Pharmacists' practices and views regarding management of sexual health in patients with cancer.

INTRODUCTION: Sexual health issues associated with cancer can significantly impact patients' psychosocial well-being and overall quality of life. These issues are frequently medication-related, placing pharmacists in an opportune position to manage sexual health concerns in patients with cancer. Currently, no literature exists exploring pharmacists' practices related to the management of sexual health in oncology patients. METHODS: An anonymous, descriptive, cross-sectional, web-based survey was conducted to elicit pharmacists' views and practices regarding managing sexual health in oncology patients. Pharmacists practicing in Canada who provide care to adult malignant hematology or oncology patients were eligible to participate. The survey was disseminated through the Canadian Association of Pharmacy in Oncology and through informal oncology pharmacy practitioner networks. RESULTS: Of the 102 pharmacists who participated, 96 completed the survey in its entirety. Most respondents were female, practiced in Alberta, and primarily saw oncology patients in outpatient cancer facilities. Although 85% of participants felt pharmacists should be involved in giving patients an opportunity to discuss sexual health, only 8% reported managing sexual health in at least 50% of their oncology patients. The most commonly agreed upon barriers to this were presence of family members and friends at appointments, lack of knowledge or training, limited time, and the belief that sexual health is not applicable to all oncology patients. CONCLUSIONS: This study explored pharmacists' views and practices regarding managing sexual health in patients with cancer. Several barriers were identified, which may aid in future development of resources to assist pharmacists in routinely addressing sexual health in oncology patients.

International society of oncology pharmacy practitioners (ISOPP) position statement: The role of oncology pharmacy practitioners in immunotherapy treatment with immune checkpoint inhibitors for malignant conditions.

Oncology pharmacists, pharmacy technicians and assistants are key members of the multidisciplinary health care team (MHT) caring for patients receiving immunotherapy with immune checkpoint inhibitors. The International Society of Oncology Pharmacy Practitioners (ISOPP) developed this position statement to provide guidance on the role of oncology pharmacy practitioners in caring for patients receiving immune checkpoint inhibitors.Four key recommendations were identified: 1) participation as an integrated, collaborative member of the MHT;2) provision of education and training for patients, students, residents, fellows and other members of the MHT;3) involvement in clinical governance to optimise the use of immune checkpoint inhibitors and4) involvement in research and development in the field of immunotherapy.In summary, oncology pharmacy practitioners play essential roles within the MHT in caring for patients receiving immune checkpoint inhibitors.

Educational needs of oncology pharmacists: A survey by the International Society of Oncology Pharmacy Practitioners.

BACKGROUND: The International Society of Oncology Pharmacy Practitioners (ISOPP) is committed to providing educational resources to members for their continuous learning and professional development. This survey was conducted to explore the educational needs of International Society of Oncology Pharmacy Practitioners members for the purpose of developing resources to support future learning relevant to the diverse global pharmacy practitioner membership of our society. METHODS: A cross-sectional survey of International Society of Oncology Pharmacy Practitioners membership was conducted between 10 December 2018 and 15 January 2019. The survey contained 17 questions and consisted of four sections: (1) respondents' demographics, (2) common challenges/barriers faced by members in accessing oncology pharmacy education, (3) areas within oncology pharmacy where members need education and (4) preferred methods of education delivery. Descriptive statistics were utilized to summarize survey results. RESULTS: The survey was completed by 62 out of 363 International Society of Oncology Pharmacy Practitioners members (17% response rate). Respondents were from 19 different countries, representing all the habitable continents. Most respondents were practicing in North America (21%), Oceania (21%) and Asia (16%). The majority of respondents worked in inpatient cancer units (60%), ambulatory tertiary cancer centres (31%) and academia (26%). Reported barriers to accessing education relevant to oncology pharmacy practice included lack of financial support (44%), time spent travelling to attend educational activities (39%), limited learning opportunities in their country of practice (34%) and limited growth of the oncology pharmacy discipline in their country of practice (32%). The content areas of greatest demand included pharmacotherapy of various cancers followed by oncology pharmacy research, International Society of Oncology Pharmacy Practitioners oncology pharmacy practice standards, supportive care and medication safety. Among educational activities offered by International Society of Oncology Pharmacy Practitioners, respondents valued annual International Society of Oncology Pharmacy Practitioners symposia and Journal of Oncology Pharmacy Practice the most. Most respondents (87%) indicated webinars as an effective educational tool. CONCLUSION: Among an international oncology pharmacist cohort, we identified practice areas prioritized by pharmacists for continuing and professional development. Time and cost were common barriers to education, both in developing and developed countries. These survey findings may help to guide future education initiatives of International Society of Oncology Pharmacy Practitioners and other providers of pharmacist oncology education.

