve user protection against chemical risk, musculoskeletal disorders, and needle wounds. Nevertheless, when robotization is being planned, there are still numerous residual manual tasks to keep in mind. CONCLUSION Robotization of the production of injectable anticancer drugs is booming within anticancer chemotherapy preparation pharmacy units. Feedback from this experience needs to be further shared with the pharmacy community regarding this significant investment.
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Affiliation(s)
- Ariane Cerutti
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Thomas Ledoux
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Marie-Anne Cerfon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Reine Kimbidima
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Virginie Larbre
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Chloe Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Claire Lattard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Anne Gaelle Caffin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Vérane Schwiertz
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
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13
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Baudouin A, Guillemin MD, Rioufol C, Ranchon F, Parat S. [SARS-COV-2 pandemic: Involvement of the hospital pharmacist in securing patient care]. Ann Pharm Fr 2023; 81:900-908. [PMID: 37086966 PMCID: PMC10118052 DOI: 10.1016/j.pharma.2023.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/31/2023] [Accepted: 04/18/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVES In the context of the SARS-CoV-2 pandemic, hospital pharmacists supported the implementation of recommendations and ensured the safety of patient medication management. The aim of this study is to establish the interest of the involvement of the hospital pharmacist in this context by describing and comparing the activities carried out with patients with COVID-19 and those without. METHODS During the study period, data on clinical pharmacy activities with hospitalized patients were collected and analyzed: pharmaceutical analysis of prescriptions, participation in multi-professional consultation meetings (RCP) dedicated to COVID-19, and monitoring of adverse events. RESULTS The activities concerned 1483 patients, including 444 with COVID-19, resulting in 575 pharmaceutical interventions (PI). The main problems identified were overdoses, untreated indications, and drug-drug interactions (DDI). AMIs were significantly more common in patients with COVID-19, with 73.3% involving disease-specific therapies. Eleven PIs had a life-threatening impact, 189 a major impact. During the PCRs, 36 PIs were performed for 59% of the patients presented. A pharmacovigilance report was performed for a quarter of patients treated with hydroxychloroquine and 33% of patients treated with lopinavir/ritonavir. CONCLUSIONS This study demonstrates the value of involving hospital pharmacists in the drug management of patients with COVID-19, particularly with the evolution of available therapies and the implementation of vaccination, in order to reduce the spread of SARS-COV2 and limit the appearance of resistance.
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Affiliation(s)
- Amandine Baudouin
- Pharmacie à usage intérieur, hôpital Lyon Sud, hospices civils de Lyon, groupement hospitalier Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
| | - Marie-Delphine Guillemin
- Pharmacie à usage intérieur, hôpital Lyon Sud, hospices civils de Lyon, groupement hospitalier Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - Catherine Rioufol
- Pharmacie à usage intérieur, hôpital Lyon Sud, hospices civils de Lyon, groupement hospitalier Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; EMR3738, université de Lyon, Lyon, France
| | - Florence Ranchon
- Pharmacie à usage intérieur, hôpital Lyon Sud, hospices civils de Lyon, groupement hospitalier Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; EMR3738, université de Lyon, Lyon, France
| | - Stéphanie Parat
- Pharmacie à usage intérieur, hôpital Lyon Sud, hospices civils de Lyon, groupement hospitalier Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
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14
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Lattard C, Baudouin A, Larbre V, Herledan C, Cerutti A, Cerfon MA, Kimbidima R, Caffin AG, Vantard N, Schwiertz V, Ranchon F, Rioufol C. Clinical and economic impact of clinical oncology pharmacy in cancer patients receiving injectable anticancer treatments: a systematic review. J Cancer Res Clin Oncol 2023; 149:7905-7924. [PMID: 36853384 DOI: 10.1007/s00432-023-04630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/01/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Clinical pharmacy can reduce drug-related iatrogenesis by improving the management of adverse effects of drugs, limiting drug-drug interactions, and improving patient adherence. Given the vulnerability of cancer patients and the toxicity of injectable anticancer drugs, clinical pharmacy service (CPS) could provide a significant clinical benefit in cancer care. This review aims to synthesize existing evidence on clinical pharmacy's impact on patients treated with intravenous anticancer drugs. METHODS A comprehensive search was performed in the PubMed/Medline database from January 2000 to December 2021, associating the keywords: clinical pharmacy, pharmaceutical care, pharmacist, oncology, and chemotherapy. To be eligible for inclusion, studies have to report clinical pharmaceutical services for patients treated with intravenous chemotherapy with a clinical and/or economic impact. RESULTS Forty-one studies met the selection criteria. Various CPS were reported: medication reconciliation, medication review, and pharmaceutical interview with patient. There was a lack of randomized study (n = 3; 7.3%). In one randomized controlled trial, pharmaceutical intervention significantly improved quality of life of patients receiving pharmaceutical care during injectable anticancer drugs courses. Economical results appear to show positive impact of clinical pharmacy with cost savings reported from 3112.87$ to 249 844€. Although most studies were non-comparative, they highlighted that clinical pharmacy tend to limit chemotherapy side effects and drug-related problems, improve quality of life and satisfaction of patients and healthcare professional, and a positive economic impact. CONCLUSION Clinical pharmacy can reduce adverse drug events in cancer patients. More robust and economic evaluations are still required to support its development in everyday practice.
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Affiliation(s)
- Claire Lattard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Virginie Larbre
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Chloé Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Ariane Cerutti
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Marie-Anne Cerfon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Reine Kimbidima
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Anne-Gaelle Caffin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Vérane Schwiertz
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France.
- Université Lyon 1- EA 3738, CICLY Centre Pour l'Innovation en Cancérologie de Lyon, 69921, Lyon, Oullins Cedex, France.
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15
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Canales Albendea MÁ, Canonico PL, Cartron G, Deiters B, Jommi C, Marks R, Rioufol C, Sancho Cia JM, Santoro A, Wagner-Drouet EM. Comparative analysis of CAR T-cell therapy access for DLBCL patients: associated challenges and solutions in the four largest EU countries. Front Med (Lausanne) 2023; 10:1128295. [PMID: 37324138 PMCID: PMC10263061 DOI: 10.3389/fmed.2023.1128295] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/25/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction CAR T-cell therapy has emerged as a promising new immuno-oncology treatment that engages the patient's immune system to fight certain hematological malignancies, including diffuse large B-cell lymphoma (DLBCL). In the European Union (EU), CAR T-cell therapies have been approved for relapsed/refractory (R/R) DLBCL patients since 2018, but patient access is often still limited or delayed. This paper is aimed at discussing challenges to access and possible solutions in the largest four EU countries. Methods The analysis relied on literature review, market data collection, since homogeneous data coming from registries were not available, and discussion with experts coming from all four countries. Results We calculated that in 2020, between 58% and 83% of R/R DLBCL patients (EMA approved label population) or between 29% and 71% of the estimated medically eligible R/R DLBCL patients, were not treated with a licensed CAR T-cell therapy. Common challenges along the patient journey that may result in limited access or delays to CAR T-cell therapy were identified. These include timely identification and referral of eligible patients, pre-treatment funding approval by authorities and payers, and resource needs at CAR T-cell centers. Discussion These challenges, existing best practices and recommended focus areas for health systems are discussed here, with the aim to inform necessary actions for overcoming patient access challenges for current CAR T-cell therapies as well as for future cell and gene therapies.
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Affiliation(s)
| | - Pier Luigi Canonico
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Guillaume Cartron
- Centre Hospitalier Universitaire de Montpellier, UMR-CNRS 5535, Montpellier, France
| | | | - Claudio Jommi
- Department of Pharmaceutical Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Reinhard Marks
- Department of Medicine I, Medical Center, University of Freiburg, Freiburg, Germany
| | - Catherine Rioufol
- Department of Pharmacy, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France
- EA 3738 Center for Innovation in Cancerology of Lyon (CICLY)-Claude Bernard University Lyon I, Lyon, France
| | | | - Armando Santoro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Milan, Italy
| | - Eva M. Wagner-Drouet
- Department of Hematology and Oncology, University Medical Center, Mainz, Germany
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16
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Slimano F, Tournamille JF, Bardin C, Madelaine I, Hulin C, Moreau P, Rioufol C. [Access and safety of dexamethasone in multiple myeloma patients]. Bull Cancer 2023:S0007-4551(23)00215-1. [PMID: 37225617 DOI: 10.1016/j.bulcan.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Florian Slimano
- CHU de Reims, université de Reims Champagne-Ardenne, BioSpecT, pharmacie, 51100 Reims, France; Société française de pharmacie oncologique (SFPO), Paris, France
| | - Jean-François Tournamille
- Institut Bergonié, pharmacie, 33000 Bordeaux, France; Société française de pharmacie oncologique (SFPO), Paris, France
| | - Christophe Bardin
- AP-HP, hôpital Cochin, service de pharmacie clinique, 75014 Paris, France; Société française de pharmacie oncologique (SFPO), Paris, France
| | - Isabelle Madelaine
- AP-HP, hôpital Saint-Louis, pharmacie, 75000 Paris, France; Société française de pharmacie oncologique (SFPO), Paris, France
| | - Cyrille Hulin
- CHU de Bordeaux, service d'hématologie et de thérapie cellulaire, Bordeaux, France; Intergroupe francophone du myélome (IFM), Paris, France
| | - Philippe Moreau
- CHU Hôtel-Dieu, Nantes université, hématologie clinique, 44000 Nantes, France; Intergroupe francophone du myélome (IFM), Paris, France
| | - Catherine Rioufol
- Université Lyon 1, CICLY, hospices civils de Lyon, groupement hospitalier Sud, unité de pharmacie clinique oncologique, 69310 Pierre-Bénite, France; Société française de pharmacie oncologique (SFPO), Paris, France.
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17
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Vinke PC, Combalia M, de Bock GH, Leyrat C, Spanjaart AM, Dalle S, Gomes da Silva M, Fouda Essongue A, Rabier A, Pannard M, Jalali MS, Elgammal A, Papazoglou M, Hacid MS, Rioufol C, Kersten MJ, van Oijen MG, Suazo-Zepeda E, Malhotra A, Coquery E, Anota A, Preau M, Fauvernier M, Coz E, Puig S, Maucort-Boulch D. Monitoring multidimensional aspects of quality of life after cancer immunotherapy: protocol for the international multicentre, observational QUALITOP cohort study. BMJ Open 2023; 13:e069090. [PMID: 37105689 PMCID: PMC10151860 DOI: 10.1136/bmjopen-2022-069090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Immunotherapies, such as immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy, have significantly improved the clinical outcomes of various malignancies. However, they also cause immune-related adverse events (irAEs) that can be challenging to predict, prevent and treat. Although they likely interact with health-related quality of life (HRQoL), most existing evidence on this topic has come from clinical trials with eligibility criteria that may not accurately reflect real-world settings. The QUALITOP project will study HRQoL in relation to irAEs and its determinants in a real-world study of patients treated with immunotherapy. METHODS AND ANALYSIS This international, observational, multicentre study takes place in France, the Netherlands, Portugal and Spain. We aim to include about 1800 adult patients with cancer treated with immunotherapy in a specifically recruited prospective cohort, and to additionally obtain data from historical real-world databases (ie, databiobanks) and medical administrative registries (ie, national cancer registries) in which relevant data regarding other adult patients with cancer treated with immunotherapy has already been stored. In the prospective cohort, clinical health status, HRQoL and psychosocial well-being will be monitored until 18 months after treatment initiation through questionnaires (at baseline and 3, 6, 12 and 18 months thereafter), and by data extraction from electronic patient files. Using advanced statistical methods, including causal inference methods, artificial intelligence algorithms and simulation modelling, we will use data from the QUALITOP cohort to improve the understanding of the complex relationships among treatment regimens, patient characteristics, irAEs and HRQoL. ETHICS AND DISSEMINATION All aspects of the QUALITOP project will be conducted in accordance with the Declaration of Helsinki and with ethical approval from a suitable local ethics committee, and all patients will provide signed informed consent. In addition to standard dissemination efforts in the scientific literature, the data and outcomes will contribute to a smart digital platform and medical data lake. These will (1) help increase knowledge about the impact of immunotherapy, (2) facilitate improved interactions between patients, clinicians and the general population and (3) contribute to personalised medicine. TRIAL REGISTRATION NUMBER NCT05626764.
