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.

Potential issues with complementary medicines commonly used in the cancer population: A retrospective review of a tertiary cancer center's experience.

AIM: Complementary medicine (CAM) use in the cancer population is higher than the general population: some studies estimate up to 70%. Our Medicines Information Centre, in a tertiary cancer institution, receives many enquiries regarding use and safety of CAM with conventional cancer therapies (chemotherapy, radiotherapy and surgery). This project aims to review the CAM most commonly enquired about with an emphasis on potential interactions with conventional cancer therapies. METHODS: An audit and review of CAM enquiries from patients or medical professionals at our center, over a 2-year period (July 2011-June 2013), was conducted. The most commonly enquired about CAM, excluding vitamins and minerals, were identified, reviewed and potential interactions described. RESULTS: Enquiries were received from 462 patients involving 330 different CAMs. The 10 CAMs most commonly enquired about were fish oil (3.54%), turmeric (3.24%), coenzyme Q10 (2.63%), milk thistle (2.44%), green tea (2.38%), ginger (2.14%), lactobacillus (2.08%), licorice (1.83%), astragalus (1.77%) and reishi mushroom (1.59%). All were found to have predicted or potential drug interactions or therapeutic issues when combined with conventional therapies. Human studies are lacking and potential drug interactions are often predicted using in vitro or in vivo animal data. CONCLUSIONS: While many CAMs may be safe when taken by themselves, there is theoretically a potential for interactions and/or increased risk of serious adverse effects when taken concurrently with conventional anticancer therapies. The paucity of human data implies that their clinical significance is difficult to quantify and hence caution is required.

Practical recommendations for the choice of anticoagulants in the management of patients with atrial fibrillation on ibrutinib.

The management of AF represents a major challenge in patients with CLL, especially in elderly patients with multiple comorbidities who are representative of the majority of patients with CLL. This is especially complex in the case of ibrutinib. Many anticoagulants have potential for pharmacological interaction with ibrutinib, and ibrutinib itself has antiplatelet properties. Use of ibrutinib therapy in these patients mandates review and revision of the need for anticoagulation and best anticoagulant to use. Herein, we review the current knowledge of the metabolism of common anticoagulants and how they may interact with ibrutinib.