Complementary and alternative medicine in cancer patients: characteristics of use and interactions with antineoplastic agents.

PURPOSE: Our objectives were to analyze the use of complementary and alternative medicine (CAM) in cancer patients and to describe the incidence and characteristics of interactions between CAM and antineoplastic agents. METHODS: We performed an observational study in cancer outpatients at a university hospital. Variables were collected through a 22-item questionnaire. Potential interactions between CAM and antineoplastic agents were analyzed using the Lexicomp®, the About Herbs®, and the summary of product characteristics. Mechanism of action, reliability, and the potential clinical effect of interactions were analyzed. RESULTS: The study population comprised 937 patients, of whom 65% used CAM (70.6% herbal products, 25.8% dietary supplements, and 3.6% homeopathy). Female sex, younger age, and breast cancer were associated with more frequent use of CAM. The primary source of information about CAM was friends and family (43.5%). A total of 335 (57.1%) patients did not tell their doctor that they took CAM. The five most common CAM were chamomile, green tea, pennyroyal mint, linden, and rooibos. At least one interaction between CAM and antineoplastic agents was reported by 65.0% of CAM users (33.9% of all patients). Depending on the mechanism of action, 80% of CAM diminished the metabolism of the antineoplastic agents. CONCLUSION: Our results reveal a high incidence of interactions between CAM and antineoplastic agents. The most frequent CAM were herbal products. Family and friends were the primary sources of information that led patients to start taking CAM, and more than half of the patients did not tell their doctor that they were taking CAM.

Mobile Apps for Hematological Conditions: Review and Content Analysis Using the Mobile App Rating Scale.

BACKGROUND: Hematological conditions are prevalent disorders that are associated with significant comorbidities and have a major impact on patient care. Concerning new tools for the care of these patients, the number of health apps aimed at hematological patients is growing. Currently, there are no quality analyses or classifications of apps for patients diagnosed with hematological conditions. OBJECTIVE: The aim of this study is to analyze the characteristics and quality of apps designed for patients diagnosed with hematological conditions by using the Mobile App Rating Scale (MARS). METHODS: We performed an observational, cross-sectional descriptive study of all smartphone apps for patients diagnosed with hematological conditions. A search was conducted in March 2021 using the following terms: anemia, blood cancer, blood disorder, hematological cancer, hematological malignancy, hematological tumor, hematology, hemophilia, hemorrhage, lymphoma, leukemia, multiple myeloma, thalassemia, thrombocytopenia, and thrombosis. The apps identified were downloaded and evaluated by 2 independent researchers. General characteristics were registered, and quality was analyzed using MARS scores. Interrater reliability was measured by using the Cohen κ coefficient. RESULTS: We identified 2100 apps in the initial search, and 4.19% (88/2100) of apps met the inclusion criteria and were analyzed. Of the 88 apps, 61% (54/88) were available on Android, 30% (26/88) were available on iOS, and 9% (8/88) were available on both platforms. Moreover, 7% (6/88) required payment, and 49% (43/88) were updated in the last year. Only 26% (23/88) of the apps were developed with the participation of health professionals. Most apps were informative (60/88, 68%), followed by preventive (23/88, 26%) and diagnostic (5/88, 6%). Most of the apps were intended for patients with anemia (23/88, 26%). The mean MARS score for the overall quality of the 88 apps was 3.03 (SD 1.14), ranging from 1.19 (lowest-rated app) to 4.86 (highest-rated app). Only 47% (41/88) of the apps obtained a MARS score of over 3 points (acceptable quality). Functionality was the best-rated section, followed by aesthetics, engagement, information, and app subjective quality. The five apps with the highest MARS score were the following: Multiple Myeloma Manager, Hodgkin Lymphoma Manager, Focus On Lymphoma, ALL Manager, and CLL Manager. The analysis by operating system, developer, and cost revealed statistically significant differences in MARS scores (P<.001, P<.001, and P=.049, respectively). The interrater agreement between the 2 reviewers was substantial (k=0.78). CONCLUSIONS: There is great heterogeneity in the quality of apps for patients with hematological conditions. More than half of the apps do not meet acceptable criteria for quality and content. Most of them only provide information about the pathology, lacking interactivity and personalization options. The participation of health professionals in the development of these apps is low, although it is narrowly related to better quality.

Assessment of diarrhea as side effect of oral targeted antineoplastic agents in clinical practice.