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Affiliation(s)
- Petra C Vinke
- Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marc Combalia
- Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
- Dermatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Geertruida H de Bock
- Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Clémence Leyrat
- Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne Mea Spanjaart
- Hematology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- LYMMCARE, Amsterdam, The Netherlands
| | - Stephane Dalle
- Dermatology, Cancer Research Center of Lyon, Lyon Sud Hospital, Pierre-Bénite, France
- University Claude Bernard Lyon 1, Villeurbanne, France
- ImmuCare, Cancer Institute of the Hospices Civils de Lyon, Lyon, France
| | | | | | - Aurélie Rabier
- ImmuCare, Cancer Institute of the Hospices Civils de Lyon, Lyon, France
| | - Myriam Pannard
- INSERM Unit U1296 Radiation: Defence, Health, Environment, Lumière University Lyon 2 Psychology Institute, Bron, France
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, Massachusetts, USA
| | - Amal Elgammal
- Scientific Academy for Service Technology e.V. (ServTech), Potsdam, Germany
- Egypt University of Informatics, Cairo, Egypt
| | - Mike Papazoglou
- Scientific Academy for Service Technology e.V. (ServTech), Potsdam, Germany
- School of Computer Science and Engineering, University of New South Wales, Sydney, New South Wales, Australia
- School of Computing, Macquarie University, Sydney, New South Wales, Australia
| | - Mohand-Said Hacid
- LIRIS, CNRS UMR 5205, Universite Claude Bernard Lyon 1, Villeurbanne, France
| | - Catherine Rioufol
- Clinical Oncology Pharmacy Department, Hospital Lyon-South, Cancer Institute of the Hospices Civils de Lyon, Pierre-Benite, France
| | - Marie-José Kersten
- Hematology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- LYMMCARE, Amsterdam, The Netherlands
| | - Martijn Gh van Oijen
- Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Erick Suazo-Zepeda
- Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ananya Malhotra
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Emmanuel Coquery
- LIRIS, CNRS UMR 5205, Universite Claude Bernard Lyon 1, Villeurbanne, France
| | - Amélie Anota
- Direction of Clinical Research and Innovation & Human and Social Sciences, Centre Léon Bérard, Lyon, France
- French National platform Quality of Life and Cancer, Lyon, France
| | - Marie Preau
- INSERM Unit U1296 Radiation: Defence, Health, Environment, Lumière University Lyon 2 Psychology Institute, Bron, France
| | - Mathieu Fauvernier
- University Claude Bernard Lyon 1, Villeurbanne, France
- Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
- UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, CNRS, Villeurbanne, France
| | - Elsa Coz
- University Claude Bernard Lyon 1, Villeurbanne, France
- Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
- UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, CNRS, Villeurbanne, France
| | - Susana Puig
- Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
- Dermatology, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | - Delphine Maucort-Boulch
- University Claude Bernard Lyon 1, Villeurbanne, France
- Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, France
- UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, CNRS, Villeurbanne, France
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18
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Herledan C, Cerfon MA, Baudouin A, Larbre V, Lattard C, Poletto N, Ranchon F, Rioufol C. Impact of pharmaceutical care interventions on multidisciplinary care of older patients with cancer: A systematic review. J Geriatr Oncol 2023; 14:101450. [PMID: 36813686 DOI: 10.1016/j.jgo.2023.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/22/2022] [Accepted: 02/09/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Optimizing medication use is a major issue in older patients with cancer and pharmacists are increasingly involved in their multidisciplinary care. The implementation of pharmaceutical care interventions must be supported by impact evaluations to enable their development and funding. This systematic review aims to synthesize evidence on the impact of pharmaceutical care interventions in older patients with cancer. MATERIALS AND METHODS A comprehensive search was performed in the PubMed/Medline, Embase, and Web of Science databases, for articles reporting evaluations of pharmaceutical care interventions for patients with cancer aged 65 years or older. RESULTS Eleven studies met the selection criteria. Most pharmacists were part of multidisciplinary geriatric oncology teams. Whether in outpatient or inpatient settings, interventions had common components, including patient interview, medication reconciliation, and comprehensive medication review to assess drug-related problems (DRPs). DRPs were identified in 95% of patients with 1.7 to 3 DRPs on average. Pharmacist recommendations resulted in a 20-40% reduction in the total number of DRPs and a 20-25% decrease in the prevalence of DRP. Prevalence of potentially inappropriate or omitted medications and their subsequent deprescribing or addition varied greatly between studies, notably depending on detection tools used. Clinical impact was insufficiently evaluated. Only one study reported a reduction of anticancer treatment toxicities following a joint pharmaceutical and geriatric assessment. A single economic evaluation calculated a potential net benefit of $3,864.23 per patient resulting from the intervention. DISCUSSION These encouraging results must be confirmed by more robust evaluations to support the involvement of pharmacists in multidisciplinary care of older patients with cancer.
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Affiliation(s)
- Chloé Herledan
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France.
| | - Marie-Anne Cerfon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France
| | - Amandine Baudouin
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France
| | - Virginie Larbre
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Claire Lattard
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Nicolas Poletto
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France
| | - Florence Ranchon
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Catherine Rioufol
- Department of Pharmacy, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex 69495, France; Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
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19
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Herledan C, Cerfon M, Baudouin A, Ranchon F, Falandry C, Rioufol C. Contribution of a clinical pharmacist in a multidisciplinary assessment of older patients with cancer. J Geriatr Oncol 2022. [DOI: 10.1016/s1879-4068(22)00395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Beaurain M, Rioufol C, Vantard N, Teixeira A, Baudouin A, Herledan C, Souquet PJ, Couraud S, Ranchon F. Intravenous route for folate supplementation in a patient with celiac disease treated by pemetrexed-based chemotherapy for non-small-cell lung cancer. J Oncol Pharm Pract 2022; 29:750-754. [PMID: 35918825 DOI: 10.1177/10781552221117734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Oral folic acid supplementation is essential for patients treated with pemetrexed, to prevent the risk of severe hematologic toxicity. In case of intestinal absorption disorder, no recommendations exist for intravenous folic acid supplementation. CASE REPORT We describe a 74-year-old patient with multimetastatic non-small-cell lung adenocarcinoma, receiving first-line chemotherapy with carboplatin AUC5, pemetrexed 500 mg/m2 and pembrolizumab 200 mg intravenously every 3 weeks. The patient presented neglected celiac disease, resulting in malabsorption syndrome with iron and folic acid deficiency. The question was how to administer folic acid supplementation during the pemetrexed-based chemotherapy. MANAGEMENT AND OUTCOMES Intravenous injection of 200 mg levoleucovorin on day 1 of cycle 1 of pemetrexed-based chemotherapy was administered and well tolerated. During the second cycle, the levoleucovorin perfusion was not renewed by omission. The patient was hospitalized for 7 days because of febrile aplasia. Piperacillin-tazobactam was started, and then switched to amoxicillin-clavulanate plus ciprofloxacin. After this episode of post-chemotherapy febrile aplasia, it was decided to systematically supplement the patient with intravenous levoleucovorin, with blood folate concentration monitoring at each cycle. At 16 months after start of treatment, the patient was in complete remission, indicating that the immune-chemotherapy was effective, with no further febrile neutropenia. DISCUSSION/CONCLUSION This case report highlights intravenous levoleucovorin supplementation as an alternative to oral folic acid if needed during pemetrexed-antifolate-based chemotherapy.
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Affiliation(s)
- Marie Beaurain
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France.,Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Alexandre Teixeira
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Chloe Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Pierre-Jean Souquet
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Pierre-Bénite, France
| | - Sebastien Couraud
- Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France.,Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Pierre-Bénite, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France.,Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
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21
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Hayden PJ, Roddie C, Bader P, Basak GW, Bonig H, Bonini C, Chabannon C, Ciceri F, Corbacioglu S, Ellard R, Sanchez-Guijo F, Jäger U, Hildebrandt M, Hudecek M, Kersten MJ, Köhl U, Kuball J, Mielke S, Mohty M, Murray J, Nagler A, Rees J, Rioufol C, Saccardi R, Snowden JA, Styczynski J, Subklewe M, Thieblemont C, Topp M, Ispizua ÁU, Chen D, Vrhovac R, Gribben JG, Kröger N, Einsele H, Yakoub-Agha I. Management of adults and children receiving CAR T-cell therapy: 2021 best practice recommendations of the European Society for Blood and Marrow Transplantation (EBMT) and the Joint Accreditation Committee of ISCT and EBMT (JACIE) and the European Haematology Association (EHA). Ann Oncol 2022; 33:259-275. [PMID: 34923107 DOI: 10.1016/j.annonc.2021.12.003] [Citation(s) in RCA: 130] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Several commercial and academic autologous chimeric antigen receptor T-cell (CAR-T) products targeting CD19 have been approved in Europe for relapsed/refractory B-cell acute lymphoblastic leukemia, high-grade B-cell lymphoma and mantle cell lymphoma. Products for other diseases such as multiple myeloma and follicular lymphoma are likely to be approved by the European Medicines Agency in the near future. DESIGN The European Society for Blood and Marrow Transplantation (EBMT)-Joint Accreditation Committee of ISCT and EBMT (JACIE) and the European Haematology Association collaborated to draft best practice recommendations based on the current literature to support health care professionals in delivering consistent, high-quality care in this rapidly moving field. RESULTS Thirty-six CAR-T experts (medical, nursing, pharmacy/laboratory) assembled to draft recommendations to cover all aspects of CAR-T patient care and supply chain management, from patient selection to long-term follow-up, post-authorisation safety surveillance and regulatory issues. CONCLUSIONS We provide practical, clinically relevant recommendations on the use of these high-cost, logistically complex therapies for haematologists/oncologists, nurses and other stakeholders including pharmacists and health sector administrators involved in the delivery of CAR-T in the clinic.
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Affiliation(s)
- P J Hayden
- Department of Haematology, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | - C Roddie
- UCL Cancer Institute, London, UK; University College London Hospital NHS Foundation Trust, London, UK.