Implementation of additional prescribing authorization among oncology pharmacists in Alberta.

PURPOSE: To describe the practice settings and prescribing practices of oncology pharmacists with additional prescribing authorization. METHODS: A descriptive, cross-sectional survey of all oncology pharmacists in Alberta was conducted using a web-based questionnaire over four weeks between March and April 2016. Pharmacists were identified from the Cancer Services Pharmacy Directory and leadership staff in Alberta Health Services. Descriptive statistics were used to describe the practice setting, prescribing practices, motivators to apply for additional prescribing authorization, and the facilitators and barriers of prescribing. Logistic regression was used to explore factors associated with having additional prescribing authorization. RESULTS: The overall response rate was 41% (71 of 175 pharmacists). Oncology pharmacists with additional prescribing authorization made up 38% of respondents. They primarily worked in urban, tertiary cancer centers, and practiced in ambulatory care. The top 3 clinical activities they participated in were medication reconciliation, medication counseling/education, and ambulatory patient assessment. Respondents thought additional prescribing authorization was most useful for ambulatory patient assessment and follow-up. Antiemetics were prescribed the most often. The median number of prescriptions written in an average week of clinical work was 5. Competence, self-confidence, and the potential impact on patient care/perceived impact on work environment were the strongest facilitators of prescribing. The strongest motivators to apply for additional prescribing authorization were relevancy to practice, the potential for increased efficiency, and advancing the profession. CONCLUSION: The current majority of oncology pharmacist prescribing in Alberta occurs in ambulatory care with a large focus on antiemetic prescribing. Pharmacists found additional prescribing authorization most useful for ambulatory patient assessment and follow-up.

Effects of gender on capecitabine toxicity in colorectal cancer.

BACKGROUND: Capecitabine is a highly water soluble prodrug of 5-fluorouracil that is dosed by patient body surface area. Body surface area dosing makes no allowances for differences in body composition. There is mounting evidence that lean body mass is a better predictor of toxicity than body surface area for drugs which distribute into the lean compartment. Because women, on average, have lower lean body mass than men, we expect that women would experience a higher incidence of toxicity than men when body surface area dosing is used. OBJECTIVE: To determine whether female colorectal cancer patients experienced a higher incidence of dose-limiting toxicity than men when treated with adjuvant capecitabine. METHODS: We conducted a retrospective chart review of colorectal cancer patients treated with adjuvant capecitabine at our institute between 2008 and 2012. Patients receiving capecitabine were identified from the pharmacy dispensing database and then screened for inclusion. Dosing and toxicity information were gathered and dose-limiting toxicity incidence (defined as a composite endpoint of dose delay, dose reduction, or discontinuation of therapy) was compared between males and females using the chi-square test. Binary logistic regression analysis was then performed to account for differences between male and female populations. RESULTS: A total of 299 patients (163 males, 136 females) met inclusion criteria. Females had a significantly higher dose-limiting toxicity incidence than males (67.7 vs. 52.2%, p = 0.007). Relationships between gender and dose-limiting toxicity incidence remained significant after logistic regression analysis (OR: 2.04; 95% CI: 1.23-3.36). CONCLUSION: Female colorectal cancer patients experience a higher dose-limiting toxicity incidence than male patients when given adjuvant capecitabine dosed according to body surface area.

Adherence to adjuvant endocrine therapy in women with breast cancer.

PURPOSE: To determine how many breast cancer patients who initiated adjuvant endocrine therapy discontinued early and to evaluate adherence in patients who persisted with therapy. Secondary objectives were to explore possible trends to see if certain factors may correlate to early discontinuation of therapy. METHODS: A retrospective review of charts and pharmacy dispensing records was conducted, including patients who initiated adjuvant endocrine therapy for breast cancer at the Cross Cancer Institute from 1 January to 31 December, 2006. RESULTS: Out of 346 patients, 81 (22%) discontinued therapy within 2 years. Adherence rates calculated for the 265 patients who remained on therapy beyond 2 years showed that 247 (93%) of these patients had 80% or better adherence. Patients who did not undergo chemotherapy and patients with Cross Cancer Institute follow-up times of less than 1 year were significantly more likely to discontinue therapy early. CONCLUSIONS: The majority of patients who were prescribed adjuvant endocrine therapy for breast cancer at the Cross Cancer Institute remained on therapy for at least 2 years and were adherent. Longer follow-up by Cross Cancer Institute practitioners may help decrease discontinuation rates.

