1632P_PRCharacterizing the risk of drug-drug interactions in sarcoma treated patients: Role of pharmacist integration

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... Education level was university degree in 19%, high school diploma in 46.5%. The mean age of minors was 14 years [8][9][10][11][12][13][14][15][16][17][18] [ Table 1]. ...
... In this study, the authors reported that in 202 sarcoma patients 18% patients experienced drug-drug interactions and one-third of these interactions (29%) were associated with CAM use. [15] Even fewer trials exist on the results usage of some specific CAM in sarcoma while more studies were carried out in other more common cancers such as breast, lung, or colorectal cancer. [16] The results of a small randomized study on the use of Viscum Album Fermentatum Pini were reported in 2014. ...
Background: Bone and soft-tissue sarcoma are rare tumors. Complementary and alternative medicine (CAM) is often used in cancer patients however limited data are available in sarcoma patients. The aim of the present study is to explore the use of CAM in patients with bone and soft-tissue sarcoma. Methods: Patients in follow-up visit for high grade bone or soft-tissue sarcoma at the Rizzoli outpatient clinic from September 1, 2014, to December 31, 2015, were asked, after written consent, to fill out a questionnaire with items pertaining to sociodemographic factors and their use of CAM before, during, or after chemotherapy. Results: Four hundred and sixty-nine participated to the survey: 409 were adults and 60 were <18 years old. The percentage of use of CAM in adults was 44.7% and in minors 38.3%. The most common type of CAM was vitamins and minerals, followed by phytotherapy and homeopathy. The majority of patients used CAM after the sarcoma diagnosis. None used CAM alone instead of conventional chemotherapy. Benefits from use of CAM were reported by 75% of patients (some benefit in 53% plus high benefit in others 22%) and side effects in 6.7%. A significant correlation was found with CAM use and female gender, young age (18-44) and higher education. Disclosure to the oncologist was 56% and 69% to their family doctors. Conclusions: This study shows that CAM use is frequent among adults and pediatric patients with bone and soft tissue sarcoma as in other cancer patients. Moreover, the profile of these Italian CAM consumers in sarcoma patients is similar to other studies. Patients disclosure to their oncologist or physician about the use of CAM was similar to other Italian studies, but higher compared to other international studies.
... In these patients, 24% of the time, a pharmacist suggested discontinuation, substitution, monitoring, or adjustments. Drug-drug interactions were more common in patients on tyrosine kinase inhibitors, and 29% of interactions were due to DS use [45]. ...
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PurposeThis project evaluated the dietary supplement (DS) use of patients referred to an integrative oncology program and documented the frequency and reasons for recommending stopping DS. Many patients with cancer are taking dietary supplements and may not disclose such to their care teams. There is potential for harm in several ways: (1) interactions with their medications that may increase side effects, (2) interactions with their treatment that may lead to decreased efficacy, and 3) direct toxicity from the supplement.Methods Patient data (N = 100) were collected prospectively from an Integrative Oncology Clinic. The number and type of DS were documented. Using the Natural Medicines Database, we determined whether supplements interacted with the patient’s other medications or cancer therapies. We calculated the percentage of patients in which a recommendation for discontinuation (DC) of DS was provided, along with the supporting reasons.ResultsWe found that 91% of patients took DS, averaging 5.5 per patient (range 0–20). In 35% of patients, we recommended stopping some of their DS or other therapies, the reasons being: DC antioxidants, vitamin B12/iron while on chemo/RT (unless deficient or part of protocol) 32%; DC due to taking excess amounts (i.e., fat-soluble vitamins, calcium, iron) 13.5%; DC supplements with known toxicity (i.e., laetrile, Miracle mineral solution) 13.5%; DC due to interactions with other medications (i.e., anticoagulants) 13.5%; DC DS with potential to increase cancer growth (i.e., estrogenic potential in those with hormone-sensitive cancers, glutamine) 11%; DC due to potential for increased toxicity with chemotherapy (i.e., increased risk of bleeding, CIPN) 11%; DC probiotics, immune stimulants, and cannabis while on immunotherapy 5.4%.Conclusions Patients with cancer referred to an integrative oncology clinic use large numbers of DS with the potential for adverse effects and/or decreasing efficacy of treatments. This study highlights the prevalence of DS usage in cancer patients referred to an integrative oncology clinic and demonstrates the need for counseling about safe supplement use.
Clinical Decision Support Systems (CDSSs) signify the framework shift in the medical sector in the modern age. CDSSs are utilized in augmenting healthcare facilities in the process of making complex clinical decisions. Since the first application of CDSSs in the 80s, the framework has witnessed significant transformation. The frameworks are now administered through electronic healthcare records with complex capacities. Irrespective of these complex advancements, there are existing questions concerning the impacts of CDSSs on service providers, healthcare costs, and patients’ records. There are many published texts concerning the success stories of CDSSs, but significant setbacks have proved that CDSSs are not without any potential risks. In this research, we provide critical analysis on the application of CDSSs in clinical setting, integrating various forms, present application cases with proven effectiveness, potential harms and common pitfalls. We therefore conclude with evidence-centered recommendation for mitigating the issues of CDSSs maintainability, evaluation, implementation and designing.
Résumé Une série de sessions organisées lors du congrès ESMO 2018 se sont penchées sur l’accompagnement du patient atteint de cancer. Le pharmacien d’officine qui intervient principalement dans le contexte des soins de support auprès de ces malades doit actualiser ses connaissances.
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