| | - P Bader
- Clinic for Children and Adolescents, University Children's Hospital, Frankfurt, Germany
| | - G W Basak
- Medical University of Warsaw, Department of Hematology, Transplantation and Internal Medicine, Warsaw, Poland
| | - H Bonig
- Institute for Transfusion Medicine and Immunohematology of Goethe University and German Red Cross Blood Service, Frankfurt, Germany
| | - C Bonini
- Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - C Chabannon
- Aix-Marseille université, Inserm CBT-1409, Institut Paoli-Calmettes, centre de thérapie cellulaire, unité de transplantation et de thérapie cellulaire, département de biologie du cancer, Marseille, France
| | - F Ciceri
- Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - S Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Franz-Josef-Strauss-Allee 11, University Hospital of Regensburg, Regensburg, Germany
| | - R Ellard
- Royal Marsden Hospital, Fulham Rd, London, UK
| | - F Sanchez-Guijo
- IBSAL-Hospital Universitario de Salamanca, CIC, Universidad de Salamanca, Salamanca, Spain
| | - U Jäger
- Clinical Department for Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - M Hildebrandt
- Department of Transfusion Medicine, Cell Therapeutics and Haemostaseology, LMU University Hospital Grosshadern, Munich
| | - M Hudecek
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - M J Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE, Amsterdam, the Netherlands
| | - U Köhl
- Fraunhofer Institute for Cell Therapy and Immunology (IZI) and Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany; Institute of Cellular Therapeutics, Hannover Medical School, Hannover, Germany
| | - J Kuball
- Department of Hematology and Centre for Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - S Mielke
- Karolinska Institutet and University Hospital, Department of Laboratory Medicine/Department of Cell Therapy and Allogeneic Stem Cell Transplantation (CAST), Stockholm, Sweden
| | - M Mohty
- Hôpital Saint-Antoine, APHP, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - J Murray
- Christie Hospital NHS Trust, Manchester, UK
| | - A Nagler
- The Chaim Sheba Medical Center, Tel-Hashomer, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - J Rees
- University College London Hospital NHS Foundation Trust, London, UK; UCL Institute of Neurology, University College of London Hospitals NHS Foundation Trust, London, UK
| | - C Rioufol
- Hospices Civils de Lyon, UCBL1, EMR 3738 CICLY, Lyon, France
| | - R Saccardi
- Cell Therapy and Transfusion Medicine Department, Careggi University Hospital, Florence, Italy
| | - J A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J Styczynski
- Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland
| | - M Subklewe
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Thieblemont
- AP-HP, Saint-Louis Hospital, Hemato-oncology, University of Paris, Paris, France
| | - M Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Á U Ispizua
- Department of Hematology, ICMHO, Hospital Clínic de Barcelona, Barcelona, Spain
| | - D Chen
- University College London Hospital NHS Foundation Trust, London, UK; Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - R Vrhovac
- Department of Haematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - J G Gribben
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - N Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg, Germany
| | - H Einsele
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - I Yakoub-Agha
- CHU de Lille, Univ Lille, INSERM U1286, Infinite, Lille, France
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22
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Martin J, Barral M, Janoly Dumenil A, Carre E, Poletto N, Goutelle S, Rioufol C, Novais T, Pivot C, Hoegy D, Mouchoux C. Implementation assessment of a patient personalized clinical pharmacy programme (5P project) into orthogeriatric care pathway. J Clin Pharm Ther 2022; 47:956-963. [PMID: 35218218 DOI: 10.1111/jcpt.13627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The orthogeriatric path (hip-fractured elderly patients) is composed of several transition points (emergency surgery, orthopaedic, geriatric and rehabilitation units). The intervention of clinical pharmacists can ensure the continuity of patients' drug management during their hospital stay. The aim of the study was to assess the implementation of clinical pharmacy activities in an orthogeriatric pathway, regarding its impact on medication error prevention, the healthcare professionals' and patients' satisfaction, and the estimated associated pharmaceutical workload. METHODS Participants were aged 75 or older and managed for proximal femoral fracture. Their admission prescription was reviewed. If they were evaluated at high risk of adverse event (AE), medication reconciliation (MedRec) and pharmaceutical interviews (admission, discharge, and targeted on oral anticoagulant) were added at different steps of their care pathway. The achievement and duration of each clinical pharmacy activity were recorded. The number of pharmaceutical interventions (PI) made during prescription review, and unintentional discrepancies (UID) identified during MedRec were collected. A satisfaction questionnaire was sent to patients and healthcare professionals. RESULTS AND DISCUSSION Among 455 included patients, 284 patients were considered at high risk of AE. Clinical pharmacy activity achievement rates varied between 12% and 98%. A total of 622 PI and 333 UID were identified. The overall patients' and healthcare professionals' satisfaction was rated from 63% to 100%. The total workload was estimated at 376 h: on average 16 min per prescription review, 43 min per admission MedRec, 26 min per discharge MedRec and 17 to 25 minutes per interview. CONCLUSION The implementation of the programme showed a high potential of drug management securing. To sustain it, additional pharmaceutical human resources and high-performance computing tools are needed.
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Affiliation(s)
- Julie Martin
- Pharmacie, Hospices Civils de Lyon, Lyon, France
| | | | - Audrey Janoly Dumenil
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Emmanuelle Carre
- Pharmacie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Poletto
- Pharmacie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Sylvain Goutelle
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Villeurbanne, France
| | - Catherine Rioufol
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.,EA3738, CICLY Centre pour l'innovation en cancérologie de Lyon, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Teddy Novais
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Univ Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Christine Pivot
- Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Delphine Hoegy
- Pharmacie, Hospices Civils de Lyon, Lyon, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Christelle Mouchoux
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, INSERM U1028, CNRS, UMR5292, Lyon, France
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Collomb B, Dubromel A, Caffin AG, Herledan C, Larbre V, Baudouin A, Cerutti A, Couturier L, Maire M, Karlin L, Maucort-Boulch D, Huot L, Dalle S, Bachy E, Ghesquieres H, Salles G, Couraud S, You B, Freyer G, Trillet-Lenoir V, Ranchon F, Rioufol C. Assessment of Patient Reported Outcomes (PROs) in Outpatients Taking Oral Anticancer Drugs Included in the Real-Life Oncoral Program. Cancers (Basel) 2022; 14:cancers14030660. [PMID: 35158928 PMCID: PMC8833408 DOI: 10.3390/cancers14030660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/25/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Patients receiving oral anticancer agents (OAAs) have a substantial symptom burden. Given the trend toward patient-centered care, the use of patient-reported outcomes (PROs) seems appropriate to secure medication management, and to improve clinical decision-making. The aim of this study was to assess symptoms potentially related to adverse events experienced by cancer outpatients treated by OAAs using PROs. In total, 407 questionnaires were completed by 63 patients, in which 2333 symptoms were reported. Almost three-quarters (74.6%) reported at least one high-level symptom. The symptoms most commonly experienced were fatigue, various psychological disorders and general pain. This initiative is the first step in the implementation of symptom assessment by PROs in patients treated by OAAs. The results highlight the need for close coordination between community and hospital health professionals, and the integration of patient self-reporting systems in oncologic clinical practice. Abstract Background In previous studies, patient-reported outcomes (PROs) have been shown to improve survival in cancer patients. The aim of the present study was to assess symptoms potentially related to adverse events experienced by cancer outpatients treated by oral anticancer agents (OAAs) using PROs. Methods Between September 2018 and May 2019, outpatients starting OAAs were included in a 12-week follow-up to assess 15 symptoms listed in the National Cancer Institute PRO Common Terminology Criteria for Adverse Events, using a 5-point scale of severity or frequency. Patients were requested to alert a referral nurse or pharmacist when they self-assessed high-level (level 3 or 4) symptoms. Results 407 questionnaires were completed by 63 patients in which 2333 symptoms were reported. Almost three-quarters (74.6%) reported at least one high-level symptom. The symptoms that were most commonly experienced were fatigue (>9 in 10 patients; 13.2% of symptoms declared), various psychological disorders (>9 in 10 patients; 28.6% of symptoms declared) and general pain (>8 in 10 patients; 9.4% of symptoms declared). Conclusion PROs are appropriate to detect potential adverse events in cancer outpatients treated by OAAs. This study is the first step for integrating the patient’s perspective in a digital e-health device in routine oncology care.
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Affiliation(s)
- Bastien Collomb
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Amélie Dubromel
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Anne Gaëlle Caffin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Chloé Herledan
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
| | - Virginie Larbre
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
| | - Amandine Baudouin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Ariane Cerutti
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Laurence Couturier
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Magali Maire
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Lionel Karlin
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Delphine Maucort-Boulch
- Department of Statistics and Bioinformatics, Hospices Civils de Lyon, 69002 Lyon, France
- CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, 69622 Lyon, France
| | - Laure Huot
- Cellule Innovation, Département de la Recherche Clinique et de L'innovation, Hospices Civils de Lyon, 69002 Lyon, France
| | - Stéphane Dalle
- Dermatology Department, Groupement Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Emmanuel Bachy
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Hervé Ghesquieres
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Gilles Salles
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Sébastien Couraud
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
- Department of Pneumology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Benoit You
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
- Department of Oncology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Gilles Freyer
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
- Department of Oncology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Véronique Trillet-Lenoir
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
- Department of Oncology, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
| | - Florence Ranchon
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
| | - Catherine Rioufol
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 69495 Lyon, France
- CICLY Centre pour l'Innovation en Cancérologie de Lyon, Université Lyon 1-EA 3738, 69921 Lyon, France
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Barral M, Martin J, Carre E, Janoly-Dumenil A, Ranchon F, Parat S, Rioufol C, Goutelle S, Bourguignon L, Novais T, Doh S, Malatray M, Chaudier P, Gauthier J, Pivot C, Mouchoux C, Hoegy D. How a Patient Personalised Clinical Pharmacy Programme Can Secure Therapeutic Care in an Orthogeriatric Care Pathway (5P Project)? Clin Interv Aging 2021; 16:1857-1867. [PMID: 34707352 PMCID: PMC8544550 DOI: 10.2147/cia.s325035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023] Open
Abstract
Background A new model was developed for integrating a personalised clinical pharmacy programme (5P project) into the orthogeriatric care pathway. Objective To secure the therapeutic care of orthogeriatric patients. Design and Setting Prospective descriptive study in a multisite teaching hospital from June 2019 to January 2020. Subjects Patients aged ≥75 years admitted for hip fracture. Methods A prescription review was performed for all patients at inclusion. Other clinical pharmacy activities (additional prescription review, pharmaceutical interviews, medication reconciliation) were dedicated to “high-risk” patients. Potential medication errors (ME), either pharmaceutical interventions (PI) or unintentional discrepancies (UID), were recorded. The potential clinical impact of PI was evaluated by a pluriprofessional expert panel using a validated tool. Results In the 455 patients included, 955 potential ME were detected, that is ≥1 potential ME for 324/455 (71%) patients. In acute care, 561 PI were formulated during prescription review for 440/455 (97%) patients and 348/561 (62%) were accepted by physicians. Medication reconciliation was performed for 213 patients, 316 UID were identified. In rehabilitation units, a second prescription review was performed for 112/122 (92%) “high-risk” patients, leading to 61 PI. The clinical impact was evaluated for 519/622 (83%) PI. A consensus was obtained for 310/519 (60%) PI: 147/310 (47%) were rated as having minor clinical impact, 138/310 (45%) moderate, 22/310 (7%) major, 2/310 (0.6%) vital, and 1/310 (0.3%) null. Conclusion The 5P project secured the orthogeriatric care pathway by detecting a great number of potential ME, including PI mostly considered as having a significant clinical impact.
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Affiliation(s)
| | - Julie Martin
- Pharmacie, Hospices Civils de Lyon, Lyon, France
| | - Emmanuelle Carre
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Audrey Janoly-Dumenil
- Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,6-EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Florence Ranchon
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,EA3738, CICLY Centre pour l'Innovation en cancérologie de Lyon, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Stéphanie Parat
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Catherine Rioufol
- Pharmacie Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,EA3738, CICLY Centre pour l'Innovation en cancérologie de Lyon, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
| | - Sylvain Goutelle
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Villeurbanne, France
| | - Laurent Bourguignon
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital Pierre Garraud, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Villeurbanne, France
| | - Teddy Novais
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Sebastien Doh
- Service de Gériatrie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Matthieu Malatray
- Service de Chirurgie Orthopédique Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Philippe Chaudier
- Service de Chirurgie Orthopédique Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jerome Gauthier
- Service d'anesthésie et réanimation Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Christine Pivot
- Pharmacie Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Christelle Mouchoux
- Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,Pharmacie Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, Lyon, France
| | - Delphine Hoegy
- Pharmacie, Hospices Civils de Lyon, Lyon, France.,Institut des Sciences Pharmaceutiques et Biologiques, Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France.,6-EA 4129 P2S Parcours Santé Systémique- Univ Claude Bernard Lyon 1, Univ Lyon 1, Lyon, France
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Dubromel A, Caffin AG, Hacard F, Vantard N, Baudouin A, Herledan C, Larbre V, Schwiertz V, Nosbaum A, Pralong P, Nicolas JF, Berard F, Rioufol C, Ranchon F. Preparations of exploration of immediate hypersensitivity to antineoplastic agents: An oncology pharmacy perspective. J Oncol Pharm Pract 2021; 28:1552-1559. [PMID: 34546819 DOI: 10.1177/10781552211035695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cancer patients are being exposed to antineoplastic drugs more frequently and for longer periods, resulting in a higher risk of hypersensitivity reactions. The aim of this study was to assess the pharmaceutical time and direct cost of drug allergy explorations following immediate hypersensitivity reactions to antineoplastic agents. METHODS A micro-costing method was used to collect data on consumption of human and material resources for allergy exploration preparations. The monetisation was carried out on the basis of prices and hourly wage costs applied in 2018. The number and type of allergy explorations prepared by the pharmacy as well as nature of antineoplastic drugs tested, and the number of culprit drugs reintroductions were collected. RESULTS Almost 1.5 h is required to realise allergy tests for one patient including pharmacist time for prescription analysis and pharmacy technician's time for tests preparation. The mean manufacturing cost of these tests is estimated at €62.87 (€57.82-65.49) per culprit drug for one patient. Programming patients according to culprit drugs tested allows rationalising healthcare provider time and increasing efficiency. From January 2010 to December 2018, 277 patients were tested and 490 allergy explorations were performed, corresponding to more than 5000 preparations. Mostly, the culprit drug could be reintroduced (n = 383, 78.2%) allowing patients to receive the best possible treatment. CONCLUSION Management of hypersensitivity reactions is constantly progressing, as it contributes to improving patient care in oncology. This activity is time-consuming for the pharmacy team but allows patients with previous hypersensitivity reaction to continue effective treatment.