The Role of Home Care Pharmacists in the Edmonton Zone: A Retrospective Study.

Background: Despite the rising demand for home-based health care services in Canada and the increasing medical complexity of elderly patients, there is limited literature exploring the role of home care pharmacists and the clinical activities they perform. Objectives: The primary objective was to describe the types and frequencies of clinical activities (both interventions and recommendations) performed by home care pharmacists upon initial consultation. The secondary objective was to determine which patient characteristics resulted in the highest number of clinical activities. Methods: This study was a retrospective review of adult patients who had an initial in-person or telemedicine consultation with home care pharmacists from June 2018 to May 2019 in the Edmonton Zone of Alberta Health Services. Results: Of the 355 patients whose records were screened, 318 (89.6%) were included in the analysis. Of these, 191 (60.1%) were female, and the median age was 79 years (interquartile range [IQR] 68-86 years). The median numbers of medical conditions and medications were 6 and 10, respectively. Of the total of 1172 clinical activities, there was a median of 3 (IQR 2-5) per patient, irrespective of the patient's medical conditions, including those with the most common conditions. The most common activities were patient counselling (n = 160, 13.7%), collaboration with another health care professional (n = 157, 13.4%), and deprescribing (n = 140, 11.9%). Across all activities, pharmacists performed a total of 562 interventions and made 610 recommendations. Each additional year of age and each additional medication on a patient's medication list resulted in an increase in the number of clinical activities (by 0.01 for each additional year of age [p = 0.003] and by 0.03 for each additional medication [p < 0.001]). Conclusions: Home care pharmacists in the Edmonton Zone performed a wide range of clinical activities, particularly for older patients and those with more medications. Further research is required to evaluate the outcomes of pharmacist consultations.

Contexte: Malgré l'augmentation de la demande de services de soins de santé à domicile au Canada et la complexité médicale croissante des patients âgés, il existe peu de documentation examinant le rôle des pharmaciens au sein de l'équipe de soins à domicile et leurs activités cliniques. Objectifs: L'objectif primaire consistait à décrire le type et la fréquence des activités cliniques (interventions et recommandations) effectuées par les pharmaciens à domicile lors de la consultation initiale. L'objectif secondaire consistait quant à lui à déterminer les caractéristiques des patients qui ont entraîné le plus grand nombre d'activités cliniques. Méthodes: Cette étude était une revue rétrospective de patients adultes ayant eu une première consultation en personne ou par télémédecine avec des pharmaciens de soins à domicile de juin 2018 à mai 2019 dans la zone d'Edmonton des services de soins de santé de l'Alberta. Résultats: Sur les 355 patients dont les dossiers ont été examinés, 318 (89,6 %) ont été inclus dans l'analyse. Parmi eux, l'âge médian était de 79 ans (écart interquartile [IQR] 68­86) et 191 (60,1 %) étaient des femmes. Le nombre médian de problèmes médicaux et de médicaments était respectivement de 6 et 10. Sur les 1172 activités cliniques au total, le nombre médian était de 3 activités (IQR 2­5) par patient, indépendamment de ses problèmes médicaux, y compris ceux présentant les maladies les plus courantes. Les activités les plus courantes étaient le conseil aux patients (n = 160, 13,7 %), la collaboration avec un autre fournisseur de soins de santé (n = 157, 13,4 %) et la déprescription (n = 140, 11,9 %). Toutes activités confondues, les pharmaciens ont effectué 562 interventions et fait 610 recommandations. Chaque année d'âge supplémentaire et chaque médicament ajouté à la liste des médicaments donnaient lieu à une augmentation du nombre d'activités cliniques (de 0,01 pour chaque année d'âge supplémentaire [p = 0,003] et de 0,03 pour chaque médicament supplémentaire [p < 0,001]). Conclusions: Les pharmaciens de soins à domicile de la zone d'Edmonton effectuaient un large éventail d'activités cliniques, en particulier pour les patients âgés et ceux prenant plus de médicaments. Des recherches supplémentaires sont nécessaires pour évaluer les résultats des consultations des pharmaciens.

