User acceptance of an app-based adherence intervention: Perspectives from patients taking oral anticancer medications.

BACKGROUND: Widespread adoption by patients is imperative for the success of app-based interventions for enhancing adherence to oral anticancer medications. Patients' attitudes and beliefs should be evaluated to understand determinants of their acceptance and adoption of such interventions. OBJECTIVE: To identify factors that influence cancer patients' intention to adopt an app-based system for enhancing oral anticancer medication adherence. METHODS: This study was conducted as part of the usability evaluation of an app-based system for enhancing adherence. We followed the grounded theory approach employing audio-recorded face-to-face interviews for data collection from patients taking oral anticancer medications (n = 15) and caregivers of such patients (n = 3). Data analysis involved verbatim transcription of all interviews, coding of the transcripts and field notes, detailed memo writing, and constant comparative evaluation of emergent categories. RESULTS: A conceptual framework of facilitating and hindering factors for users' adoption intention for an oral anticancer medication adherence app was developed. Findings suggest that facing difficulties in maintaining adherence and patients' perceived superiority of the app over their current methods facilitate adoption intention. In contrast, having to pay, lack of language options and users' perception of low competence in using an app were the hindrance factors. CONCLUSION: This study showed that adoption of adherence apps could be explained by technology acceptance constructs, such as performance expectancy. Adoption intention was also facilitated by patients perceived vulnerabilities in maintaining adherence to their medications, which was a health behaviour construct. Implementation of app-based programs should address patients' perceived vulnerabilities and relative advantage of the app over their current methods. Clinicians and app developers should also consider the financial, technological and language barriers for end users.

Design Considerations in the Development of App-Based Oral Anticancer Medication Management Systems: a Qualitative Evaluation of Pharmacists' and Patients' Perspectives.

Smartphone apps can potentially help in enhancing oral anticancer medication (OAM) adherence. Patient adoption and efficacy of such apps depends on inclusion of user-centred and evidence-based features. The objective of this study was to identify important design considerations from the perspectives of patients taking OAMs, caregivers and oncology pharmacists. The study employed a qualitative study design. Data were collected using in-depth interviews with patients (n = 15), caregivers (n = 3) and pharmacists (n = 16). Interviews were audio-recorded, transcribed verbatim and inductive thematic analysis approach was used in data analysis. Monitoring medication-related problems, medication information, replacement of or integration with current systems and accessibility of app content on devices other than smartphones were the key themes identified in the analysis. Flexible input methods for monitored data, glanceability of monitored reports/information, near real-time adherence enhancing and symptom management interventions and customisable reminder options were design considerations identified under the monitoring medication-related problems theme. Participants suggested the provision of focused and easily understandable medication information with a potential for personalisation. Integration of app-based adherence systems with patients' electronic medical records with added mechanisms for alerts in the dispensing system was also suggested as a key design requirement to improve quality of patient care and facilitate adoption by clinicians. Finally, smartphones were the most favoured platform with optional accessibility of app content on other devices. In conclusion, important design considerations were identified through a user-centred design approach. The findings will help developers and clinicians in the design of new app-based systems and evaluation of existing ones.

Patients' Perception of App-based Educational and Behavioural Interventions for Enhancing Oral Anticancer Medication Adherence.

Well-designed smartphone apps can potentially help in enhancing adherence to oral anticancer medications (OAMs). The objective of this study was to evaluate patients' perception on inclusion of various adherence-enhancing strategies as features of an app and their interest in using such app. A cross-sectional survey was conducted at the National Cancer Centre Singapore. A structured self-administered questionnaire was used to collect data from patients taking OAMs. Final analysis was based on 409 surveys and most of the respondents were female (291, 71.1%), Chinese (332, 81.2%), married (296, 72.4%) and breast cancer patients (211, 51.6%). Close to two-thirds of respondents rated medication information (65.0%), disease information (60.2%) and side effect self-management (60.2%) features as having the highest level of importance in an adherence app. Three hundred thirty-two (81.2%) of the respondents owned a smartphone, among which 92 (27.7%) reported using health-related apps. From respondents with smartphones, 219 (66.0%) were interested in using an app for OAM adherence. Age 65 and older compared to 21-54 years old (adjusted OR = 0.34; 95% CI = 0.15-0.76) and current use of a health app (adjusted OR = 1.91; 95% CI = 1.07-3.41) were significant predictors of interest to adopt an adherence app. In conclusion, patients value the inclusion of educational and behavioural interventions in adherence apps. Developers of adherence apps should consider including tools for side effect self-management and provision of information to educate patients on their medications and disease condition.