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Affiliation(s)
- Amélie Dubromel
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France
| | - Anne-Gaëlle Caffin
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France
| | - Florence Hacard
- Groupement Hospitalier Sud, Allergy and Clinical Immunology Department, 26900Hospices Civils de Lyon, France
| | - Nicolas Vantard
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France
| | - Amandine Baudouin
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France
| | - Chloé Herledan
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France.,27098Université Lyon 1, EA 3738, Centre d'Innovation en Cancérologie de Lyon, France
| | - Virginie Larbre
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France.,27098Université Lyon 1, EA 3738, Centre d'Innovation en Cancérologie de Lyon, France
| | - Vérane Schwiertz
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France
| | - Audrey Nosbaum
- Groupement Hospitalier Sud, Allergy and Clinical Immunology Department, 26900Hospices Civils de Lyon, France
| | - Pauline Pralong
- Groupement Hospitalier Sud, Allergy and Clinical Immunology Department, 26900Hospices Civils de Lyon, France
| | - Jean-François Nicolas
- Groupement Hospitalier Sud, Allergy and Clinical Immunology Department, 26900Hospices Civils de Lyon, France.,Université Lyon 1, Inserm, U111 CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Frédéric Berard
- Groupement Hospitalier Sud, Allergy and Clinical Immunology Department, 26900Hospices Civils de Lyon, France.,Université Lyon 1, Inserm, U111 CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Catherine Rioufol
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France.,27098Université Lyon 1, EA 3738, Centre d'Innovation en Cancérologie de Lyon, France
| | - Florence Ranchon
- Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, 26900Hospices Civils de Lyon, France.,27098Université Lyon 1, EA 3738, Centre d'Innovation en Cancérologie de Lyon, France
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26
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Francis R, Guinet Lacoste A, Aygalinc M, Rioufol C, Carre E. Infections urinaires en service de rééducation neurologique : suivi sur 7 ans de 3 indicateurs qualité de prescription des antibiotiques. Infect Dis Now 2021. [DOI: 10.1016/j.idnow.2021.06.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Laplace N, Kepenekian V, Friggeri A, Vassal O, Ranchon F, Rioufol C, Gertych W, Villeneuve L, Glehen O, Bakrin N. Sodium thiosulfate protects from renal impairement following hyperthermic intraperitoneal chemotherapy (HIPEC) with Cisplatin. Int J Hyperthermia 2021; 37:897-902. [PMID: 32689832 DOI: 10.1080/02656736.2020.1795277] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to provide benefits in the management of peritoneal metastasis. Cisplatin (CDDP) is one of the most frequently used drugs for peritoneal infusion. A major restriction is that CDDP causes renal toxicity and acute renal failure, sometimes leading to chronic renal failure. The aim of the present study was to assess the impact of sodium thiosulfate (ST) in preventing renal impairment (RI) following HIPEC with CDDP. METHODS This prospective study assessed the RI rates for all patients who underwent HIPEC with CDDP during two successive periods: without ST (nST Period; from November 2016 to September 2017) and with ST (ST Period; from October 2017 to March 2018). During the ST Period, patients received an ST infusion at 9 mg/m2 prior to HIPEC and at 12 mg/m2 at the end of the procedure. RI was defined by postoperative serum creatinine >1.6 times elevation of baseline value. The impact of ST treatment was evaluated by comparison of the RI rates between the two periods. RESULTS During ST Period, none of 38 patients (0%) developed RI versus 11/35 patients (31.4%) during the nST Period (p < .005); 2 of whom required definitive hemodialysis. Baseline characteristics, background circumstances, indications and laboratory parameters before HIPEC were comparable between the two groups, as well as CDDP dose use during HIPEC. CONCLUSION ST appears to be an effective drug for the prevention of the renal toxicity of CDDP used for HIPEC and should be used for all such procedures.
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Affiliation(s)
- N Laplace
- Department of Surgical Oncology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,EMR 3738, Faculte de Medecine et de Maieutique Lyon-Sud Charles Merieux,, Lyon 1 University, Lyon, France
| | - V Kepenekian
- Department of Surgical Oncology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,EMR 3738, Faculte de Medecine et de Maieutique Lyon-Sud Charles Merieux,, Lyon 1 University, Lyon, France
| | - A Friggeri
- Department of Anaesthesiology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,UMR CNRS 5308, Inserm U1111, Claude Bernard University, Lyon 1, Lyon, France
| | - O Vassal
- Department of Anaesthesiology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,UMR CNRS 5308, Inserm U1111, Claude Bernard University, Lyon 1, Lyon, France
| | - F Ranchon
- EMR 3738, Faculte de Medecine et de Maieutique Lyon-Sud Charles Merieux,, Lyon 1 University, Lyon, France.,Department of Pharmacology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - C Rioufol
- EMR 3738, Faculte de Medecine et de Maieutique Lyon-Sud Charles Merieux,, Lyon 1 University, Lyon, France.,Department of Pharmacology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - W Gertych
- EMR 3738, Faculte de Medecine et de Maieutique Lyon-Sud Charles Merieux,, Lyon 1 University, Lyon, France.,Department of Gynecology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - L Villeneuve
- EMR 3738, Faculte de Medecine et de Maieutique Lyon-Sud Charles Merieux,, Lyon 1 University, Lyon, France.,Service de Recherche et Epidémiologie Cliniques, Pôle de Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - O Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,EMR 3738, Faculte de Medecine et de Maieutique Lyon-Sud Charles Merieux,, Lyon 1 University, Lyon, France
| | - N Bakrin
- Department of Surgical Oncology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,EMR 3738, Faculte de Medecine et de Maieutique Lyon-Sud Charles Merieux,, Lyon 1 University, Lyon, France
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Prely H, Herledan C, Caffin AG, Baudouin A, Larbre V, Maire M, Schwiertz V, Vantard N, Ranchon F, Rioufol C. Real-life drug-drug and herb-drug interactions in outpatients taking oral anticancer drugs: comparison with databases. J Cancer Res Clin Oncol 2021; 148:707-718. [PMID: 33914124 DOI: 10.1007/s00432-021-03645-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Due to polypharmacy and the rising popularity of complementary and alternative medicines (CAM), oncology patients are particularly at risk of drug-drug interactions (DDI) or herb-drug interactions (HDI). The aims of this study were to assess DDI and HDI in outpatients taking oral anticancer drug. METHOD All prescribed and non-prescribed medications, including CAM, were prospectively collected by hospital pharmacists during a structured interview with the patient. DDI and HDI were analyzed using four interaction software programs: Thériaque®, Drugs.com®, Hédrine, and Memorial Sloan Kettering Cancer Center (MSKCC) database. All detected interactions were characterized by severity, risk and action mechanism. The need for pharmaceutical intervention to modify drug use was determined on a case-by-case basis. RESULTS 294 patients were included, with a mean age of 67 years [55-79]. The median number of chronic drugs per patient was 8 [1-29] and 55% of patients used at least one CAM. At least 1 interaction was found for 267 patients (90.8%): 263 (89.4%) with DDI, 68 (23.1%) with HDI, and 64 (21.7%) with both DDI and HDI. Only 13% of the DDI were found in Thériaque® and Drugs.com® databases, and 125 (2.5%) were reported with similar level of risk on both databases. 104 HDI were identified with only 9.5% of the interactions found in both databases. 103 pharmaceutical interventions were performed, involving 61 patients (20.7%). CONCLUSION Potentially clinically relevant drug interaction were frequently identified in this study, showing that several databases and structured screening are required to detect more interactions and optimize medication safety.
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Affiliation(s)
- H Prely
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacy, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - C Herledan
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacy, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Centre Pour l'Innovation en Cancérologie de Lyon, Université Lyon 1- EA 3738, Lyon, France
| | - A G Caffin
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacy, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - A Baudouin
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacy, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - V Larbre
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacy, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Centre Pour l'Innovation en Cancérologie de Lyon, Université Lyon 1- EA 3738, Lyon, France
| | - M Maire
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacy, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - V Schwiertz
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacy, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - N Vantard
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacy, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France
| | - F Ranchon
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacy, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France.,Centre Pour l'Innovation en Cancérologie de Lyon, Université Lyon 1- EA 3738, Lyon, France
| | - C Rioufol
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacy, 165 Chemin du Grand Revoyet, 69495, Pierre Bénite, France. .,Centre Pour l'Innovation en Cancérologie de Lyon, Université Lyon 1- EA 3738, Lyon, France.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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30
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Périchou J, Ranchon F, Herledan C, Huot L, Larbre V, Carpentier I, Lazareth A, Karlin L, Beny K, Vantard N, Schwiertz V, Caffin AG, Baudouin A, Sesques P, Brisou G, Ghesquières H, Salles G, Rioufol C. Immunomodulatory drugs in multiple myeloma: Impact of the SCARMET (Self CARe and MEdication Toxicity) educational intervention on outpatients' knowledge to manage adverse effects. PLoS One 2020; 15:e0243309. [PMID: 33275634 PMCID: PMC7717911 DOI: 10.1371/journal.pone.0243309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/18/2020] [Indexed: 12/18/2022] Open
Abstract
Long-term multiple myeloma therapy by immunomodulatory drugs (IMiDs) raises the question of management of adverse effects. The aim of this study is to assess the impact of an educational session for patients on the acquisition of knowledge to manage hematologic and thromboembolic adverse effects of IMiDs. In this prospective single-center study, patients attended an educational session with a hospital clinical pharmacist and a nurse. The primary endpoint was the patient's level of knowledge for the management of IMiDs adverse effects, assess with a dedicated questionnaire administered before the session then 1 and 6 months after. Assessment of knowledge was combined with self-assessment of certainty. The secondary endpoints were adherence and IMiD treatment satisfaction. 50 patients were included. Patient knowledge increased at 1 month (p<0.001) despite a loss of knowledge at 6 months (p<0.05). Six months after the educational intervention, the number of patients with skills considered satisfactory by the pharmacist and nurse increased (p<0.01). Most patients showed satisfactory adherence, with medication possession ratio ≥ 80%. The Self CARe and MEdication Toxicity (SCARMET) study highlighted the impact of multidisciplinary follow-up in multiple myeloma patients to improve knowledge of toxicity self-management.
