A retrospective study comparing interventions by oncology and non-oncology pharmacists in outpatient chemotherapy.

BACKGROUND: The differences in the clinical pharmacy services (CPS) provided by oncology and non-oncology pharmacists have not been sufficiently explained. AIM: This study aimed to demonstrate the differences in direct CPS provided by oncology and non-oncology pharmacists for patients and physicians, and to assess the potential impact of these services on medical costs. METHODS: We retrospectively examined CPS provided by oncology and non-oncology pharmacists for outpatients who underwent chemotherapy between January and December 2016. RESULTS: In total, 1177 and 1050 CPS provided by oncology and non-oncology pharmacists, respectively, were investigated. The rates of interventions performed by oncology and non-oncology pharmacists for physicians-determined treatment were 18.5% and 11.3%, respectively (p < .001). The rates of oncology and non-oncology pharmacist interventions accepted by physicians were 84.6 and 78.8%, respectively (p = .12). Level 4 and Level 5 interventions accounted for 64.6% of all oncology pharmacist interventions and 53.0% of all non-oncology pharmacist interventions (p = .03). The rates of improvement in symptoms from adverse drug reactions among patients resulting from interventions by oncology and non-oncology pharmacists were 89.4 and 72.1%, respectively (p = .02). Conservative assessments of medical cost impact showed that a single intervention by an oncology and by a non-oncology pharmacist saved ¥6355 and ¥3604, respectively. CONCLUSION: The results of the present study suggested that CPS by oncology pharmacists enable safer and more effective therapy for patients with cancer and indirectly contribute to reducing health care fees.

Beneficial effects of curcumin on antitumor activity and adverse reactions of doxorubicin.

Many medicines used in cancer chemotherapy decrease the quality of life (QOL). It is believed that an increase in food intake during cancer chemotherapy may produce an improvement in QOL. Curcumin is widely used as a coloring and flavoring agent in food. The effects of curcumin in relation to the chemotherapeutic drug doxorubicin (DOX) were examined. While DOX alone did not decrease tumor weight, the combination of DOX and curcumin significantly reduced tumor weight to 56.5% (p<0.05) of that of the control group. The combined curcumin enhanced apoptosis by DOX and decreased cell viability. The curcumin-DOX combination also suppressed activation of caspase-3, -8, and -9 compared to DOX alone. It is presumed that combining curcumin increased DOX-induced antitumor activity by suppressing the main caspase pathway and activating the main caspase independent pathway. The combination of curcumin and DOX suppressed the reduction of glutathione peroxidase activity and increased lipid peroxide levels in the heart. Therefore, it is expected that curcumin may reduce the adverse reactions associated with DOX. Our results suggest that curcumin can be used as a modulator to enhance the therapeutic index of cancer patients and improve their QOL.

Efficacy of theanine is connected with theanine metabolism by any enzyme, not only drug metabolizing enzymes.

Theanine increases the antitumor effect of doxorubicin (DOX) with decreasing adverse reaction. We clarified the mechanism by which theanine decreases the adverse reaction of DOX on any metabolizing enzymes of theanine. There was no change in the activity of any CYPs and the cytochrome P450 content by theanine treatment. Namely, it was considered that the decrease of DOX adverse reactions by theanine was not connected with CYP activity. In other words, it is shown that theanine has no effect on the metabolism of other medicines and is safe as a food (tea) or supplement. Glutathione S-transferase activity did not change in the theanine-alone group whereas increased in the theanine and DOX-combined group. These results suggested that theanine combination increased the conjugate with DOX and GSH, promoted the efflux of GS-DOX conjugates from the liver, and decreased DOX concentration in the liver. In medium containing theanine with glutaminase in vitro, glutamate gradually generated, showing that glutaminase reacted with theanine. Furthermore, the generation of glutamate increased by reaction of theanine and gamma-glutamyltranspeptidase (gamma-GTP), showed that gamma-GTP converted theanine to glutamate. It is expected that theanine metabolism occurred by hydrolysis and rearrangement reaction by gamma-GTP in the liver. Namely, it is suggested that the metabolism of theanine mediated by glutaminase and gamma-GTP and the increase of glutamate mediated GSH is important for theanine-induced action. In conclusion, it appeared that theanine does not change the biodistribution of combined drugs but it modulates biodistribution or damage to the relative site of GSH, and shows preventive effects in tissue.