Technological preferences of aging cancer patients for delivery services and devices to solve drug-related problems in oncology.

AIM: To identify the technological preferences of aging cancer patients with regard to the delivery services and devices for preventing/solving three common drug-related problems (DRPs): medication nonadherence, lack of knowledge in medications, and side effects management. METHODS: A survey was conducted at a cancer center from May to August 2011. Delivery services included in the interviewer-administered questionnaire included voice-activated dispensing, voice reminders, electronic messages, helplines, and mobile phone applications, among others. Three devices were proposed-watches, bracelets, and mobile phones. Descriptive statistics and chi-square tests were performed. RESULTS: A total of 361 surveys were analyzed. Median age of respondents was 61 years. The majority of respondents were female (57.3 %), Chinese (88.9 %), and 65 years and younger (73.4 %). More than half (59.0-63.2 %) were receptive to the use of the delivery services. Patients preferred voice reminder alerts (28.0 %) and electronic messages (17.7 %) to help with their medication nonadherence, and helplines for medications (52.6 %) and side effects management (47.4 %). Higher educated patients were more likely to want delivery services to improve their medication adherence (p = 0.045) and knowledge in medications management (p = 0.050). Middle age patients (age 50-65) were also more likely to want delivery services for the latter DRP (p = 0.009). Among those who wanted delivery services, most preferred mobile phones. CONCLUSION: Middle age and elderly cancer patients are accepting of delivery services to help them with their DRPs. With middle aged patients being more receptive of the delivery services, technology can potentially play an important role in minimizing DRPs.

Impact of cancer-related fatigue on chemotherapy-induced nausea and vomiting in Asian cancer patients.

INTRODUCTION: Cancer-related fatigue (CRF) has been suggested to be associated with the occurrence of chemotherapy-induced nausea and vomiting (CINV). This study aims to evaluate the potential of CRF in predicting the occurrence of CINV. METHOD: This is a prospective, observational study. Recruited patients received moderately to highly emetogenic single-day chemotherapy regimens. On the day of chemotherapy, patients were instructed to provide a score (Likert scale of 0-10) to describe how CRF interfered with his or her ability to engage in daily activities and a score for how severe it was. Patients were then given a standardized 5-day diary to document their CINV events. RESULTS: A total of 473 eligible patients (median age: 55 years, interquartile range (IQR): 48-61 years) were recruited, with most of the patients diagnosed with gastrointestinal (45%) and breast (37%) cancers. The median score of fatigue interference was 3 (IQR: 0-5). After confounders were adjusted for, patients with low fatigue interference scores (≤3) were more likely to achieve complete protection (no nausea, no vomiting, and no breakthrough antiemetics) of CINV (adjusted odds ratio = 1.57, 95%CI [1.05, 2.35], p = 0.027). CONCLUSION: This is the largest study to date to evaluate the association between CRF and CINV. Patients experiencing CRF possessed a higher risk of poor control for CINV.

Affordability of cancer treatment for aging cancer patients in Singapore: an analysis of health, lifestyle, and financial burden.

BACKGROUND: With the expected rise in newly diagnosed cancer cases among the elderly in Singapore, the affordability of cancer treatments, particularly of targeted therapies, will be a growing concern for patients. This study examines the perspectives of aging cancer patients on the financial burden of their cancer treatments. METHODS: A single-center, prospective study was conducted in the largest ambulatory cancer center in Singapore. Older (50 years old and above) cancer patients receiving treatment were recruited. Patients completed three sets of self-reporting tools assessing their (a) demographics and lifestyles, (b) health-related quality of life, and (c) perceptions of cancer treatment costs. The association between targeted therapy utilities and their perceived financial burden was evaluated using a multivariable logistic regression. RESULTS: Five hundred and sixteen patients were included in the study. The majority of the respondents (69.6 %) were between 50 and 64 years old. The majority were Singaporeans (97.7 %), belonged to the ethnic Chinese group (88.4 %), and most were female (59.1 %). The users of targeted therapies were 2.92 times more likely to perceive that the amount of cash that they spent on cancer treatment was more than expected and 2.52 times more likely to have difficulty paying for cancer treatments. Fortunately, the majority of the respondents (70.6 %) found their existing financial schemes helpful in reducing the necessary out-of-pocket expenses. CONCLUSIONS: Although aging cancer patients feel that the financial schemes in Singapore have helped them tremendously, the general perception is that they require further help to offset their out-of-pocket expenses. This is especially true for users of targeted therapies and those who have a poorer health status.