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Affiliation(s)
- Juliette Périchou
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Florence Ranchon
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Chloé Herledan
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Laure Huot
- Département de la Recherche Clinique et de l’Innovation, Cellule Innovation, Hospices Civils de Lyon, Lyon, France
| | - Virginie Larbre
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | | | - Anne Lazareth
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Lionel Karlin
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Karen Beny
- Pharmacie Centrale, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Nicolas Vantard
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Vérane Schwiertz
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Anne Gaelle Caffin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Amandine Baudouin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
| | - Pierre Sesques
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Gabriel Brisou
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Hervé Ghesquières
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Gilles Salles
- Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Centre de Recherche en Cancérologie de Lyon, INSERM 1052 CNRS 5286, Université Lyon 1, Lyon, France
| | - Catherine Rioufol
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
- Université Lyon 1- EMR 3738, Lyon, France
- * E-mail:
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31
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Sesques P, Ferrant E, Safar V, Wallet F, Tordo J, Dhomps A, Karlin L, Brisou G, Vercasson M, Hospital‐Gustem C, Schwiertz V, Ranchon F, Rioufol C, Choquet M, Sujobert P, Ghergus D, Bouafia F, Golfier C, Lequeu H, Lazareth A, Novelli S, Devic P, Traverse Glehen A, Viel S, Venet F, Mialou V, Hequet O, Chauchet A, Arkam Y, Nicolas‐Virelizier E, Peyrade F, Cavalieri D, Ader F, Ghesquières H, Salles G, Bachy E. Commercial anti-CD19 CAR T cell therapy for patients with relapsed/refractory aggressive B cell lymphoma in a European center. Am J Hematol 2020; 95:1324-1333. [PMID: 32744738 DOI: 10.1002/ajh.25951] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/08/2020] [Accepted: 07/28/2020] [Indexed: 11/07/2022]
Abstract
Two autologous anti-CD19 chimeric antigen receptors (CAR) T cells (axicabtagene ciloleucel [axi-cel] and tisagenlecleucel [tisa-cel]) are commercially approved in Europe for relapsed/refractory (R/R) diffuse large B cell lymphoma (DLBCL). We performed a retrospective study to evaluate patterns of use, efficacy and safety for axi-cel and tisa-cel. Data from 70 patients who underwent apheresis for commercial CAR T cells between January 2018 and November 2019 in our institution were retrospectively collected. Sixty-one patients were infused. The median age at infusion was 59 years old (range 27-75 years). The median number of prior therapies was 3 (range, 2-6). The overall response rates (ORRs) at 1 month and 3 months were 63% and 45%, respectively, with 48% and 39% achieving a complete response (CR), respectively. After a median follow-up after infusion of 5.7 months, the median progression-free survival (PFS) was 3.0 months (95% CI, 2.8-8.8 months), and the median overall survival (OS) was 11.8 months (95% CI, 6.0-12.6 months). In multivariate analysis, factors associated with poor PFS were the number of previous lines of treatment before CAR T cells (≥4) (P = .010) and a C reactive protein (CRP) value >30 mg/L at the time of lymphodepletion (P < .001). Likewise, the only factor associated with a shorter OS was CRP >30 mg/L (P = .009). Cytokine release syndrome (CRS) of any grade occurred in 85% of patients, including 8% of patients with CRS of grade 3 or higher. Immune cell-associated neurotoxicity syndrome (ICANS) of any grade occurred in 28% of patients, including 10% of patients with ICANS of grade 3 or higher. Regarding efficacy and safety, no significant difference was found between axi-cel and tisa-cel. This analysis describes one of the largest real-life cohorts of patients treated with axi-cel and tisa-cel for R/R aggressive B cell lymphoma in Europe.
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Affiliation(s)
- Pierre Sesques
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Claude Bernard Lyon 1 University Lyon France
| | - Emmanuelle Ferrant
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Violaine Safar
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Florent Wallet
- Department of Critical Care Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Jérémie Tordo
- Department of Nuclear Medicine Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Anthony Dhomps
- Department of Nuclear Medicine Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Lionel Karlin
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Gabriel Brisou
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Claude Bernard Lyon 1 University Lyon France
| | - Marlène Vercasson
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Carole Hospital‐Gustem
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Vérane Schwiertz
- Department of Pharmacy Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Florence Ranchon
- Claude Bernard Lyon 1 University Lyon France
- Department of Pharmacy Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Catherine Rioufol
- Claude Bernard Lyon 1 University Lyon France
- Department of Pharmacy Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Marion Choquet
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Pierre Sujobert
- Claude Bernard Lyon 1 University Lyon France
- Department of Hematology Laboratory Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Lyon Cancer Research Center INSERM U1052 and CNRS UMR5286 Lyon France
| | - Dana Ghergus
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Fadhela Bouafia
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Camille Golfier
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Claude Bernard Lyon 1 University Lyon France
| | - Helène Lequeu
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Anne Lazareth
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Silvana Novelli
- Lyon Cancer Research Center INSERM U1052 and CNRS UMR5286 Lyon France
| | - Perrine Devic
- Department of Neurology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Alexandra Traverse Glehen
- Claude Bernard Lyon 1 University Lyon France
- Lyon Cancer Research Center INSERM U1052 and CNRS UMR5286 Lyon France
- Department of Pathology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
| | - Sébastien Viel
- Claude Bernard Lyon 1 University Lyon France
- Department of Biological Immunology Hospices Civils de Lyon, Lyon Sud Hospital Lyon France
- International Center for Research in Infectious Diseases INSERM U1111 and CNRS UMR5308 Lyon France
| | - Fabienne Venet
- Claude Bernard Lyon 1 University Lyon France
- Department of Clinical Immunology Hospices Civils de Lyon, Edouard Herriot Hospital Lyon France
| | - Valérie Mialou
- Department of Biology and Therapy Etablissement Français du Sang Auvergne‐Rhône‐Alpes Decines‐Charpieu France
| | - Olivier Hequet
- Department of Biology and Therapy Etablissement Français du Sang Auvergne‐Rhône‐Alpes Decines‐Charpieu France
| | - Adrien Chauchet
- Department of Hematology Besançon University Hospital Besançon France
| | - Yazid Arkam
- Department of Hematology Hopital Emile Muller Mulhouse France
| | | | | | - Doriane Cavalieri
- Department of Hematology Clermont Ferrand University Hospital Clermont Ferrand France
| | - Florence Ader
- Department of Infectious Disease Hospices Civils de Lyon, Croix Rousse Hospital Lyon France
| | - Hervé Ghesquières
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Claude Bernard Lyon 1 University Lyon France
- Lyon Cancer Research Center INSERM U1052 and CNRS UMR5286 Lyon France
| | - Gilles Salles
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Claude Bernard Lyon 1 University Lyon France
- Lyon Cancer Research Center INSERM U1052 and CNRS UMR5286 Lyon France
| | - Emmanuel Bachy
- Department of Hematology Hospices Civils de Lyon, Lyon Sud Hospital Pierre‐Bénite France
- Claude Bernard Lyon 1 University Lyon France
- Lyon Cancer Research Center INSERM U1052 and CNRS UMR5286 Lyon France
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Baudouin A, Herledan C, Poletto N, Guillemin MD, Maison O, Garreau R, Chillotti L, Parat S, Ranchon F, Rioufol C. Economic impact of clinical pharmaceutical activities in hospital wards: A systematic review. Res Social Adm Pharm 2020; 17:497-505. [PMID: 32819880 DOI: 10.1016/j.sapharm.2020.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The positive impact of clinical pharmacy services (CPS) in improving clinical outcomes such as reduction of drug related problems is well demonstrated. Despite these results, the deployment of these activities is not systematically observed in the hospital setting. OBJECTIVES This systematic review first aimed to describe existing evidence regarding economic evaluation of ward-based CPS focusing on the entire treatment of a patient in a hospital setting. Secondly, the quality of economic evaluations of existing evidence was assessed. METHODS A comprehensive literature search was performed in PubMed/Medline, Science Direct and the NHS Economic Evaluation databases from January 2000 to March 2019. English or French language articles describing an economic evaluation of ward-based CPS on inpatients in hospital settings were included. Articles not describing a single study, dealing with a CPS not considering the entire medication regimen of the patient or presenting both inpatient and outpatient CPS were excluded. Selected articles were analyzed according to Drummond's check-list for assessing economic evaluations. RESULTS Forty-one studies were included. About one third were American publications. CPS implemented in ICU represented about half of the selected articles. Pharmacist-to-bed ratios varied according to countries and care unit type with the most favorable ratios in ICU and in American studies. Cost-avoidance was mostly used to express economic impact and ranged from €1579 to €3,089 328. Studies yielding the greater economic impact were conducted in the USA with implementation of full-time equivalents pharmacists or establishing of collaborative practice agreements. Only 6 articles dealt correctly with at least 7 of the 10 Drummond's checklist assessment criteria. CONCLUSION This review suggests that the existing evidence is not sufficient to conclude to a positive economic impact of CPS conducted according to clinical pharmacy guidelines. Funding resources, remuneration of clinical pharmacy activities and provision of standardized national clinical and economic databases appear to be essential evolutions to improve CPS development.
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Affiliation(s)
- Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Chloé Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Nicolas Poletto
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Marie-Delphine Guillemin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Ophélie Maison
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Romain Garreau
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Louis Chillotti
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Stéphanie Parat
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France; EMR3738, Université de Lyon, Lyon, France.
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France; EMR3738, Université de Lyon, Lyon, France
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Slimano F, Baudouin A, Zerbit J, Toulemonde-Deldicque A, Thomas-Schoemann A, Chevrier R, Daouphars M, Madelaine I, Pourroy B, Tournamille JF, Astier A, Ranchon F, Cazin JL, Bardin C, Rioufol C. Cancer, immune suppression and Coronavirus Disease-19 (COVID-19): Need to manage drug safety (French Society for Oncology Pharmacy [SFPO] guidelines). Cancer Treat Rev 2020; 88:102063. [PMID: 32623296 PMCID: PMC7308737 DOI: 10.1016/j.ctrv.2020.102063] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023]
Abstract
The Coronavirus disease (COVID-19) pandemic is disrupting our health environment. As expected, studies highlighted the great susceptibility of cancer patients to COVID-19 and more severe complications, leading oncologists to deeply rethink patient cancer care. This review is dedicated to the optimization of care pathways and therapeutics in cancer patients during the pandemic and aims to discuss successive issues. First we focused on the international guidelines proposing adjustments and alternative options to cancer care in order to limit hospital admission and cytopenic treatment in cancer patients, most of whom are immunocompromised. In addition cancer patients are prone to polypharmacy, enhancing the risk of drug-related problems as adverse events and drug-drug interactions. Due to increased risk in case of COVID-19, we reported a comprehensive review of all the drug-related problems between COVID-19 and antineoplastics. Moreover, in the absence of approved drug against COVID-19, infected patients may be included in clinical trials evaluating new drugs with a lack of knowledge, particularly in cancer patients. Focusing on the several experimental drugs currently being evaluated, we set up an original data board helping oncologists and pharmacists to identify promptly drug-related problems between antineoplastics and experimental drugs. Finally additional and concrete recommendations are provided, supporting oncologists and pharmacists in their efforts to manage cancer patients and to optimize their treatments in this new era related to COVID-19.
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Affiliation(s)
- Florian Slimano
- Department of Pharmacy, CHU Reims, France; Faculty of Pharmacy, Université de Reims Champagne-Ardenne, 51100 Reims, France.
| | - Amandine Baudouin
- Department of Pharmacy, Groupement Hospitalier Sud - Hospices Civils de Lyon, Lyon, France.
| | - Jérémie Zerbit
- Department of Clinical Pharmacy, CHU Paris Centre Cochin, AP-HP, 75 014 Paris, France.
| | | | - Audrey Thomas-Schoemann
- Department of Pharmacy, Groupement Hospitalier Sud - Hospices Civils de Lyon, Lyon, France; UMR8038 CNRS, U1268 INSERM, Faculty of Pharmacy, Paris Descartes University, PRES Sorbonne Paris Cité, 75006 Paris, France.
| | - Régine Chevrier
- Department of Pharmacy, Jean Perrin Cancer Center, 63011 Clermont Ferrand, France.
| | - Mikaël Daouphars
- Department of Pharmacy, Henri Becquerel Cancer Center, 76038 Rouen, France.
| | - Isabelle Madelaine
- Department of Pharmacy, Saint Louis University Teaching Hospital, Assistance Publique - Hôpitaux de Paris, 75010 Paris, France.
| | - Bertrand Pourroy
- Oncopharma Unit, La Timone University Teaching Hospital, Assistance Publique - Hôpitaux de Marseille, 13005 Marseille, France.
| | | | - Alain Astier
- Department of Pharmacy, Henri Mondor University Hospitals, 94010 Créteil, France.
| | - Florence Ranchon
- Department of Pharmacy, Groupement Hospitalier Sud - Hospices Civils de Lyon, Lyon, France; EA 3738 CICLY, UCBL1 Université de Lyon, Lyon, France.
| | - Jean-Louis Cazin
- Center of Pharmacology and Clinical Pharmacy in Oncology, Centre Oscar Lambret, 59020 Lille, France; Pharmacology and Clinical Pharmacy, Faculté de Pharmacie, Université de Lille, 59000 Lille, France.
| | - Christophe Bardin
- Department of Clinical Pharmacy, CHU Paris Centre Cochin, AP-HP, 75 014 Paris, France.
| | - Catherine Rioufol
- Department of Pharmacy, Groupement Hospitalier Sud - Hospices Civils de Lyon, Lyon, France; EA 3738 CICLY, UCBL1 Université de Lyon, Lyon, France.
