RESUMEN
Introduction: In 2020, SARS-COV-2 appeared and the most dramatic pandemic since decades spread over the world. Waiting for vaccines development, cancer patients were at a higher risk of the COVID-19 infection and more likely to be subjects of a higher morbidity and mortality. This was a big challenge for oncology teams that have to treat patients avoiding 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 pharmaceutical care of the cancer patients and their evaluation, 6 months later. Material(s) and Method(s): In April 2020, the bureau of the French Society for Oncology Pharmacy proposed these recommendations according to the French High Authority of Health regarding the guidelines for Good Practice, slightly modified according to pandemic crisis situation. These guidelines were elaborated by a working group of 7 experts in oncology pharmacy practice. Furthermore, the guidelines were assessed by 31 independent reviewers. In January 2021, guidelines were then evaluated by 47 independent reviewers through a specific survey. Results and discussion: About guidelines elaboration, 100% of reviewers approved the guidelines and 90% of them suggested some improvements. The final version incorporates the best compromises and consists of 26 recommendations organized in 8 different sections. Six months later, 47 pharmacists, mainly from Cancer Centers (17%), University Teaching Hospitals (19%) and general hospitals (49%) evaluated guidelines. Eighty one percent of them have used them and 77% judged them useful or partially useful. 22 recommendations were applied by at least 60% of pharmacists [62-93] and only 4 were applied by around40%of reviewers. Conclusion(s): These guidelines allowed to secure the pharmaceutical management of cancer patients during the COVID-19 pandemic. The most challenged recommendations were linked to external services (i.e. teleworking) or procedure in severe conditions implementation.
RESUMEN
Introduction: As part of the reorganization of our outpatient activity in onco-hematology (OH), questions were raised about the relevance of dedicating a specific structure to clinical research in this field. These questions arise all the more so as the proportion of OH clinical trials (CT) in our center has increased from 10% to 45% of all CT between 2000 and 2020. The aim of this study is to assess the evolution of this activity and thus to consider the interest of such a structure. Material(s) and Method(s): A retrospective data review of new CT related to OH in our center from 2016 to 2021 was performed. The evolution of 3 key indicators was assessed: distribution of OH CT among all CT, main OH indications and preferred routes of administration. Results and discussion: Over the period 2016-2021, OH CT represented an average of 32% of newly activated CT corresponding to 34% in 2016 and 48% in 2021 (approximately 90 CT start each year for a total of 420 CT in our center). A short decrease was observed in 2019 and 2020, 25% and 24% respectively, probably related to Covid-19. In terms of sterile preparations, OH represented steadily more than 60% of our activity over the period. The main indications were lymphomas (30%), acute myeloid leukemias (AML - 19%), myelodysplastic syndromes (12%) and CT related to transplant center (12%) in steady distribution overtime. Only new CT in myeloma increased from 7% to 18% in relation with increased subcutaneous (SC) use of daratumumab. Regarding preferred routes of administration, an increased trend in oral and SC routes is observed (respectively 53% and 7% in 2016 vs. 69%and 28% in 2021). The increasing use of SC intensified in 2017 as part of the arrival of AML treatments combining azacitidine (SC) with venetoclax (oral). New CT using the intravenous route decreased from 70% in 2016 to 51% in 2021 even if bispecific antibodies araised in 2021. Focusing in 2021, 1359 visits (772 in day hospital for protocol chemotherapy and 597 for oral treatment) were observed, i.e. 6 patients per day. Conclusion(s): This review showed OH's activity growth in our center. The increasingly frequent use of SC and oral routes requires that patients be fully informed and trained about their own management. In this context, a pharmacist has its place and could best inform patients about the adverse effects of new complex therapies (antibodies, targeted therapy). A unique place, organized and dedicated to clinical research in OH, would allow patients benefiting from a structured and exhaustive support as well as meeting all the healthcare professionals involved and finally ensuring the conditions for optimal care.