Virtual Reality-Based Intervention to Reduce Preoperative Anxiety in Adults Undergoing Elective Surgery: A Randomized Clinical Trial.

IMPORTANCE: Preoperative anxiety is common among adult patients undergoing elective surgery and is associated with negative outcomes. Virtual reality (VR)-based interventions have been considered simpler, safer, and more effective for reducing anxiety in patients undergoing surgery than conventional care. OBJECTIVE: To examine the effectiveness of a VR-based intervention with preoperative education in reducing preoperative anxiety among adult patients undergoing elective surgery. DESIGN, SETTING, AND PARTICIPANTS: An assessor-blinded prospective randomized clinical trial was conducted to recruit adult patients aged 18 years or older who were scheduled for their first elective surgery procedure under general anesthesia within the next 2 to 4 weeks at a preanesthesia assessment clinic in Hong Kong from July to December 2022. INTERVENTIONS: Participants were randomly assigned to either an intervention group (an 8-minute immersive 360° VR video tour in the operating theater via a head-mounted display console) or a control group (standard care). MAIN OUTCOMES AND MEASURES: The primary outcome of preoperative anxiety was measured using the Amsterdam Preoperative Anxiety and Information Scale (range, 6-30; higher scores indicate greater anxiety), and the secondary outcomes (ie, stress, preparedness, and pain) were assessed by Visual Analog Scale at 3 time points: baseline at beginning of clinical session (T0), at the end of the clinical session immediately after the intervention (T1), and before the surgery (T2). Pain, satisfaction levels, and postoperative length of stay were evaluated after the surgery (T3). Simulation sickness was assessed after the intervention by use of the Simulation Sickness Questionnaire. A generalized estimating equations model was applied to compare changes in outcomes over time. RESULTS: A total of 74 participants (mean [SD] age, 46.34 [14.52] years; 38 men [51.4%] and 36 women [48.6%]) were recruited and randomized to the control group (37 participants) and intervention group (37 participants). Compared with the control group, the VR-based intervention group showed significantly decreased preoperative anxiety at T1 (ß, -5.46; 95% CI, -7.60 to -3.32; P < .001) and T2 (ß, -5.57; 95% CI, -7.73 to -3.41; P < .001), lower stress at T1 (ß, -10.68; 95% CI, -16.00 to -5.36; P < .001) and T2 (ß, -5.16; 95% CI, -9.87 to -0.45; P = .03), and higher preparedness at T1 (ß, 6.60; 95% CI, 0.97 to 12.19; P = .02). Satisfaction levels were significantly increased in the intervention group vs the control group (mean [SD] score, 81.35 [9.24] vs 65.28 [8.16]; difference, 16.07; 95% CI, 12.00 to 20.15; P < .001). No significant differences in pain and postoperative length of stay were found. CONCLUSIONS AND RELEVANCE: The findings of this study suggest that a VR-based intervention is a feasible and effective way to reduce preoperative anxiety in adult patients undergoing elective surgery. Given the promising results of this study, further study in the form of large-scale, multicenter, randomized clinical trials with broader implementation is warranted. TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2100051690.

Computational prediction of state anxiety in Asian patients with cancer susceptible to chemotherapy-induced nausea and vomiting.