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34
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Pourroy B, Tournamille JF, Bardin C, Slimano F, Chevrier R, Rioufol C, Madelaine I. Providing Oncology Pharmacy Services During the Coronavirus Pandemic: French Society for Oncology Pharmacy (Société Francaise de Pharmacie Oncologique [SFPO]) Guidelines. JCO Oncol Pract 2020; 16:e1282-e1290. [PMID: 32539650 DOI: 10.1200/op.20.00295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with cancer are at higher risk for contracting the COVID-19 infection and are more likely to have higher morbidity and mortality. This is a big challenge for oncology teams that have to treat patients to avoid contamination by SARS-CoV-2. The aim of the current work is to present oncology pharmacy practice guidelines during the COVID-19 pandemic to secure the pharmaceutical care of patients with cancer. METHODS The bureau of the French Society for Oncology Pharmacy proposed these recommendations according to the French High Authority of Health following the Guidelines of Good Practice, slightly modified according to the pandemic crisis situation. These guidelines were developed by a working group of 7 experts in oncology pharmacy practice. Furthermore, the guidelines were assessed by 31 independent reviewers. RESULTS One hundred percent of reviewers approved the guidelines and 90% of them suggested some improvements. The final version incorporates the best comments and consists of 26 recommendations organized in 8 different sections. CONCLUSION These guidelines allow secure pharmaceutical management of patients with cancer during the COVID-19 pandemic.
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Affiliation(s)
- Bertrand Pourroy
- Oncopharma Unit, La Timone University Teaching Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France.,French Society for Oncology Pharmacy, Paris, France
| | | | - Christophe Bardin
- French Society for Oncology Pharmacy, Paris, France.,Pharmacy Department, Cochin University Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Florian Slimano
- French Society for Oncology Pharmacy, Paris, France.,Pharmacy, Centre Hospitalier Universitaire Reims; and Faculty of Pharmacy, EA7506, Université de Reims Champagne-Ardenne, Reims, France
| | - Régine Chevrier
- French Society for Oncology Pharmacy, Paris, France.,Pharmacy Department, Jean Perrin Cancer Center, Clermont Ferrand, France
| | - Catherine Rioufol
- French Society for Oncology Pharmacy, Paris, France.,Oncology Clinical Pharmacy Unit, Lyon Sud University Teaching Hospital. Hospices Civils de Lyon, Pierre-Bénite; and EMR3738, Lyon University, Lyon, France
| | - Isabelle Madelaine
- French Society for Oncology Pharmacy, Paris, France.,Pharmacy Department, Saint Louis University Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Herledan C, Ranchon F, Schwiertz V, Baudouin A, Karlin L, Ghesquières H, Salles G, Rioufol C. Drug cost savings in phase III hematological oncology clinical trials in a university hospital. Hematol Oncol 2020; 38:576-583. [PMID: 32469095 DOI: 10.1002/hon.2753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 01/15/2023]
Abstract
The rapid emergence of expensive anticancer therapies is leading to exponential growth in healthcare expenses. In clinical trials, most investigational drugs are provided free of charge by industrial and academic sponsors. This results in drug cost savings for healthcare payers, who are no longer charged with the cost of the standard-of-care treatment, which would have been administered outside the trial. This study aims to estimate drug cost savings resulting from patient enrolment in hematological oncology clinical trials, from a public payer perspective. Retrospective screening identified all patients with hematological malignancies included from 2011 to 2016 in a phase III trial and having received at least one sponsor-provided cycle. Drug cost savings were defined as the standard treatment costs not charged to the payer due to sponsor provision of treatment. For each patient, cost savings were determined by the number of cycles received in the trial and the cost of standard (control arm) treatment. Of the 345 patients included in eligible trials during study period, 272 received sponsor-provided drugs. Drug cost savings could be estimated for 177 patients (65.1%) included in 27 trials. Total cost savings were €5218 million (US$ 6804 million) for 1720 sponsor-provided cycles. Mean cost saving per patient was €19 182.7 ± 29 865.7 ($25 015.24 ± 39 478.25). Most cost-saving trials were industry-sponsored (77.8%), although academic trials generated 40.15% of total cost savings. Enrolling patients in clinical trials, whether industry-sponsored or academic, leads to substantial drug cost savings for payers. Implications are significant for public payers facing increasing financial constraints, as savings can be reallocated to patient care.
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Affiliation(s)
- Chloé Herledan
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre-Bénite, France.,EMR3738 Therapeutic Targeting in Oncology, Université de Lyon, Lyon, France
| | - Florence Ranchon
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre-Bénite, France.,EMR3738 Therapeutic Targeting in Oncology, Université de Lyon, Lyon, France
| | - Vérane Schwiertz
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre-Bénite, France
| | - Amandine Baudouin
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre-Bénite, France
| | - Lionel Karlin
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Hervé Ghesquières
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Faculté de Médecine Lyon-Sud Charles Mérieux, INSERM 1052, CNRS 5286, Université Claude Bernard, Université de Lyon, Pierre Bénite, France
| | - Gilles Salles
- Department of Hematology, Groupement Hospitalier Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Faculté de Médecine Lyon-Sud Charles Mérieux, INSERM 1052, CNRS 5286, Université Claude Bernard, Université de Lyon, Pierre Bénite, France
| | - Catherine Rioufol
- Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre-Bénite, France.,EMR3738 Therapeutic Targeting in Oncology, Université de Lyon, Lyon, France
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Herledan C, Baudouin A, Larbre V, Gahbiche A, Dufay E, Alquier I, Ranchon F, Rioufol C. Clinical and economic impact of medication reconciliation in cancer patients: a systematic review. Support Care Cancer 2020; 28:3557-3569. [PMID: 32189099 DOI: 10.1007/s00520-020-05400-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 03/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Medication reconciliation can reduce drug-related iatrogenesis by facilitating exhaustive information transmission at care transition points. Given the vulnerability of cancer patients to adverse drug events, medication reconciliation could provide a significant clinical benefit in cancer care. This review aims to synthesize existing evidence on medication reconciliation in cancer patients. METHODS A comprehensive search was performed in the PubMed/Medline, Scopus, and Web of Science databases, associating the keywords "medication reconciliation" and "cancer" or "oncology." RESULTS Fourteen studies met the selection criteria. Various medication reconciliation practices were reported: performed at admission or discharge, for hospitalized or ambulatory patients treated with oral or parenteral anticancer drugs. In one randomized controlled trial, medication reconciliation decreased clinically significant medication errors by 26%. Although most studies were non-comparative, they highlighted that medication reconciliation led to identification of discrepancies and other drug-related problems in up to 88% and 94.7% of patients, respectively. The impact on post-discharge healthcare utilization remains under-evaluated and mostly inconclusive, despite a trend toward reduction. No comparative economic evaluations were available but one study estimated the benefit:cost ratio of medication reconciliation to be 2.31:1, suggesting its benefits largely outweigh its costs. Several studies also underlined the extended pharmacist time required for the intervention, highlighting the need for further cost analysis. CONCLUSION Medication reconciliation can reduce adverse drug events in cancer patients. More robust and economic evaluations are still required to support its development in everyday practice.
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Affiliation(s)
- Chloé Herledan
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, Pierre-Bénite, France
- EMR3738, Université de Lyon, Lyon, France
| | - Amandine Baudouin
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, Pierre-Bénite, France
| | - Virginie Larbre
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, Pierre-Bénite, France
- EMR3738, Université de Lyon, Lyon, France
| | - Anas Gahbiche
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, Pierre-Bénite, France
| | - Edith Dufay
- Service Pharmacie, Centre Hospitalier de Lunéville, 6 Rue Jean Girardet, Lunéville, France
| | - Isabelle Alquier
- Direction de l'Amélioration de la Qualité et de la Sécurité des Soins, Service Evaluation et Outils pour la Qualité et la Sécurité des Soins, Haute Autorité de Santé, 5 avenue du Stade de France, Saint-Denis la Plaine, France
| | - Florence Ranchon
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, Pierre-Bénite, France
- EMR3738, Université de Lyon, Lyon, France
| | - Catherine Rioufol
- Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, Pierre-Bénite, France.
- EMR3738, Université de Lyon, Lyon, France.
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Marmorat T, Rioufol C, Ranchon F, Préau M. Encounters between medical and lay knowledge in therapeutic patient education. A qualitative study based on an oral chemotherapy program. Patient Educ Couns 2020; 103:537-543. [PMID: 31685357 DOI: 10.1016/j.pec.2019.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES The growing number of cancer patients treated with Oral Chemotherapy (OC) at home, is prompting many healthcare centers to develop Therapeutic Patient Education (TPE) programs. This study aimed to 1) describe the different forms of knowledge shared and learned in these programs, and 2) better understand how self-care and psychosocial skills are promoted in the TPE context. METHOD This study used qualitative data from the French "ONCORAL" program. Data collection was conducted with non-participant observations. The corpus comprised 42 TPE sessions. RESULTS Analysis highlighted that TPE specifically helps patients' functional health, revealed the medical expectations and social norms that shape the patient's role, and exposed the difficulties faced by the patient when acquiring self-care skills. Self-care skills and psychosocial skills also appeared to be mutually dependent in the context of TPE. CONCLUSION TPE programs which focus more on developing medical knowledge inevitably give less importance to psychosocial skills. Yet the recognition and promotion of the latter in TPE may lead to positive coping strategies related to medical outcomes, such as adherence. PRACTICE IMPLICATION Dedicated TPE program objectives for patients undergoing oral chemotherapy should recognize not only the value of medical knowledge but also of lay knowledge.
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Affiliation(s)
- Thibaud Marmorat
- Social Psychology Research Group (EA 4163 GRePS), Lyon 2 University, Lyon University, Lyon, France.
| | - Catherine Rioufol
- Parmacy Department, Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils of Lyon, Pierre-Bénite, France; Université Lyon 1, EMR 3738, Lyon, France
| | - Florence Ranchon
- Parmacy Department, Unité de Pharmacie Clinique Oncologique, Groupement Hospitalier Sud, Hospices Civils of Lyon, Pierre-Bénite, France; Université Lyon 1, EMR 3738, Lyon, France
| | - Marie Préau
- Social Psychology Research Group (EA 4163 GRePS), Lyon 2 University, Lyon University, Lyon, France
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Verot E, Falandry C, Régnier Denois V, Feutrier C, Chapoton B, Okala J, Pupier S, Rousset V, Bridet F, Ravot C, Rioufol C, Trillet-Lenoir V, Hureau M, Chauvin F, Bourmaud A. Conditions for the Implementation of a Patient Education Program Dedicated to Cancer Patients Treated by Oral Anticancer Therapy. Patient Prefer Adherence 2020; 14:2263-2277. [PMID: 33244223 PMCID: PMC7683887 DOI: 10.2147/ppa.s268953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A patient education program has been developed in the field of cancer for supporting cancer patients undergoing oral anticancer therapies. Its implementation was tested in 3 different settings. The objectives of this study were to 1) identify barriers and facilitators for implementing the patient education program, 2) identify practices encouraging or hindering implementation and 3) produce recommendations for its dissemination. METHODS Twenty semi-structured interviews were conducted with caregivers from all three establishments. RESULTS The main factors associated with successful implementation were as follows: prescribers' representations on patient education, considered of low value; on oral anticancer therapies, considered too dangerous to be handled by the patient him/herself, the indefinite legitimacy of certain professions in charge of patient education programs; patients' engagement in their care pathway and provision of caregivers. CONCLUSION Recommendations include developing patient education culture within the environment of the medical doctors' curriculum, to consider contextual, pre-existing cooperative units for implementing patient education, to systematically send patients to patient education programs without practicing triage. Successful implementation of patient education critically depends on the prescribing physicians' perceived value of patient education. Patient education should become mandatory, integrated as part of the cancer care pathway. Physicians lack the necessary time and/or means to assess patients' capacity for engagement, without adequate strategies for their support. Therefore, physicians should systematically refer all patients to patient education, where nurses can tailor their coaching of cancer patients. TRIAL REGISTRATION The study protocol was approved by the IRB SUD EST I (N° EudraCT: 2016-A00113-48). All participants were given written and verbal information about the study and gave informed consent to participate.
