Implementation of additional prescribing authorization among oncology pharmacists in Alberta.

PURPOSE: To describe the practice settings and prescribing practices of oncology pharmacists with additional prescribing authorization. METHODS: A descriptive, cross-sectional survey of all oncology pharmacists in Alberta was conducted using a web-based questionnaire over four weeks between March and April 2016. Pharmacists were identified from the Cancer Services Pharmacy Directory and leadership staff in Alberta Health Services. Descriptive statistics were used to describe the practice setting, prescribing practices, motivators to apply for additional prescribing authorization, and the facilitators and barriers of prescribing. Logistic regression was used to explore factors associated with having additional prescribing authorization. RESULTS: The overall response rate was 41% (71 of 175 pharmacists). Oncology pharmacists with additional prescribing authorization made up 38% of respondents. They primarily worked in urban, tertiary cancer centers, and practiced in ambulatory care. The top 3 clinical activities they participated in were medication reconciliation, medication counseling/education, and ambulatory patient assessment. Respondents thought additional prescribing authorization was most useful for ambulatory patient assessment and follow-up. Antiemetics were prescribed the most often. The median number of prescriptions written in an average week of clinical work was 5. Competence, self-confidence, and the potential impact on patient care/perceived impact on work environment were the strongest facilitators of prescribing. The strongest motivators to apply for additional prescribing authorization were relevancy to practice, the potential for increased efficiency, and advancing the profession. CONCLUSION: The current majority of oncology pharmacist prescribing in Alberta occurs in ambulatory care with a large focus on antiemetic prescribing. Pharmacists found additional prescribing authorization most useful for ambulatory patient assessment and follow-up.

The clinical significance of QT prolongation associated with tamoxifen: A review of the literature.

Objective To review the literature discussing QT prolongation associated with the use of tamoxifen in order to evaluate the clinical significance. Data sources A search of PubMed (1946 to 2017), MEDLINE (1946 to 2017) and EMBASE (1947 to 2017) was performed using a combination of the following search terms: tamoxifen, estrogen antagonist, selective estrogen receptor modulator, QT prolongation, QT interval, long QT syndrome and torsades de pointes. All searches were limited to human subjects. Reference lists of the literature found were also reviewed but did not reveal any further articles. Study selection Articles reviewed were relating to humans only and included clinical trials and case reports that mentioned QT prolongation in association with the use of tamoxifen. Data synthesis It can be common for patients on tamoxifen to also be on a number of different medications being used to treat comorbid medical conditions. Such combinations of medications increase the potential risk for drug interactions, such as drug-induced QT prolongation. Tamoxifen is often flagged by tertiary drug information sources as a drug with indeterminate effects on the QT interval. However, the risk may be elevated when combined with other QT-prolonging agents. A total of five publications were identified, including two phase I clinical trials and three case reports, which discussed the association between tamoxifen and QT prolongation. Conclusions Tertiary drug information sources identify tamoxifen as an agent that may cause QT prolongation when used in combination with other QT-prolonging agents. However, based on the limited number of published reports found, it would suggest that the use of tamoxifen concurrently with other agents known to prolong the QT interval is likely to be of low risk for causing a clinically significant QT-prolonging event, especially at a dose of 20 mg daily.

Medication adherence among adults prescribed imatinib, dasatinib, or nilotinib for the treatment of chronic myeloid leukemia.

BACKGROUND: Oral tyrosine kinase inhibitors are the standard of care for chronic myeloid leukemia. Tyrosine kinase inhibitors are administered in an outpatient setting for an indefinite period which may negatively impact adherence. Non-adherence to tyrosine kinase inhibitors is associated with disease progression. OBJECTIVES: To evaluate the need for adherence-enhancing interventions, this study was designed to determine the proportion of chronic myeloid leukemia patients non-adherent to their tyrosine kinase inhibitor regimen. The secondary objective was to identify the influence of patient characteristics on tyrosine kinase inhibitor adherence. METHODS: Cross-sectional retrospective chart and dispensing record reviews were performed to identify patients receiving a tyrosine kinase inhibitor from 1 June 2010 to 31 January 2012. Adherence was evaluated using the medication possession ratio. RESULTS: A total of 124 patients were included. Thirty-eight (31%) patients were non-adherent to their tyrosine kinase inhibitor regimen. Patients not receiving concurrent medications were more likely to be non-adherent (odds ratio (OR) 2.33, 95% confidence interval (CI) 1.05-5.13, p=0.04). The median medication possession ratio was 0.95 (IQR=0.83-1.07). Median medication possession ratio was lower in patients receiving imatinib compared to dasatinib or nilotinib (0.95 vs. 1.00, p=0.01) and in those less than 50 years old compared to those greater than 50 years old (0.92 vs. 0.97, p=0.02). CONCLUSIONS: Optimal tyrosine kinase inhibitor adherence in chronic myeloid leukemia patients poses a significant obstacle in achieving best possible outcomes while reducing healthcare costs. In this study, one in three chronic myeloid leukemia patients treated with a tyrosine kinase inhibitor were non-adherent to their regimen. Those at higher risk of non-adherence were on no concurrent medications, less than 50 years old, and those treated with imatinib. Active intervention to improve tyrosine kinase inhibitor adherence should be developed, implemented, and evaluated to improve patient outcomes at our center.

Feasibility of using the Multinational Association of Supportive Care in Cancer Antiemesis Tool for assessment of chemotherapy-induced nausea and vomiting at the Tom Baker Cancer Centre.