State anxiety, a risk factor for chemotherapy-induced nausea and vomiting (CINV), is a subjective symptom and difficult to quantify. Clinicians need appropriate anxiety measures to assess patients' risks of CINV. This study aimed to determine the anxiety characteristics that can predict CINV based on computational analysis of an objective assessment tool. A single-center, prospective, observational study was carried out between January 2007 and July 2010. Patients with breast, head and neck, and gastrointestinal cancers were recruited and treated with a variety of chemotherapy protocols and appropriate antiemetics. Chemotherapy-induced nausea and vomiting characteristics and antiemetic use were recorded using a standardized diary, whereas patients' anxiety characteristics were evaluated using the Beck Anxiety Inventory. Principal component (PC) analysis was performed to analyze the anxiety characteristics. A subset known as principal variables, which had the highest PC weightings, was identified for patients with and without complete response, complete protection, and complete control. Chemotherapy-induced nausea and vomiting events and anxiety characteristics of 710 patients were collated; 51%, 30%, and 20% were on anthracycline-, oxaliplatin-, and cisplatin-based therapies, respectively. Most patients suffered from delayed CINV, with decreasing proportions achieving complete response (58%), complete protection (42%), and complete control (27%). Seven symptoms (fear of dying, fear of the worst, unable to relax, hot/cold sweats, nervousness, faintness, numbness) were identified as potential CINV predictors. This study demonstrates the usefulness of PC analysis, an unsupervised machine learning technique, to identify 7 anxiety characteristics that are useful as clinical CINV predictors. Clinicians should be aware of these characteristics when assessing CINV in patients on emetogenic chemotherapies.

Antiemetic effectiveness and nausea and vomiting incidence during capecitabine and oxaliplatin chemotherapy.

BACKGROUND: Capecitabine and oxaliplatin (XELOX) chemotherapy causes nausea and vomiting, despite adequate administration of antiemetics. Furthermore, specific risk factors that increase this risk are not elucidated. OBJECTIVE: To appraise the effectiveness of antiemetics to prevent XELOX-induced nausea and vomiting. METHODS: This was a single-center, prospective, cohort study. Patients were recruited on the day of chemotherapy and received follow-up after 5 days to assess nausea and vomiting and use of antiemetics. Patients were assessed for nausea and vomiting control and clinical endpoints of complete response, complete protection, and complete control. Multivariate logistic regression was used to evaluate the risk factors. RESULTS: Mean age of the 156 patients analyzed was 60 years (SD = 9.0) with 88 men (56.4%) and 68 women (43.6%). Patient proportions achieving complete response (87.8%), complete protection (80.8%), and complete control (62.8%) within 24 hours after chemotherapy declined throughout the follow-up period to 76.9%, 64.7%, and 48.7%, respectively. Patients with fewer than three risk factors (odds ratio [OR] = 3.13, p = .006), those receiving oxaliplatin less than 100 mg/m (OR = 3.23, p = .009) and capecitabine less than 1,500 mg/m (OR = 5.00, p = .04), were more likely to achieve complete response. CONCLUSIONS: An unacceptably high proportion of patients receiving XELOX were identified as being unable to attain adequate control of nausea because of inadequate usage of delayed antiemetic prophylaxis. Clinicians should be aware of the chemotherapy-induced nausea and vomiting patterns in this subgroup of patients on XELOX and tailor appropriate management plans. Incorporation of delayed antiemetics to existing institutional guidelines for chemotherapy-induced nausea and vomiting management may improve patients' tolerance of XELOX.

Electronic database to detect drug-drug interactions between antidepressants and oral anticancer drugs from a cancer center in Singapore: implications to clinicians.

BACKGROUND: Electronic drug interaction databases are often utilized in clinical practice to detect for possible drug-drug interactions between drug pairs. It is uncertain, however, whether most of these detections interactions are clinically important in practice. To demonstrate these issues, this study utilized a comprehensive drug-drug interaction (DDI) electronic database to elucidate the prevalence of DDIs at a cancer centre between antidepressants and oral anticancer drugs (ACDs). METHODS: Drug utilization reports were retrieved to determine the patients who were prescribed with antidepressants oral ACDs between 2006 and 2009 at a cancer center. Medication records of these patients were retrospectively examined using OncoRx, an internet-based oncology-specific database that allows the identification of DDIs. RESULTS: Out of 910 users of antidepressants, about one-third (281 patients, 30.9%) used an oral ACD and an antidepressant concomitantly. From these patients, about one-fifth (21.0%) had potential DDIs. These patients were users of 17 potentially interacting drug pairs. Ten out of the 17 drug pairs could potentially cause pharmacokinetic interactions, and the rest were pharmacodynamic interactions, with only three out of the 17 drug pairs were clinically documented to cause interacting events. CONCLUSION: The lack of screening conditions may have led to an over detection of DDI combinations by electronic DDI databases. Many of the detected interactions may not deem high significance in clinical practice. This study exposed a major weakness of current electronic DDI databases for detecting oral ACDs and antidepressants DDIs.