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Affiliation(s)
- Elise Verot
- University of Lyon, University of Saint-Etienne, Centre Hygée, HESPER EA 7425, Rue de la Marandière, Saint-Priest-en- Jarez, 42270, France
- Correspondence: Elise Verot University of Lyon, University of Saint-Etienne, Centre Hygée, HESPER EA 7425, Rue de la Marandière, Saint-Etienne42270, FranceTel +33-682309796 Email
| | - Claire Falandry
- Oncogeriatrics Department, Lyon Sud Teaching Hospital & Claude Bernard University, Lyon, France
| | - Véronique Régnier Denois
- University of Lyon, University of Saint-Etienne, Centre Hygée, HESPER EA 7425, Rue de la Marandière, Saint-Priest-en- Jarez, 42270, France
| | - Corinne Feutrier
- Transversal Unit of Patient Education of Department of Rhône, Hospices Civils de Lyon, Lyon69004, France
| | - Boris Chapoton
- University of Lyon, University of Saint-Etienne, Centre Hygée, HESPER EA 7425, Rue de la Marandière, Saint-Priest-en- Jarez, 42270, France
| | - Jean Okala
- Public Health Department, Centre Hygée, Institut de Cancérologie Lucien Neuwirth, HESPER EA 7425, Saint-Priest-en-Jarez42270, France
| | - Sidonie Pupier
- Public Health Department, Centre Hygée, Institut de Cancérologie Lucien Neuwirth, HESPER EA 7425, Saint-Priest-en-Jarez42270, France
| | - Vanessa Rousset
- Public Health Department, Centre Hygée, Institut de Cancérologie Lucien Neuwirth, HESPER EA 7425, Saint-Priest-en-Jarez42270, France
| | - Françoise Bridet
- Transversal Unit of Patient Education of Department of Rhône, Hospices Civils de Lyon, Lyon69004, France
| | - Christine Ravot
- Oncogeriatrics Department, Lyon Sud Teaching Hospital & Claude Bernard University, Lyon, France
| | - Catherine Rioufol
- Pharmacy Department, Lyon Sud Teaching Hospital & Claude Bernard University, Lyon, France
| | - Véronique Trillet-Lenoir
- Medical Oncology Department, Lyon Sud Teaching Hospital & Claude Bernard University, Lyon, France
| | - Magali Hureau
- Department of Clinical Research and Innovation, Léon Bérard Cancer Centre, Lyon, France
| | - Franck Chauvin
- University of Lyon, University of Saint-Etienne, Centre Hygée, HESPER EA 7425, Rue de la Marandière, Saint-Priest-en- Jarez, 42270, France
| | - Aurélie Bourmaud
- Clinical Epidemiology Unit, Robert Debré Hospital, AP-HP, INSERM CIC-EC 1426; INSERM 1123 ECEVE, University of Paris, Paris, France
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Perez T, Montaleytang M, Boisseranc C, De Crozals F, Darbon F, Gérardin E, Rey JB, Chevrier R, Rioufol C, Correard F, Honoré S. [Feedback on clinical oncology pharmacy]. Ann Pharm Fr 2019; 78:70-75. [PMID: 31810516 DOI: 10.1016/j.pharma.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Abstract
The rising of oral anticancer therapies let more and more patients to be cared at home and improve their quality of life. However the toxicities of these drugs and the distance with health professionals imply that the patient needs to be more autonomous with respect to his treatment. Patients through therapeutic education programs allows them to manage side effects, to be more observant and then to subsequently benefit from the treatment. We report here, oncology clinical pharmacists experiences in some health facilities in France, presented at the 1st day of clinical oncology pharmacy (December 2017, Marseille).
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Affiliation(s)
- T Perez
- Service Pharmacie, Hôpital Timone, AP-HM, Marseille; Aix Marseille Université, Laboratoire de Pharmacie Clinique, Marseille
| | - M Montaleytang
- Service Pharmacie, Hôpital Timone, AP-HM, Marseille; Aix Marseille Université, Laboratoire de Pharmacie Clinique, Marseille
| | - C Boisseranc
- Service Pharmacie, Hôpital Timone, AP-HM, Marseille
| | - F De Crozals
- Service Pharmacie, Institut Sainte-Catherine, Avignon
| | - F Darbon
- Service Pharmacie, Institut Paoli Calmettes, Marseille
| | - E Gérardin
- Service Pharmacie, Centre Hospitalier de Martigues, Martigues
| | - J-B Rey
- Service Pharmacie, Institut Jean Godinot, Reims
| | - R Chevrier
- Service Pharmacie, Centre Jean-Perrin, Clermont-Ferrand
| | - C Rioufol
- Service Pharmacie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon
| | - F Correard
- Service Pharmacie, Hôpital Timone, AP-HM, Marseille; Aix Marseille Université, Laboratoire de Pharmacie Clinique, Marseille.
| | - S Honoré
- Service Pharmacie, Hôpital Timone, AP-HM, Marseille; Aix Marseille Université, Laboratoire de Pharmacie Clinique, Marseille
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Herledan C, Baudouin A, Tracol M, Garreau R, Poletto N, Ranchon F, Rioufol C. MEDICATION RECONCILIATION AND REVIEW TO PREVENT MEDICATION ERRORS IN ELDERLY CANCER PATIENTS. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31216-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Revy A, Hallouard F, Joyeux-Klamber S, Skanjeti A, Rioufol C, Fraysse M. Feasibility and Evaluation of Automated Methods for Radiolabeling of Radiopharmaceutical Kits with Gallium-68. Curr Radiopharm 2019; 12:229-237. [DOI: 10.2174/1874471012666190110170623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/03/2018] [Accepted: 12/20/2018] [Indexed: 01/17/2023]
Abstract
Objective:
Recent gallium-68 labeled peptides are of increasing interest in PET imaging in
nuclear medicine. Somakit TOC® is a radiopharmaceutical kit registered in the European Union for the
preparation of [68Ga]Ga-DOTA-TOC used for the diagnosis of neuroendocrine tumors. Development
of a labeling process using a synthesizer is particularly interesting for the quality and reproducibility of
the final product although only manual processes are described in the Summary of Product (SmPC) of
the registered product. The aim of the present study was therefore to evaluate the feasibility and value
of using an automated synthesizer for the preparation of [68Ga]Ga-DOTA-TOC according to the SmPC
of the Somakit TOC®.
Methods:
Three methods of preparation were compared; each followed the SmPC of the Somakit
TOC®. Over time, overheads, and overexposure were evaluated for each method.
Results:
Mean±SD preparation time was 26.2±0.3 minutes for the manual method, 28±0.5 minutes for
the semi-automated, and 40.3±0.2 minutes for the automated method. Overcost of the semi-automated
method is 0.25€ per preparation for consumables and from 0.58€ to 0.92€ for personnel costs according
to the operator (respectively, technician or pharmacist). For the automated method, overcost is 70€
for consumables and from 4.06€ to 6.44€ for personnel. For the manual method, extremity exposure
was 0.425mSv for the right finger, and 0.350mSv for the left finger; for both the semi-automated and
automated method extremity exposure were below the limit of quantification.
Conclusion:
The present study reports for the first time both the feasibility of using a [68Ga]-
radiopharmaceutical kit with a synthesizer and the limits for the development of a fully automated
process.
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Affiliation(s)
- Alban Revy
- Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, Service de Pharmacie, unite de radiopharmacie, 165 Chemin du Grand Revoyet F-69310 Pierre-Benite, France
| | - François Hallouard
- Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, Service de Pharmacie, unite de radiopharmacie, 165 Chemin du Grand Revoyet F-69310 Pierre-Benite, France
| | - Sandrine Joyeux-Klamber
- Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, Service de radioprotection, 165 Chemin du Grand Revoyet F-69310 Pierre-Benite, France
| | - Andrea Skanjeti
- Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, Service de medecine nucleaire, 165 Chemin du Grand Revoyet F-69310 Pierre-Benite, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, Service de Pharmacie, unite de radiopharmacie, 165 Chemin du Grand Revoyet F-69310 Pierre-Benite, France
| | - Marc Fraysse
- Hospices Civils de Lyon, Centre Hospitalier de Lyon Sud, Service de Pharmacie, unite de radiopharmacie, 165 Chemin du Grand Revoyet F-69310 Pierre-Benite, France
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Laloi L, Triffault-Fillit C, Lalande L, Viste A, Chaudier P, Ferry T, Rioufol C, Carré E. État des lieux sur 4 ans d’interventions pharmaceutiques concernant les antibiotiques en chirurgie orthopédique : comment adapter nos pratiques ? Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sarfati L, Ranchon F, Vantard N, Schwiertz V, Larbre V, Parat S, Faudel A, Rioufol C. Human-simulation-based learning to prevent medication error: A systematic review. J Eval Clin Pract 2019; 25:11-20. [PMID: 29383867 DOI: 10.1111/jep.12883] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/29/2017] [Accepted: 01/02/2018] [Indexed: 01/27/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES In the past 2 decades, there has been an increasing interest in simulation-based learning programs to prevent medication error (ME). To improve knowledge, skills, and attitudes in prescribers, nurses, and pharmaceutical staff, these methods enable training without directly involving patients. However, best practices for simulation for healthcare providers are as yet undefined. By analysing the current state of experience in the field, the present review aims to assess whether human simulation in healthcare helps to reduce ME. METHODS A systematic review was conducted on Medline from 2000 to June 2015, associating the terms "Patient Simulation," "Medication Errors," and "Simulation Healthcare." Reports of technology-based simulation were excluded, to focus exclusively on human simulation in nontechnical skills learning. RESULTS Twenty-one studies assessing simulation-based learning programs were selected, focusing on pharmacy, medicine or nursing students, or concerning programs aimed at reducing administration or preparation errors, managing crises, or learning communication skills for healthcare professionals. The studies varied in design, methodology, and assessment criteria. Few demonstrated that simulation was more effective than didactic learning in reducing ME. This review highlights a lack of long-term assessment and real-life extrapolation, with limited scenarios and participant samples. These various experiences, however, help in identifying the key elements required for an effective human simulation-based learning program for ME prevention: ie, scenario design, debriefing, and perception assessment. The performance of these programs depends on their ability to reflect reality and on professional guidance. CONCLUSION Properly regulated simulation is a good way to train staff in events that happen only exceptionally, as well as in standard daily activities. By integrating human factors, simulation seems to be effective in preventing iatrogenic risk related to ME, if the program is well designed.
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Affiliation(s)
- Laura Sarfati
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France.,Université Lyon 1, EMR, 3738, Lyon, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France
| | - Vérane Schwiertz
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France
| | - Virginie Larbre
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France
| | - Stéphanie Parat
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France
| | - Amélie Faudel
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie, Unité de Pharmacie Clinique Oncologique, Pierre Bénite, France.,Université Lyon 1, EMR, 3738, Lyon, France
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Larbre V, Alyami M, Mercier F, Vantard N, Bonnefoy I, Opsomer MA, Villeneuve L, Bakrin N, Rioufol C, Glehen O, Kepenekian V. No Renal Toxicity After Repeated Treatment with Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) in Patients with Unresectable Peritoneal Metastasis. Anticancer Res 2019; 38:6869-6875. [PMID: 30504403 DOI: 10.21873/anticanres.13062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/10/2018] [Accepted: 11/13/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a recent approach for intraperitoneal chemotherapy with promising results for patients with peritoneal metastasis (PM). The aim of this study was to report renal toxicity for patients who received at least 3 repeated PIPAC procedures. PATIENTS AND METHODS All patients who underwent at least 3 PIPAC cycles of cisplatin (7.5 mg/m2) and doxorubicin (1.5 mg/m2) for unresectable PM from December 2015 to September 2017, were analysed regarding postoperative renal toxicity. RESULTS Among 103 patients registered in a prospective single center database, 43 patients underwent at least 3 PIPAC cycles representing a total of 175 PIPAC. Median age was 59.8 years, 24 (55.8%) patients were female and median BMI was 22.2 kg/m2 Most common origins of PM were gastric 22 (51.1%) and ovarian 11 (25.6%) cancer. Median peritoneal cancer index (PCI) was 17 (range=5-39). For 39 (90.1%) patients, systemic chemotherapy was performed in addition to PIPAC. Forty-three (100%), 17 (39.5%), 14 (32.5%), 8 (18.6%), 3 (7%), 2 (4.7%) and 2 (4.7%) patients underwent three, four, five, six, seven, eight and nine PIPAC procedures, respectively. Repeated PIPAC did not induce significant acute nor cumulative renal toxicity in any patients. CONCLUSION Repeated PIPAC did not induce clinically relevant renal toxicity. This study confirms the previous published results in a larger group of patients.
