Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms. / [Artículo traducido] Modelo de estratificación de riesgo de atención farmacéutica para pacientes oncológicos con neoplasias sólidas o hematológicas.

OBJECTIVE: We aimed to develop of a risk stratification model for the pharmaceutical care (PC) of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD: The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through three workshops and a pilot study. Variables were defined, grouped into four dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into three priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS: The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score =11); social and health variables and cognitive and functional status (maximum = 19); clinical and health services utilization (maximum = 25); and treatment-related (maximum = 41). From the results of applying the model to the 199 patients enrolled, the cutoff points for categorization were 28 or more points for priority 1, 16 to 27 points for priority 2 and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of 'clinical and health services utilization' and 'treatment-related'. Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION: This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.

Criteria and indicators to evaluate quality of care in genitourinary tumour boards.

PURPOSE: Genitourinary (GU) multidisciplinary tumour boards (GUMTBs) are key components of patient care, as they might lead to changes in treatment plan, improved survival, and increased adherence to guidelines. However, there are no guidelines on how GUMTBs should operate or how to assess their quality of performance. METHODS: A systematic literature review was conducted to identify criteria and indicators to evaluate quality in GUMTBs. A scientific committee-comprising 12 GU cancer specialists from seven disciplines-proposed a list of criteria and developed indicators, evaluated in two rounds of Delphi method. Appropriateness and utility of indicators were scored using a 9-point Likert scale. Consensus was defined as at least two-thirds of Delphi respondents selecting a score sub-category that encompassed the median score of the group. RESULTS: Forty-five criteria were selected to evaluate the quality of GUMTBs covering five dimensions: organisation, personnel, protocol and documentation, resources, and interaction with patients. Then, 33 indicators were developed and evaluated in the first round of Delphi, leading to a selection of 26 indicators in two dimensions: function, governance and resources, and GUMTB sessions. In the second round, consensus was reached on the appropriateness of all 26 indicators and on the utility of 24 of them. Index cards for criteria and indicators were developed to be used in clinical practice. CONCLUSIONS: Criteria and indicators were developed to evaluate the quality of GUMTBs, aiming to serve as a guide to improve quality of care and health outcomes in patients with GU cancer.

Estudio observacional sobre interacciones farmacológicas en pacientes oncológicos ingresados / Observational study of drug-drug interactions in oncological inpatients

Objetivo: Determinar la prevalencia de potenciales interacciones clínicamente relevantes en pacientes oncológicos adultos ingresados, mediante una base de datos de uso habitual, así como describir las interacciones más frecuentes. Método: Estudio observacional, transversal, descriptivo, que incluye pacientes ingresados a cargo del Servicio de Oncología de un hospital de referencia. Se recopilaron todas las prescripciones dos veces por semana durante un periodo de un mes. Se analizaron mediante la base de datos Lexicomp ® , registrando todas las interacciones clasificadas con un nivel de riesgo C, D o X. Resultados: Se detectaron un total de 1.850 interacciones farmacológicas en 218 tratamientos. La prevalencia de tratamientos con al menos una interacción clínicamente relevante fue de un 95%, siendo del 94,5% para las de nivel C y del 26,1% para los niveles D y X. Los analgésicos opioides, antipsicóticos (butirofenonas), benzodiacepinas, pirazolonas, glucocorticoides y heparinas fueron los fármacos más comúnmente involucrados en las interacciones detectadas, mientras que las interacciones con antineoplásicos fueron mínimas, destacando las relacionadas con paclitaxel y entre metamizol y diversos antineoplásicos. Conclusiones: La prevalencia de tratamientos con interacciones farmacológicas clínicamente relevantes fue muy elevada, destacando el elevado porcentaje de riesgo X. Por la frecuencia de aparición y potencial gravedad destacan el uso concomitante de fármacos depresores del sistema nervioso central con riesgo de depresión respiratoria, el riesgo de aparición de síntomas anticolinérgicos cuando se combinan morfina o haloperidol con butilescopolamina, bromuro de ipratropio o dexclorfe-niramina, así como las múltiples interacciones que implican al metamizol (AU)