Mobile Health Apps That Act as Surgical Preparatory Guides: App Store Search and Quality Evaluation.

BACKGROUND: Mobile health (mHealth) apps are becoming increasingly common in surgical practices for training, education, and communication. Factors leading to increased delays, morbidity, and mortality in surgery include inadequate preoperative patient preparation due to a failure to identify patients and procedure details, and missing instruments and equipment required for the procedure. Many apps are available for supporting preoperative, intraoperative, and postoperative care. However, there is a lack of studies that assess the quality of apps that act as surgical preparatory guides. OBJECTIVE: The aim of this study is to evaluate the quality of apps that act as surgical preparatory guides for operating room personnel through an in-house quality assessment tool. METHODS: The quality assessment tool comprises 35 questions categorized into 5 sections: (1) engagement (customization, interactivity, target audience; 19 points), (2) functionality (performance, ease of use, navigation; 12 points), (3) aesthetics (layout, visual appeal; 6 points), (4) information (quality and quantity of information, visual information, credibility; 29 points), and (5) privacy and security (4 points). An app search was conducted in the Australian Apple and Google Play stores using the following keywords: "surgical apps", "surgical preferences", "surgeon preferences", "operating room", and "perioperative procedures". The overall total scores and scores for each section were reported as medians and IQRs, expressed as raw scores and percentages. RESULTS: A total of 5 unique apps were evaluated on both iOS and Android platforms. The median overall score across all apps was 35/70 (50%; IQR 38.6%-64.3%). ScrubUp (48/70, 69%) and MySurgeon (42/70, 60%) had the highest overall scores, followed by PrefCard (35/70, 50%) and Scrubnote (28/70, 40%). The lowest scoring app was BrainPadd (26/70, 37%). The sections with the highest median scores, in decreasing order, were privacy and security (4/4, 100%; IQR 75%-100%), aesthetics (5/6, 83%; IQR 75%-91.7%), engagement (15/19, 79%; IQR 57.9%-86.8%), functionality (7/12, 58%; IQR 29.2%-75%), and information (5/29, 17%; IQR 15.5%-34.5%). Most apps scored well (4/4, 100%) on privacy and security, except for Scrubnote (2/4, 50%). ScrubUp received a perfect score for aesthetics (6/6, 100%). MySurgeon (17/19, 90%) had the highest engagement score, while ScrubUp and MySurgeon had the highest functionality scores (9/12, 75% each). All apps scored below 50% for the information section, with ScrubUp having the highest score of 13/29 (45%). CONCLUSIONS: ScrubUp and MySurgeon had the highest quality scores and can be used as adjuncts to hospital protocols by operating room personnel for their surgical preparation. Developers are encouraged to develop appropriate apps for surgical preparation based on relevant guidelines and standards, as well as the quality evaluation criteria in our tool. Operating room personnel can also use this tool as a guide to select and assess their preferred apps in their practices.

Quality evaluation of stress, anxiety and depression apps for COVID-19.

BACKGROUND: COVID-19 has caused increased stress, anxiety and depression with increased barriers to treatment. Mobile apps offer a potential solution, but there is no information on the quality of such apps recommended for COVID-19. This study aims to evaluate the quality of stress, anxiety and depression apps recommended for COVID-19. METHODS: A search was conducted to identify relevant apps on the iOS and Android platforms. 44 apps were evaluated using the Mobile App Rating Scale (MARS), and the American Psychiatric Association's app evaluation model for data privacy and security. RESULTS: Overall quality scores of iOS and Android apps were 3.69 ± 0.43 and 3.66 ± 0.47. Thirty percent had good/excellent overall scores. In general, the iOS and Android versions of the apps scored best for functionality (4.21 ± 0.48, 4.12 ± 0.53), followed by aesthetics (3.84 ± 0.50, 3.78 ± 0.56), information (3.39 ± 0.54, 3.40 ± 0.60), and engagement (3.31 ± 0.81, 3.34 ± 0.84). Over half (59%) shared personal information with third parties and 14% were compliant with data protection standards. LIMITATIONS: Only free apps available in Singapore were evaluated. Our results are time sensitive due to addition, removal, and update of apps in the app stores, thus our results should be extrapolated with caution to apps from other countries and paid apps. CONCLUSION: Apps that addressed all three conditions had the highest overall quality scores. The top ranked apps (Sanvello, Woebot, Happify, Youper, Bloom) were of good quality, but majority were of acceptable quality and had room for improvement. App developers are encouraged to use our findings to improve and develop better quality apps.