BACKGROUND: Diarrhea is one of the most frequent class adverse events associated with targeted oral antineoplastic agents (OAAs). Our objective was to analyze the incidence, characteristics, and severity of diarrhea in cancer patients in clinical practice. METHODS: An observational, longitudinal, and prospective study of cancer outpatients treated with targeted OAAs was carried out in a tertiary hospital. Targed OAAs analyzed were anaplastic lymphoma kinase inhibitors, BCR-ABL inhibitors, cyclin-dependent kinase inhibitors, epidermal growth factor receptor inhibitors, mTOR inhibitors, poly (ADP-ribose) polymerase inhibitors, and vascular endothelial growth factor receptor inhibitors. Patients were given a data collection form to record daily the number, severity (CTCAE version 5.0), and characteristics of stools during the first 30 days of treatment with OAAs. Multivariate analysis was performed to identify risk factors associated with the incidence of diarrhea. RESULTS: We analyzed 240 patients, of whom 28.7% experienced diarrhea (25.4% grades 1-2 and 3.3% grades 3-4). Patients treated with EGFR and VEGFR inhibitors had a higher incidence of diarrhea. The multivariate analysis revealed that taking the OAA with food was associated with a lower risk of diarrhea (OR = 0.404 [0.205-0.956], p = 0.038). CONCLUSIONS: More than a third of patients in treatment with OAAs presented diarrhea (any grade), and 22.1% of stools were semi-liquid/liquid. In multivariate analysis, taking the OAA on an empty stomach was associated with a statistically significant increase in the incidence of diarrhea.

Estudio del consumo de antibióticos en pacientes de farmacia comunitaria / No disponible

INTRODUCCIÓN: España presenta una de las cifras más elevadas de resistencias bacterianas de Europa y paralelamente se sitúa entre los países que más antibióticos consume. La participación del farmacéutico comunitario educando al paciente sobre el buen uso de los antibióticos es importante para conseguir los objetivos marcados en el PRAN 2019-21. OBJETIVOS: El objetivo de este estudio fue describir en pacientes de Farmacia Comunitaria: I) el tipo de antibiótico que el paciente retiraba, II) el perfil de prescripción en Atención Primaria y III) el conocimiento que los pacientes tenían sobre el tratamiento. MÉTODOS: Se realizó un estudio observacional descriptivo en 86 pacientes de 5 oficinas de farmacia. Para ello, se elaboró un cuestionario basado en el de Molinero y cols. (2018), al que se han incluido nuevas preguntas para evaluar el conocimiento y el tipo de infección/antibiótico que tenía el paciente RESULTADOS: El 90% de los pacientes encuestados mostró un buen conocimiento del tratamiento prescrito (duración y/o pauta); sin embargo, sólo un 56% retiraba el antibiótico sobrante en el punto SIGRE. El tratamiento antibiótico más utilizado en las infecciones más prevalentes en nuestro estudio, infecciones respiratorias y urinarias, siguió las recomendaciones de las guías terapéuticas, amoxicilina en el 39% y fosfomicina (75% mujeres)/ciprofloxacino (80% hombres), respectivamente. CONCLUSIONES: Las campañas dirigidas contra la resistencia a antibióticos están empezando a dar resultados positivos tanto en los pacientes como en los prescriptores de Atención Primaria. El farmacéutico comunitario constituye un pilar fundamental en la promoción del correcto uso de antibióticos

INTRODUCTION: Spain presents one of the highest numbers of bacterial resistances in Europe and in parallel it constitutes one of the countries that consume higher amounts of antibiotics. The contribution of community pharmacists in educating patients on the appropriate use of antibiotics is important to achieve the objectives set in the PRAN 2019-21. OBJECTIVES: The aim of this study was to describe in Community Pharmacy patients: I) the type of antibiotic that patients withdrew, II) the prescription profile in Primary Care and III) the knowledge that patients had about the treatment. METHODS: A descriptive observational study was performed in 86 patients from 5 pharmacies. For this, a questionnaire based on that of Molinero et al. (2018) was designed and several questions were added to assess the knowledge and type of infection / antibiotic that patients presented. RESULTS: 90% of the patients surveyed showed a good knowledge of the prescribed treatment (duration and / or pattern); however, only 56% left the remaining antibiotic at the SIGRE point. The most commonly used antibiotics for the most prevalent infections in our study were amoxicillin in 39% of respiratory infections, fosfomycin in 75% of urinary infections in women and ciprofloxacin in 80% of urinary infections in men, following the recommendations of current therapeutic guidelines. CONCLUSIONS: The dispensation of antibiotics was carried out in all the cases under medical prescription which was done, basically, by primary care physicians and mainly as an initial treatment in respiratory and urinary infections