Objective: To determine the prevalence of potential clinically relevant drug-drug interactions in adult oncological inpatients, as well as to describe the most frequent interactions. A standard database was used. Method: An observational, transversal, and descriptive study including patients admitted to the Oncology Service of a reference hospital. All prescriptions were collected twice a week during a month. They were analysed using Lexicomp ®database, recording all interactions classified with a level of risk: C, D or X. Results: A total of 1 850 drug-drug interactions were detected in 218 treatments. The prevalence of treatments with at least one clinically relevant interaction was 95%, being 94.5% for those at level C and 26.1% for levels D and X. The drugs most commonly involved in the interactions detected were opioid analgesics, antipsychotics (butyrophenones), benzodiazepines, pyrazolones, glucocorticoids and heparins, whereas interactions with antineoplastics were minimal, highlighting those related to paclitaxel and between metamizole and various antineoplastics. Conclusions: The prevalence of clinically relevant drug-drug interactions rate was very high, highlighting the high risk percentage of them related to level of risk X. Due to the frequency of onset and potential severity, highlighted the concomitant use of central nervous system depressants drugs with risk of respiratory depression, the risk of onset of anticholinergic symptoms when combining morphine or haloperidol with butyl scopolamine, ipratropium bromide or dexchlorpheniramine and the multiple interactions involving metamizole (AU)

Observational study of drug-drug interactions in oncological inpatients.

OBJECTIVE: To determine the prevalence of potential clinically relevant drug- drug interactions in adult oncological inpatients, as well as to describe the most  frequent interactions. A standard database was used. METHOD: An observational, transversal, and descriptive study including patients  admitted to the Oncology Service of a reference hospital. All prescriptions were  collected twice a week during a month. They were analysed using Lexicomp®  database, recording all interactions classified with a level of risk: C, D or X. RESULTS: A total of 1 850 drug-drug interactions were detected in 218  treatments. The prevalence of treatments with at least one clinically relevant  interaction was 95%, being 94.5% for those at level C and 26.1% for levels D  and X. The drugs most commonly involved in the interactions detected were  opioid analgesics, antipsychotics (butyrophenones), benzodiazepines,  pyrazolones, glucocorticoids and heparins, whereas interactions with  antineoplastics were minimal, highlighting those related to paclitaxel and  between metamizole and various antineoplastics. CONCLUSIONS: The prevalence of clinically relevant drug-drug interactions rate  was very high, highlighting the high risk percentage of them related to level of  risk X. Due to the frequency of onset and potential severity, highlighted the  concomitant use of central nervous system depressants drugs with risk of  respiratory depression, the risk of onset of anticholinergic symptoms when  combining morphine or haloperidol with butylscopolamine, ipratropium bromide  or dexchlorpheniramine and the multiple interactions involving metamizole.

Objetivo: Determinar la prevalencia de potenciales interacciones clínicamente relevantes en pacientes oncológicos adultos ingresados, mediante una base de datos de uso habitual, así como describir las interacciones más frecuentes.Método: Estudio observacional, transversal, descriptivo, que incluye pacientes ingresados a cargo del Servicio de Oncología de un hospital de referencia. Se recopilaron todas las prescripciones dos veces por semana durante un periodo de un mes. Se analizaron mediante la base de datos Lexicomp®, registrando todas las interacciones clasificadas con un nivel de riesgo C, D o X.Resultados: Se detectaron un total de 1.850 interacciones farmacológicas en  218 tratamientos. La prevalencia de tratamientos con al menos una interacción  clínicamente relevante fue de un 95%, siendo del 94,5% para las de nivel C y  del 26,1% para los niveles D y X. Los analgésicos opioides, antipsicóticos  (butirofenonas), benzodiacepinas, pirazolonas, glucocorticoides y heparinas  fueron los fármacos más comúnmente involucrados en las interacciones  detectadas, mientras que las interacciones con antineoplásicos fueron mínimas,  destacando las relacionadas con paclitaxel y entre metamizol y diversos  antineoplásicos.Conclusiones: La prevalencia de tratamientos con interacciones farmacológicas clínicamente relevantes fue muy elevada, destacando el elevado  porcentaje de riesgo X. Por la frecuencia de aparición y potencial gravedad  destacan el uso concomitante de fármacos depresores del sistema nervioso  central con riesgo de depresión respiratoria, el riesgo de aparición de síntomas  anticolinérgicos cuando se combinan morfina o haloperidol con  butilescopolamina, bromuro de ipratropio o dexclorfeniramina, así como las  múltiples interacciones que implican al metamizol.