Management and health-related quality of life among patients with prostate cancer in a Kenyan tertiary health facility.

INTRODUCTION: Advances made in the screening, diagnosis and management of prostate cancer have improved the survival rates of the patients. However, many of these treatments including surgery, radiotherapy, and pharmacotherapy, have an impact on the subsequent health-related quality of life (HRQoL) of these patients. Since it is an important prognostic factor of survival, failure to evaluate the HRQoL and its predictors in these patients typically results in long-term deficits in their overall well-being, that is, their physical, social, emotional, and mental health. The objective of this study was to evaluate the management and HRQoL among patients with prostate cancer at Kenyatta National Hospital. METHODS: This was a descriptive cross-sectional study. The sample size of 62 patients who met the eligibility criteria was selected through simple random sampling on the respective clinic days of the cancer treatment centre and urology clinic. Data was collected through a pre-tested structured questionnaire and HRQoL tools which are EORTC-QLQ-C30 and EORTC-QLQ-PR25 and analysed using STATA version 13 software. Descriptive analysis was used to summarise the continuous and categorical variables. Spearman's rho (rs) correlation was used to determine the predictors of HRQoL based on the strength and significance of association at 0.05 level of significance. RESULTS: The mean age of the participants was 70.5 (±7.35) years. The majority (52, 83.9%) of the patients had a prostate specific antigen (PSA) above 20 ng/ml. Twenty-one (33.9%) were graded as Gleason group 5 and 41 (66.1%) had stage IV disease at diagnosis. Fifty (80.9%) participants were on hormonal therapy, with most of them being on combined androgen blockade. The overall HRQoL was 65.1. Fatigue, one of the major complaints among these patients, was negatively associated with physical functioning (p = 0.0005), role functioning (p = 0.0026), social functioning (p = 0.0001), financial difficulties (p = 0.0077) and quality of life (p = 0.0050). CONCLUSION: Fatigue was the most common predictor of poor HRQoL in several scales of measurement. For those on management, frequent assessment of HRQoL should be carried out and interventions instituted immediately.

Impact of coronavirus of 2019 on the delivery of pharmacy services to patients with cancer: An international survey of oncology pharmacy practitioners.

INTRODUCTION: The coronavirus of 2019 pandemic has necessitated vast and rapid changes in the way oncology pharmacy services are delivered around the world. METHODS/AIMS: An international survey of oncology pharmacists and technicians was conducted via the International Society of Oncology Pharmacy Practitioners and collaborating global pharmacy organisations to determine the impact that the coronavirus of 2019 has had on pharmacy service delivery, pharmacy practitioners and oncology practice. RESULTS: The survey received 862 responses from 40 different countries from September to October 2020. The majority of respondents were pharmacists (n = 841, 97.6%), with 24% involved in the direct care of patients with the coronavirus of 2019. Of the survey participants, 55% increased their time working remotely, with remote activities including dispensing, patient assessment/follow-up and attending multi-disciplinary rounds. Respondents reported a 72% increase in the use of technology to perform remote patient interaction activities and that participation in educational meetings and quality improvement projects was reduced by 68% and 44%, respectively. Workforce impacts included altered working hours (50%), cancelled leave (48%) and forced leave/furloughing (30%). During the pandemic, respondents reported reduced access to intensive care (19%) and anti-cancer (15%) medications. In addition, 39% of respondents reported reduced access to personal protective equipment, including N95 masks for chemotherapy compounding. Almost half of respondents (49%) reported that cancer treatments were delayed or intervals were altered for patients being treated with curative intent. A third of practitioners (30%) believed that patient outcomes would be adversely impacted by changes to pharmacy services. Sixty-five percent of respondents reported impacts on their mental health, with 12% utilising support services. CONCLUSION: The coronavirus of 2019 pandemic has altered the way oncology pharmacy services are delivered. These results demonstrate the adaptability of the oncology pharmacy profession and highlight the importance of formal evaluation of the varied practice models to determine the evidence-based practices that enhance pharmacy services and, thus, should be reinstated as soon as practical and reasonable.

Drug therapy problems and health related quality of life among patients with colorectal cancer in a Kenyan tertiary health facility.

BACKGROUND: Colorectal cancer is the third most common form of cancer in males and the second in females globally. The ill-health due to cancer and use of multiple therapies may result in drug related problems and also affect the health-related quality of life of the patients. OBJECTIVE: To characterize drug therapy problems and health-related quality of life among patients with colorectal cancer at Kenyatta National Hospital.Methodology: A descriptive prospective cross-sectional study design was used and simple random sampling utilized to select seventy- one participants. The participants were interviewed and their responses captured using World Health Organisation Quality of Life-BREF and a structured questionnaire. The data were analysed using STATA version 15.0. Data was summarized using descriptive statistic such as mean, range and standard deviation. Association between variables was determined using linear regression model at 0.05% level of significance. Ethical approval was granted by the relevant authorities to conduct the study. RESULTS: Patients were predominantly females (52.1%), had a mean age of 55.9± 14.4 years. The main drug therapy problems were adverse drug reactions (45.1%). Approximately two thirds (67.6%) of the participants complained of gastrointestinal problems followed by cardiovascular diseases (29.6%). Quality of life assessment indicated that psychological health had the highest score at 60.5%. On linear regression analysis, the presence of anemia (p = 0.021), coverage (p = 0.038), and cardiovascular problems (p = 0.034) were significantly associated with the overall health-related quality of life. CONCLUSION: The health-related quality of life was is dependent on several patient related factors. Interventions regarding prevention of drug therapy problems should be considered alongside other measures used to manage colorectal cancer.