Evaluation of care delivery by a novel multidisciplinary bone health clinic for patients at risk of glucocorticoid-induced osteoporosis.

Glucocorticoid-induced osteoporosis (GIOP) is a common condition associated with increased risk for fracture. Many patients receive suboptimal care. We created a novel GIOP clinic model which successfully fills a gap in osteoporosis care by providing multidisciplinary intervention in key components of GIOP preventive care to an underserved patient population. INTRODUCTION: This study characterizes the patient population referred to our novel glucocorticoid-induced osteoporosis (GIOP) clinic and evaluates how well the clinic performed in addressing key components of GIOP preventive care. METHODS: This population-based prospective cohort study derives data from patients reviewed at the University of Alberta Multidisciplinary Bone Health Clinic from January 2017 to September 2019. To create our clinic model, key components of GIOP preventive care were summarized based on current guidelines, and clear responsibilities were delegated to each multidisciplinary team member. A REDCap database was constructed, and each patient's multidisciplinary assessment was entered at each visit. Demographic and treatment data was extracted from our database. RESULTS: The clinic was able to achieve optimal GIOP preventive care in 60.1% of patients and in 78.7% of patients when excluding wait time. Of the 245 GIOP patients assessed, over half were females (56.7%) and the mean age was 56.7 years (range 16-95 years). Referrals were primarily made by specialists. Low-trauma fractures were reported in 24.9% of patients and 95.5% of patients had a baseline dual-energy X-ray absorptiometry (DXA). The mean current daily prednisone-equivalent dose was 14.1 mg. All patients received a recommendation for pharmacotherapy (100%) and the majority received counseling on vitamin D (98.8%), calcium (97.8%), smoking cessation (98.8%), alcohol reduction (98.4%), falls prevention (88.6%), and exercise (85.3%). CONCLUSION: Our novel GIOP clinic model successfully fills a gap in osteoporosis care by providing multidisciplinary intervention in key components of GIOP preventive care to an underserved patient population. Further studies are required to assess the real-world long-term outcomes of our model.

Concomitant Administration of Proton Pump Inhibitors and Capecitabine is Associated With Increased Recurrence Risk in Early Stage Colorectal Cancer Patients.

BACKGROUND: Capecitabine is used to treat colorectal (CRC) cancer. TRIO-013, a study examining capecitabine/oxaliplatin ± lapatinib in metastatic gastro-esophageal cancer did not show increases in overall survival (OS) with lapatinib. An analysis showed concurrent proton pump inhibitor (PPI) usage negatively impacted recurrence-free survival (RFS). We retrospectively studied PPI effects on capecitabine efficacy in early stage CRC and how capecitabine adjustments impacted RFS. METHODS: Early stage CRC patients taking monotherapy capecitabine treated from 2008 to 2012 were reviewed for demographics, medications, toxicities, and patient outcomes. RESULTS: Of 298 identified patients, 25.8% (n = 77) received concurrent PPIs. Five-year RFS was 74% versus 83% (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.07-3.35; P = .03) in PPI versus non-PPI patients respectively. OS was 81% versus 78%, respectively (HR, 1.13; 95% CI, 0.60-2.14; P = .7). After accounting for gender, stage, age, and performance status, PPI patients tended toward decreased RFS (HR, 1.65; 95% CI, 0.93-2.94; P = .09). Capecitabine dose modifications affected outcomes. Five-year RFS was 84% in the control group, 100% in the treatment-delay group (P = .99), 67% in the dose reduction group (HR, 2.46; 95% CI, 1.23-4.93; P = .01), and 64% in the discontinuation group (HR, 2.27; 95% CI, 0.93-5.53; P = .07). Five-year OS was significantly less in the discontinuation group than control group (59% vs. 82%; HR, 3.27; 95% CI, 1.44-7.45; P = .005). CONCLUSIONS: PPIs appear to impact RFS; this may be due to PPIs preventing capecitabine tablet dissolution and absorption. Patients with dose reductions or who stopped treatment had worse outcomes than patients who continued with treatment at starting doses.