Assessing the quality of COVID-19 vaccine videos on video-sharing platforms.

BACKGROUND: Video-sharing platforms are a common source for health information such as Coronavirus Disease 2019 (COVID-19) vaccines. It is important that they provide good quality, evidence-based information. However, to date, the quality of information surrounding COVID-19 vaccines on video-sharing platforms has not been established. OBJECTIVE: This study developed an assessment tool to evaluate the quality of Coronavirus Disease 2019 (COVID-19) vaccine videos on YouTube, Facebook Watch and TikTok. METHODS: Assessment of quality was based on understandability, actionability, accuracy, comprehensiveness and reliability. Videos were searched using the keywords "COVID-19 vaccine", "Coronavirus vaccine" and "SARS-CoV-2 vaccine". Seventy-two videos were evaluated. Descriptive statistics, Kruskal-Wallis and Wilcoxon-rank sum tests were used for analysis. RESULTS: YouTube had the highest median composite score compared to TikTok (36.8% versus 27.5%, p = 0.001). YouTube also had the highest median reliability score (37.5%), but those of Facebook Watch (35.0%) and TikTok (35.0%) were only marginally lower. Median accuracy scores of all platforms were 100%, but their median comprehensiveness scores were low (YouTube 12.5%; Facebook Watch 6.3%; TikTok 6.3%, p = 0.004). Median actionability scores (0%) were the lowest for all platforms. TikTok had the highest median understandability score compared to YouTube and Facebook Watch (96.9% versus 80.0 each, p < 0.001). CONCLUSION: The overall quality of videos on all video-sharing platforms were low. All platforms provided accurate COVID-19 vaccine information, but TikTok videos were the most understandable. Most videos did not provide full details about COVID-19 vaccines, thus viewers would need to watch several videos before making a better-informed decision.

Development of a Probiotics Practice E-Reference Database for Health Care Professionals.

PURPOSE: Currently available references provide evidence on the efficacy of probiotics strains but exclude product-specific information, making it challenging for health care professionals (HCPs) to provide consumers with suitable recommendations on probiotics. An online probiotics e-reference database was developed to assist HCPs in delivering evidence-based recommendations on probiotics to consumers. The usability and applicability of the database in health care practice were evaluated. METHODS: Information on the efficacy of probiotics and probiotic products was collated using a PubMed literature search, and from local pharmacies and online supplement stores. A web database was compiled using various programming scripts and uploaded onto a web server. The database was beta-tested using an online self-administered questionnaire for community-based pharmacists, and responses were analyzed using descriptive statistics. FINDINGS: The database comprised 584 clinical study excerpts, 449 probiotic products, and 1879 unique product-study links. Users can search for suitable probiotics based on their indication profile or for a specific probiotic product. Information provided includes the probiotic constituents, dosage regimen, and indications of the product, with supporting clinical evidence. Overall, all participants of the beta-test indicated that they were satisfied with the database and were willing to use it again (both, 13 participants [100%]). In addition, all participants indicated that they found the database intuitive to use and smooth functioning, without inconsistencies (both, 13 [100%]). The majority also indicated that they found the information provided to be clear, comprehensive, and useful in health care practice (12 [92.3%] each). IMPLICATIONS: The probiotics e-reference database is an integrated resource that is user-friendly, and provides HCPs with ready access to clear and comprehensive information on probiotic products and clinical studies, so that HCPs can provide consumers with relevant and evidence-based recommendations on probiotics.

Harnessing the internet cloud for managing drug interactions with chemotherapy regimens in patients with cancer suffering from depression.