INTRODUCTION: Chemotherapy-induced nausea and vomiting (CINV) has been shown to adversely impact patient anxiety, quality of life, treatment adherence, and use of health care resources. CINV control still remains a challenge, and lack of effective communication between the patient and clinician has been highlighted in the literature as the main barrier to optimal control. The Multinational Association of Supportive Care in Cancer (MASCC) has developed a tool (MASCC Antiemesis Tool (MAT)) to improve assessment and subsequent management of CINV by enhancing communication between patients and their clinicians. This study assessed the feasibility of using the MAT in patients at the Tom Baker Cancer Centre. The secondary objective was to describe the incidence of CINV as identified by the tool. METHODS AND MATERIALS: This study involved a prospective survey using the MAT in patients receiving intravenous chemotherapy. Subjects completed the MAT twice post-chemotherapy regarding CINV symptoms and returned it at their next clinic appointment. Participants were also surveyed to evaluate feasibility with regard to using the MAT. RESULTS: Of the 50 patients recruited, 56% returned surveys. The majority of patients reported that the MAT facilitated communication with their clinician, particularly those who had experienced CINV. Fifty-four percent of patients who returned the MAT reported CINV; however, less than half of them had received American Society of Clinical Oncology-recommended antiemetic regimens. Only four patients with CINV had antiemetic changes made for subsequent cycles. CONCLUSION: The MAT is a feasible tool which can improve communication of CINV symptoms between patients and clinicians, a foundational step toward improving CINV management.

Evaluation of clinical pharmacists' follow-up service in an oncology pain clinic.

BACKGROUND: Patients who present with pain in an oncology setting are often complex and require a multidisciplinary approach for symptom control. The Pain and Symptom Control Clinic at Tom Baker Cancer Center includes two pharmacists who participate in weekly multidisciplinary clinics and provide a follow-up service to patients. OBJECTIVE: This study will assess the impact of the pharmacists' follow-up service with respect to activities performed as well as patient and health care professional satisfaction. The activities performed will also be compared to defined objectives for pharmacy practice in a hospital setting. METHODS: Activities performed by the pharmacists over a 10-week period were recorded and tabulated. Online surveys were completed by health care professionals and telephone surveys were completed by patients 1 month post clinic visit. RESULTS: Over 6 weeks, 44 patients assessed in clinic required follow-up from a pharmacist. There was an average of 2.3 interactions per patient and an average time of 85 min was spent on each patient outside of clinic. The three activities that occurred most frequently included: (1) interacting with other health care professionals, (2) making alterations to patients' medication regimens, and (3) organizing refills. All health care professionals surveyed felt that the pharmacists' follow-up service was a valuable component of the Pain and Symptom Control Clinic and nearly all patients surveyed reported a positive experience with the service received. CONCLUSION: The inclusion of pharmacists in the Pain and Symptom Control Clinic is favored by patients and health care professionals and provides increased efficiency to the clinic.

A medication error prevention survey: five years of results.

BACKGROUND: The Alberta Cancer Board is composed of 19 cancer centers in Alberta, Canada. In 1996, the Alberta Cancer Board's Medication Error Prevention Committee developed a medication error prevention survey based on the medication error prevention policies. Since 1996, this survey has been sent annually to the pharmacy departments of the 19 cancer centers. Each year, the results are presented to the Pharmacy and Therapeutics Committee of the Alberta Cancer Board. OBJECTIVES: The purpose of the paper was to present and analyze five years of medication error prevention survey results, thus summarizing adherence to the Alberta Cancer Board's medication error prevention policies. METHODS: Medication error prevention survey results from 2003 to 2007 were collected. For each of the five years, a medication error prevention survey was faxed to the pharmacy department at each of the 19 cancer centers of the Alberta Cancer Board. Results of the survey were tabulated by the pharmacist responsible for quality assurance. RESULTS: Analysis of the five years of medication error prevention survey results revealed that over 90% of the medication error prevention policies were followed within the 19 Alberta Cancer Board sites. Adherence to the policies was 490% in the tertiary sites and associate clinics. Adherence was also >90% in the community cancer centers. CONCLUSIONS: Results from the survey indicated that the medication error prevention policies are practiced within the Alberta Cancer Board. Potential areas of improvement have been identified and will be addressed by the Medication Error Prevention Team.

Efficacy vs. effectiveness--docetaxel and prednisone in hormone refractory prostate cancer.

OBJECTIVES: To assess the clinical effectiveness of docetaxel and prednisone in a clinical setting and to compare the results to those seen in the pivotal clinical trial. To assess the impact of various factors on the prognosis of patients treated with docetaxel. DESIGN: Retrospective chart review. The primary outcome measured was survival. Survival data was analyzed through the Kaplan-Meier methodology. A multivariate analysis of prognostic variables was also conducted. SETTING: Public cancer centers within the Canadian province of Alberta. PATIENTS: Hormone refractory, metastatic prostate cancer patients initiated on docetaxel chemotherapy between September 2004 and February 2007 within the Alberta Cancer Board. Main Outcome Measured. The primary outcome measured was median survival. RESULTS: Among 161 patients eligible for review, median survival was 17.22 months. Chemotherapy received after docetaxel was determined to be a significant favorable prognostic factor for survival (p<0.0001). CONCLUSION: In a clinical setting, docetaxel and prednisone did not perform as well in terms of median survival, as it was shown to in prior clinical trials (17.22 vs. 18.9 months). Further investigation into the impact of docetaxel and prednisone on quality of life in clinical practice, would complement the findings of this study.