International Society of Oncology Pharmacy Practitioners (ISOPP) position statement: Role of the oncology pharmacy team in cancer care.

The Oncology Pharmacy Team (OPT), consisting of specialty-trained pharmacists and/or pharmacy technicians, is an integral component of the multidisciplinary healthcare team (MHT) involved with all aspects of cancer patient care. The OPT fosters quality patient care, safety, and local regulatory compliance. The International Society of Oncology Pharmacy Practitioners (ISOPP) developed this position statement to provide guidance on five key areas: 1) oncology pharmacy practice as a pharmacy specialty; 2) contributions to patient care; 3) oncology pharmacy practice management; 4) education and training; and 5) contributions to oncology research and quality initiatives to involve the OPT. This position statement advocates that: 1) the OPT be fully incorporated into the MHT to optimize patient care; 2) educational and healthcare institutions develop programs to continually educate OPT members; and 3) regulatory authorities develop certification programs to recognize the unique contributions of the OPT in cancer patient care.

Metformin's effectiveness in preventing prednisone-induced hyperglycemia in hematological cancers.

BACKGROUND: Research has established the development of steroid-induced hyperglycemia as a glucometabolic side effect of high-dose prednisone therapy. Few studies, however, have demonstrated preventative measures that could effectively curtail this side effect in susceptible patients undergoing high-dose prednisone treatment. OBJECTIVE: To assess metformin's prophylactic effectiveness of prednisone-induced hyperglycemia among hematological cancer patients. SETTING: Prospective randomized controlled trial conducted at the Kenyatta National Hospital Oncology Clinic and Wards, Nairobi, Kenya. METHOD: Non-hyperglycemic hematological cancer patients on current or newly initiated high-dose prednisone-based chemotherapy were randomized to receive metformin 850 mg once then 850 mg twice daily for two successive weeks each or to the control group receiving the standard care. Patients were subjected to once weekly fasting and 2-h postprandial glucose measurements for four weeks. MAIN OUTCOME MEASURE: The primary outcome of measure was the development of hyperglycemia defined by fasting capillary blood glucose values >5.6 mmol/L or 2-h postprandial capillary blood glucose values >7.8 mmol/L. RESULTS: Eighteen of 24 randomized patients completed the study (11 control and 7 treatment). The proportion of the control subjects that developed prediabetes was 72.7% (95% confidence interval 45.5-90.9%) using fasting glucose and 54.5% (95% confidence interval 27.3-81.8%) using 2-h postprandial glucose. One treatment group participant developed prediabetes using fasting glucose, representing 14.3% (95% confidence interval 0-42.9%). No prediabetes was detected using the 2-h postprandial glucose. Analysis of mean fasting glucose between the two arms found no significant difference. However, significant differences in mean 2-h postprandial glucose were noted in week 2 (p = 0.0144), week 3 (p = 0.0095), and week 4 (p = 0.0074) of the study. Double dose (1700 mg) metformin was more effective in lowering blood glucose than single dose (850 mg) (p = 1.0000 (fasting), p = 0.4531(2-h postprandial). CONCLUSION: Metformin's prophylactic effectiveness was demonstrated in this randomized study on new and previously exposed non-diabetic cancer patients on high-dose prednisone-based chemotherapy.

Proactive risk assessment of vincristine use process in a teaching and referral hospital in Kenya and the implications.

INTRODUCTION: The chemotherapy use process is potentially risky for cancer patients. Vincristine, a "High Alert" medicine, has been associated with fatal but preventable medication errors. Consequently, there is a need to improve the use of vincristine especially in lower- and middle-income countries where there are constraints with resources and often a lack of trained personnel to administer cancer medicines. However, where there is a rising prevalence of cancer cases. These concerns can be addressed by performing proactive risk assessments using Healthcare Failure Mode Effect Analysis (HFMEA) and implementing the findings. METHODS: A multidisciplinary health team driven by pharmacists identified and evaluated potential failure modes based on a vincristine use process flow diagram using a hazard scoring matrix in a leading referral hospital in Kenya. RESULTS: The processes evaluated were: prescribing, preparation and dispensing, transportation and storage, administration and monitoring of the use of vincristine. Seventy-seven failure modes were identified over the three-month study period, of which 25 were classified as high risk. Thirteen were adequately covered by existing control measures while 12 including one combined mode required new strategies. Two of the failure modes were single-point weaknesses. Recommendations were subsequently made for improving the administration of vincristine. CONCLUSIONS: HFMEA is a useful tool to identify improvements to medication safety and reduction of patient harm. The HFMEA process brings together the multidisciplinary team involved in patient care in actively identifying potential failure modes and owning the recommendations made, which are now being actively followed up in this hospital. Pharmacists are a key part of this process.