UNLABELLED: Concomitant use of anticancer drugs (ACDs) and antidepressants (ADs) in the treatment of depression in patients with cancer may result in potentially harmful drug-drug interactions (DDIs). It is crucial that clinicians make timely, accurate, safe and effective decisions regarding drug therapies in patients. The ubiquitous nature of the internet or "cloud" has enabled easy dissemination of DDI information, but there is currently no database dedicated to allow searching of ACD interactions by chemotherapy regimens. We describe the implementation of an AD interaction module to a previously published oncology-specific DDI database for clinicians which focuses on ACDs, single-agent and multiple-agent chemotherapy regimens. METHODS: Drug- and DDI-related information were collated from drug information handbooks, databases, package inserts, and published literature from PubMed, Scopus and Science Direct. Web documents were constructed using Adobe software and programming scripts, and mounted on a domain served from the internet cloud. RESULTS: OncoRx is an oncology-specific DDI database whose structure is designed around all the major classes of ACDs and their frequently prescribed chemotherapy regimens. There are 117 ACDs and 256 regimens in OncoRx, and it can detect over 1 500 interactions with 21 ADs. Clinicians are provided with the pharmacokinetic parameters of the drugs, information on the regimens and details of the detected DDIs during an interaction search. CONCLUSION: OncoRx is the first database of its kind which allows detection of ACD and chemotherapy regimen interactions with ADs. This tool will assist clinicians in improving clinical response and reducing adverse effects based on the therapeutic and toxicity profiles of the drugs.

An onco-informatics database for anticancer drug interactions with complementary and alternative medicines used in cancer treatment and supportive care: an overview of the OncoRx project.

PURPOSE: Cancer patients are at high risk of manifesting interactions from use of anticancer drugs (ACDs) and complementary and alternative medicines (CAMs). These interactions can result in sub-therapeutic effects or increased toxicities which may compromise the outcome of chemotherapy. It is important for practitioners to gain convenient access to ACD-CAM interaction information so as to make better-informed decisions in daily practice. This paper describes the creation of an oncology database (OncoRx) that documents ACD-CAM interactions, including traditional Chinese medicines (TCMs) that are commonly used for cancer treatment, prevention, and supportive care therapy. METHODS: Information regarding ACDs, CAMs, and drug interactions were collated from 14 sources, inclusive of hardcopy and online resources, and input into a modified web server with a database engine and a programming interface using a combination of software and programming scripts. RESULTS: OncoRx currently contains a total of 117 ACDs and 166 CAMs. Users are able to search for interactions based on various CAM uses: cancer treatment or prevention, immune-system-related, alopecia, nausea, and vomiting, peripheral neuropathy and pain, inflammation, fatigue, and non-cancer related. Pharmacokinetic data on ACDs and CAMs, characteristics of CAMs based on TCM principles, and drug interaction parameters such as effects, mechanisms, evidences, and proposed management plans, are shown in the search results. CONCLUSION: OncoRx is an oncology database which detects ACD interactions. It is currently able to detect interactions with CAMs. It is hoped that OncoRx will serve as a useful resource to clinicians, educators, trainers, and students working in the oncology setting.

Drug-drug interactions between oral antiepileptics and oral anticancer drugs: implications to clinicians.

BACKGROUND: Existing research has suggested that there can be potential drug-drug interaction (DDI) between antiepileptic drugs (AED) and anticancer drugs (ACD). However, information on the prevalence of patients on concurrent oral AED and oral ACD is limited. METHODS: A retrospective study was conducted at the National Cancer Centre Singapore. Prevalence was calculated by identifying prescriptions with both oral AED and oral ACD from the outpatient prescription database over three years. Prevalence and physicians' prescribing patterns were evaluated. Co-prescription was defined as medications that were prescribed by the same physician on the same day. Potentially interacting combinations were further detected using an existing database, OncoRx (www.onco-informatics.com). RESULTS: 42,810 prescriptions that contained at least one oral ACD were identified from the database. The number and prevalence of prescriptions that had a combination of oral ACD and AED were 274 and 0.64%, respectively, with the majority (82.8%) of the AED-oral ACD pairs being co-prescribed. Per patient, the average number of exposure days to the AED-oral ACD pair was 19.5 days annually. Fifty-one (18.6%) prescriptions were identified as containing potentially interacting AED-oral ACD pairs. DISCUSSION: There is a relatively low prevalence of AED-oral ACD combined exposure in the population we sampled; however, the combined exposure is long enough to produce clinically important DDI effects.

OncoRx-IQ: a tool for quality assessment of online anticancer drug interactions.