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Affiliation(s)
- Virginie Larbre
- Department of Clinical Oncology Pharmacy, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Mohammad Alyami
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France .,EMR 3738, Lyon 1 University, Lyon, France.,Department of General Surgery and Surgical Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Frederic Mercier
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,Department of Surgical Oncology, Centre Hospitalo-Universitaire de Montreal, Montreal, Canada
| | - Nicolas Vantard
- Department of Clinical Oncology Pharmacy, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Isabelle Bonnefoy
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Marie-Agnès Opsomer
- Department of Clinical Oncology Pharmacy, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Laurent Villeneuve
- EMR 3738, Lyon 1 University, Lyon, France.,Clinical Research Unit, Department of Public Health, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Naoual Bakrin
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Catherine Rioufol
- Department of Clinical Oncology Pharmacy, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Olivier Glehen
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
| | - Vahan Kepenekian
- Department of Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,EMR 3738, Lyon 1 University, Lyon, France
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Cerfon M, Parat S, Chambrier C, Barnoud D, Ait S, Rioufol C. Nutrition artificielle chez le sujet âgé de plus de 75 ans : audit clinique des prescriptions. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hallouard F, Sauze W, Emery S, Skanjeti A, Rioufol C, Fraysse M. Stability Study of [18F]Fludeoxyglucose and [18F]Fluorocholine in Different Medical Devices for Intravenous Administration. Curr Radiopharm 2018; 11:138-146. [PMID: 29972107 DOI: 10.2174/1874471011666180703165639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 06/21/2018] [Accepted: 06/28/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The present study had determine the impact of prolonged storage in a cartridge or syringe on the quality of the [18F]-radiopharmaceuticals used in our center [18F]fludeoxyglucose and [18F]fluorocholine). [18F]-radiopharmaceuticals registered as ready-to-use drugs are prepared in multidose flasks. When the change of packaging must be made extemporaneously for the preparation of patient unit doses in a syringe or cartridge, this is under the responsibility of radiopharmacists. As drug quality in medical devices (syringe or cartridge) is not evaluated during the marketing authorization of such radiopharmaceuticals, an evaluation of drug stability in such devices seems interesting. In addition, if there are difficulties in patient care (placement of the catheter, lack of personal, etc.) or equipment problems (technical issue with the automated dispenser delaying the delivery of the prepared dose), the contact time of [18F]-radiopharmaceuticals with the medical devices (cartridge or syringe) increases. METHODS Appearance, pH, radiochemical purity, sterility and endotoxin tests were made according the current European Pharmacopoeia. Adsorption tests were made according the literature. RESULTS There was no drug absorption of [18F]fludeoxyglucose or [18F]fluorocholine after 1.5h, which may be related to their hydrophilic nature. No drug radiolysis was observed even after dilution of the radiopharmaceuticals (appearance, pH, and radiochemical purity were unchanged). No impurity from medical devices (cartridge or syringe) was observed, and microbiological aspects remained in specification of the current European Pharmacopoeia. CONCLUSION These radiopharmaceuticals repackaged in plastic medical devices retained their quality after dispensing and prolonged storage.
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Affiliation(s)
- F Hallouard
- Pharmacy Department, Radiopharmacy Unit, Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet F-69310 Pierre-Benite, France
| | - W Sauze
- Pharmacy Department, Radiopharmacy Unit, Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet F-69310 Pierre-Benite, France
| | - S Emery
- Pharmacy Department, Radiopharmacy Unit, Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet F-69310 Pierre-Benite, France
| | - A Skanjeti
- Nuclear Medicine Department, Hospices Civils de Lyon, Lyon Sud hospital, 165 Chemin du Grand Revoyet F-69310 Pierre-Benite, France
| | - C Rioufol
- Pharmacy Department, Radiopharmacy Unit, Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet F-69310 Pierre-Benite, France.,Lyon I University, EMR 3738, Ciblage Thérapeutique en Oncologie (CTO), 165 Chemin du Grand Revoyet F-69921 Oullins, France
| | - M Fraysse
- Pharmacy Department, Radiopharmacy Unit, Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet F-69310 Pierre-Benite, France
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Grezard C, Bour F, Goyet F, Rioufol C, Luauté J, Courtois S, Rode G, Carré E. Retrospective study of psychotropic drugs used in neurological rehabilitation (2010–2016): Impact of a collaboration between prescribers and pharmacists. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.1114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bour F, Grezard C, Cheminon M, Peraud I, Luaute J, Rioufol C, Carre E. REMOVAL NOTICE: Medication adherence of hospitalized Parkinson's patients included in an intensive rehabilitation program’. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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D’Huart E, Vigneron J, Ranchon F, Vantard N, Rioufol C, Demoré B. Physico-Chemical Stability of Sodium Thiosulfate Infusion Solutions in Polyolefin Bags at Room Temperature over a Period of 24 Hours. Pharmaceutical Technology in Hospital Pharmacy 2018. [DOI: 10.1515/pthp-2018-0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Many publications described sodium thiosulfate used to prevent the renal toxicity induced by cisplatin hyperthermic intraperitoneal chemotherapy. After around 60 or 90 minutes of hyperthermic chemotherapy, cisplatin was drained and then, sodium thiosulfate was infused by intravenous route. Sodium thiosulfate is used in two steps: a first step, at 9 g/m2 in 250 mL of 0.9 % sodium chloride over 10 minutes followed by a second step, at 12 g/m2 in 1000 mL of 0.9 % sodium chloride over 6 hours. The purpose of this work was to study the stability of sodium thiosulfate at 16 mg/mL in 0.9 % sodium chloride polyolefin bags 1000 mL and at 72 mg/mL in 0.9 % sodium chloride polyolefin bags 250 mL, at 25 °C, protected or unprotected from light.
Methods
Chemical stability was analysed by high performance liquid chromatography (HPLC) coupled to a photodiode array detector after preparation and after 6-hour or 24-hour storage. The method was validated according to the International Conference on Harmonisation (ICH). Physical stability was evaluated by visual and subvisual inspection (turbidimetry by UV spectrophotometry at 550 nm). Three bags for each condition were prepared. On each time of the analysis, three samples were prepared for each bag and analysed by HPLC. pH values were evaluated on each moment of the analysis.
Results
Sodium thiosulfate solutions diluted in 0.9 % sodium chloride at 16 and 72 mg/mL retained more than 95 % of the initial concentration during 24 hours. Concerning pH measurements, the maximum variation was 0.24 pH unit. No visual modification such as colour change, precipitation or gas formation was observed. The absorbance at 550 nm obtained for each sample was less than 0.010 AU.
Conclusions
Sodium thiosulfate solutions at 16 mg/mL in 1000 mL 0.9 % sodium chloride and at 72 mg/mL in 250 mL 0.9 % sodium chloride are stable physically and chemically over a period of 24 hours at 25 °C, with or without protection from light. This stability study allows the use of sodium thiosulfate in renal protection protocols during cisplatin hyperthermic intraperitoneal chemotherapy.
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Affiliation(s)
- Elise D’Huart
- Pharmacy Department , University Hospital of Nancy , Vandoeuvre-lès-Nancy , France
| | - Jean Vigneron
- Pharmacy Department , University Hospital of Nancy , Vandoeuvre-lès-Nancy , France
| | - Florence Ranchon
- Pharmacy Department, Unité de Pharmacie Clinique Oncologique , Groupement Hospitalier Sud, Hospices Civils of Lyon , Pierre-Bénite , France
- Université Lyon 1 , EMR 3738 , Lyon , France
| | - Nicolas Vantard
- Pharmacy Department, Unité de Pharmacie Clinique Oncologique , Groupement Hospitalier Sud, Hospices Civils of Lyon , Pierre-Bénite , France
| | - Catherine Rioufol
- Pharmacy Department, Unité de Pharmacie Clinique Oncologique , Groupement Hospitalier Sud, Hospices Civils of Lyon , Pierre-Bénite , France
- Université Lyon 1 , EMR 3738 , Lyon , France
| | - Béatrice Demoré
- Pharmacy Department , University Hospital of Nancy , Vandoeuvre-lès-Nancy , France
- Université de Lorraine , EA 4360 APEMAC , Nancy , France
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Rioufol C, Lamy S, Conte C, Jeanneau P, Compaci G, Delpierre C, Lapeyre-Mestre M, Laurent G, Despas F. Non-cancer drug consumption during the early trajectory of lymphoma survivorship. Therapie 2017; 73:307-317. [PMID: 29229217 DOI: 10.1016/j.therap.2017.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 09/06/2017] [Accepted: 10/12/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE This study explored the use of non-cancer drugs in lymphoma survivors during the early trajectory (0 to 2 years) of cancer survivorship and determined the factors that influenced this consumption. METHODS Between January and March 2014, a cross-sectional survey was conducted to assess drug consumption in adult lymphoma survivors at the Toulouse University Hospital. This study was based on a questionnaire consisting of ten open questions related to medical prescription and/or self-medication occurring within the last 3 months. RESULTS A total of 83/103 lymphoma survivors returned the questionnaire. This study showed that 91.6% of patients were drug consumers (about twice more than the general French population). Twenty percent of patients were treated with≥5 drugs. Overall drug consumption mainly concerned analgesics, anti-inflammatory drugs and psychotropics. The presence of comorbidity, urban residence and female gender were associated with overall drug consumption. Moreover, half of survivors required at least one self-medication. Finally, only seven survivors (8.4%) reported no use of any medication. CONCLUSION This study shows that, at least during the early trajectory of cancer survivorship, lymphoma patients are heavily treated with non-cancer drug therapy. This drug consumption profile may have serious implications in terms of safety, overall benefit and health economics.
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Affiliation(s)
- Catherine Rioufol
- Medical and clinical pharmacology ward, college of medicine, university of Toulouse III Paul-Sabatier, 31000 Toulouse, France; Medical and clinical pharmacology laboratory, Toulouse university hospital, 31000 Toulouse, France; INSERM UMR1027 (French National Institute of Health and Medical Research), 31000 Toulouse, France
| | - Sébastien Lamy
- Medical and clinical pharmacology laboratory, Toulouse university hospital, 31000 Toulouse, France; INSERM UMR1027 (French National Institute of Health and Medical Research), 31000 Toulouse, France
| | - Cécile Conte
- Medical and clinical pharmacology ward, college of medicine, university of Toulouse III Paul-Sabatier, 31000 Toulouse, France; Medical and clinical pharmacology laboratory, Toulouse university hospital, 31000 Toulouse, France; INSERM UMR1027 (French National Institute of Health and Medical Research), 31000 Toulouse, France; INSERM CIC 1436, Toulouse clinical investigation center, 31000 Toulouse, France
| | - Pauline Jeanneau
- Medical and clinical pharmacology laboratory, Toulouse university hospital, 31000 Toulouse, France
| | - Giselle Compaci
- Department of hematology - internal medicine, Toulouse university, hospital, cancer university institute of Toulouse Oncopole, 31000 Toulouse, France
| | - Cyrille Delpierre
- INSERM UMR1027 (French National Institute of Health and Medical Research), 31000 Toulouse, France
| | - Maryse Lapeyre-Mestre
- Medical and clinical pharmacology ward, college of medicine, university of Toulouse III Paul-Sabatier, 31000 Toulouse, France; Medical and clinical pharmacology laboratory, Toulouse university hospital, 31000 Toulouse, France; INSERM UMR1027 (French National Institute of Health and Medical Research), 31000 Toulouse, France; INSERM CIC 1436, Toulouse clinical investigation center, 31000 Toulouse, France
| | - Guy Laurent
- INSERM UMR1027 (French National Institute of Health and Medical Research), 31000 Toulouse, France; Department of hematology - internal medicine, Toulouse university, hospital, cancer university institute of Toulouse Oncopole, 31000 Toulouse, France
| | - Fabien Despas
- Medical and clinical pharmacology ward, college of medicine, university of Toulouse III Paul-Sabatier, 31000 Toulouse, France; Medical and clinical pharmacology laboratory, Toulouse university hospital, 31000 Toulouse, France; INSERM UMR1027 (French National Institute of Health and Medical Research), 31000 Toulouse, France; INSERM CIC 1436, Toulouse clinical investigation center, 31000 Toulouse, France.
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