Study of the use of complementary and alternative medicine by cancer patients at Kenyatta National Hospital, Nairobi, Kenya.

INTRODUCTION: Cancer is not only a burden in the country but also a global burden with among the highest rate of mortality. In spite of the great strides made by the conventional therapy, many cancer patients have resorted to using complementary and alternative medicine (CAM) as human beings have an innate urge to try new and alternative ways to relieve their suffering. OBJECTIVES: There is a need for us to establish if the cancer patients at Kenyatta National Hospital, Nairobi use CAM, to establish the socio-demographic characteristics of patients in the oncology clinic, to establish the types and patterns of CAM use, to establish the reasons and factors that may contribute to CAM use and if the primary health care provider is aware that they are using CAM. METHODOLOGY: Face-to-face interviews using semi-structured questionnaires were used to determine the use of CAM by the cancer patients. All consenting cancer patients who satisfied the inclusion criteria were interviewed as they presented to the oncology clinic. RESULTS: A total of 78 respondents were interviewed during the study out of which 35 (44.9%) were male, while 43 (55.1%) were female. The age distribution was from 18 to above. Eleven patients (14.1%) have used CAM at one point during their treatment. The use of CAM was not affected by the age, gender, and marital status, level of education and level of income. The most frequently used CAM was herbal medicine; 64.0% of the patients used CAM with the hope of curing their disease, while 36.0% used it with the hope of getting symptomatic relief. Among the CAM users, only 45.0% were satisfied with the use of it, while 55.0% were disappointed as it did not meet their expectations and would therefore never recommend the of CAM to anyone else; 27.0% obtained some benefit from the use of CAM, 27.0% did not experience any benefit and a further 46.0% were unclear about any notable benefit experienced; 55.0% of the CAM users had disclosed their use of CAM to the doctor, while 45.0% did not disclose this reason mostly because they do not feel it is important to let the doctor know as he/she never asks. CONCLUSION: The prevalence of CAM use among cancer patients in Kenyatta National Hospital ranks lower compared to other countries. The most common type of CAM in use is herbal medicine. However, most patients do not obtain the expected benefits and do not disclose this information to the doctors as they feel it is not important.

Assessment of drug therapy problems among patients with cervical cancer at Kenyatta National Hospital, Kenya.

BACKGROUND: Although cervical cancer is preventable, it is still the second leading cause of cancer deaths among women in the world. Further, it is estimated that around 5-10% of hospital admissions are due to drug related problems (DRPs), of which 50% are avoidable. In cancer therapy, there is an immense potential for DRPs due to the high toxicity of most chemotherapeutic regimens. Hence, this study sought to assess DRPs among patients with cervical cancer at Kenyatta National Hospital (KNH). METHODS: A cross-sectional study was conducted at the oncology units of KNH. A total of 81 study participants were recruited through simple random sampling. Data were collected from medical records and interviewing patients. The appropriateness of medical therapy was evaluated by comparing with National Compressive Cancer Network and European Society for Medical Oncology practice guideline of cervical cancer treatment protocol. The degree of adherence was determined using eight-item Morisky medication adherence scale. The likelihood of drug interaction was assessed using Medscape, Micromedex and Epocrates drug interaction checkers. The data were entered in Microsoft Excel and analysed using statistical software STATA version 13.0. Descriptive statistics such as mean, percent and frequency were used to summarise patients' characteristics. Univariable and multivariable binary logistic regression were used to investigate the potential predictors of DRPs. RESULT: A total of 215 DRPs were identified from 76 patients, translating to a prevalence of 93.8% and a mean of 2.65 ± 1.22 DRPs. The predominant proportion of DRPs (48.2%) was identified in patients who had been treated with chemoradiation regimens. Adverse drug reactions 56(69.1%) and drug interactions 38(46.9%) were the most prevalent DRPs. Majority (67.9%) of the study population were adherent to their treatment regimens. Forgetfulness 18(69.2%), expensive medications 4(15.4%) and side effects of medications 4(15.4%) were the main reasons for medication non-adherence. Patients with advanced stage cervical cancer were 15.4 times (AOR = 15.4, 95% CI = 1.3-185.87, p = 0.031) more likely to have DRPs as compared to patients with early stage disease. CONCLUSION: Adverse drug reactions, drug interactions, and need of additional drug therapy were the most common DRPs identified among cervical cancer patients. Advanced stage cervical cancer was the only predictor of DRPs.