OBJECTIVE: The quality of online anticancer drug interaction information varies among online drug databases. We describe the creation of OncoRx-IQ, a tool which assesses the information quality of online drug databases for anticancer drug interactions, and a pilot study done with the tool. DESIGN: OncoRx-IQ was designed in the form of a questionnaire containing 25 questions in three quality domains, separated into two sections (Section A: content accuracy and Section B: ease-of-use and reliability). Each question was scored based on the number of options assigned. SETTING: A pilot study utilizing this tool was done on four drug databases (Drugs.com, Drug Digest, Medscape and Micromedex). Statistical analyses of the composite and domain scores were done using descriptive statistics, Spearman's correlation coefficient and Friedman and Wilcoxon signed-rank tests. PARTICIPANTS: Six pre-registration pharmacists participated in the pilot study. MAIN OUTCOME MEASURES: The drug databases were evaluated based on the accuracy of their drug interaction content, usability and reliability, as well as their overall quality. RESULTS: Micromedex (66.9%) and Drug Digest (35.8%) were the highest and lowest scoring databases, respectively. Micromedex scored the highest in all quality domains (content accuracy 56.3%, ease-of-use 75.0% and reliability 73.6%), whereas Drug Digest scored the lowest in content accuracy (8.0%) and reliability (48.2%). CONCLUSIONS: We have created and pilot-tested OncoRx-IQ, a quality assessment tool, which helps clinicians systematically evaluate the quality and information accuracy of drug databases for anticancer drug interaction information. We hope this tool can lay the groundwork for future long-term evaluation of online drug interaction information.

Improving pharmaceutical care in oncology by pharmacoinformatics: the evolving role of informatics and the internet for drug therapy.

Health-care has rapidly evolved with the informatics revolution. The rapid growth of the world-wide web as a tool for global connectivity has affected the way in which health-related information is distributed and accessed over the internet. Many informatics and internet applications are now available for use by both oncology health-care professionals and patients with cancer, with many people using the internet to search for drug-related and other health-related information. The practice of pharmaceutical care aims to ensure optimum medication-related therapeutic outcomes in patients, and involves identifying, solving, and preventing potential or actual drug-related problems (DRPs) with regards to a patient's drug therapy. Pharmacoinformatics involves the use of informatics, the internet, and interactive technologies to solve DRPs, with a focus on providing optimum pharmaceutical care and improved patient safety. This paper highlights the different pharmacoinformatics channels that have been used in the provision of pharmaceutical care, which are relevant to both oncology health-care professionals and patients with cancer. We will discuss several issues that have arisen as a result of cybermedicine, which can potentially affect the quality of pharmaceutical care in patients with cancer, and also provide insights into how pharmacoinformatics can potentially affect the future of healthcare. The opportunity of integrating pharmacoinformatics in the practice of clinical oncology as an aid to solve DRPs is indeed appealing. Oncology practitioners should not only focus on the acquistion of new treatment strategies, but also continue to embrace and harness new information and communication technologies, so as to increase their efficiency and improve on the pharmaceutical care of patients with cancer.

Personalizing symptom monitoring and contact tracing efforts through a COVID-19 web-app.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic has sparked attention in many countries, especially those that have experienced a steep spike in the number of identified cases. The continued spread of the coronavirus suggests that this situation may be here to stay for a while. Contact tracing is a time-consuming and resource-intensive process, which taps on the already lean healthcare resource in certain countries. Furthermore, the massive infodemic on COVID-19 on the Internet has also resulted in widespread circulation of misinformation online. This outbreak has evoked irrational fear and anxiety from the public, which has resulted in destabilizing of societal norms, such as panic buying and hoarding of daily necessities, and can potentially pose serious health risks to the public. The aim of this paper is to present a COVID-19 Symptom Monitoring and Contact Tracking Record (CoV-SCR) web-app as a bottom-up, proactive approach to supplement the current management strategies for COVID-19. MAIN TEXT: The CoV-SCR web-app ( http://bit.ly/covscrapp ) enables individuals to keep a personal record of their close contacts and monitor their symptoms on a daily basis, so that they can provide relevant and accurate details when they see the doctor and during the contact tracing process. Individuals can record their temperature and rate their symptoms on a 5-point severity scale, as well as record details of their travel and contact history for the last 14 days. The recorded information will be sent to their e-mail address for potential symptom monitoring and contact tracing purposes. In addition, this web-app consolidates evidence-based information on the coronavirus from credible sources, such as the World Health Organization, countries' health authorities, and PubMed literature. CONCLUSIONS: A COVID-19 Symptom Monitoring and Contact Tracking web-app has been developed to facilitate contact tracing efforts through public engagement. This app serves an additional purpose of providing information about COVID-19 from reliable resources.