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Practical Issues for Pharmacists

Neutropenia is a common dose-limiting toxicity of myelosuppressive chemotherapy and exposes patients to life-threatening infections and treatment delays. Febrile neutropenia, a concerning complication of chemotherapy, is defined as neutropenia associated with an oral temperature of more than 38.5°C or 2 consecutive readings of more than 38.0°C for 2 hours and an absolute neutrophil count of <0.5 × 109/L, or a count that is expected to decrease to less than 0.5 × 109/L within 48 hours.
The American Society of Health-System Pharmacists (ASHP) Foundation's Pharmacy Forecast, now in its fourth edition, serves to improve the effectiveness of leaders in hospital and health-system pharmacy practice.
Jacob K Kettle, PharmD, BCOP, Oncology Clinical Pharmacy Specialist, Department of Pharmacy, University of Missouri Health Care, Columbia, MO, discusses the clinical significance of his study, “Analyzing Trends in Oral Anticancer Agents in an Academic Medical Facility.”
David W. Stewart, PharmD, BCPS, Associate Professor of Pharmacy Practice, East Tennessee State University, Bill Gatton College of Pharmacy, discusses the clinical significance of his study, “Prescribing of Low-Molecular-Weight Heparin and Warfarin in Patients with Acute Venous Thromboembolism and Active Cancer.”
The dispensing and management of oral chemotherapies involves many challenges, with access to and the finances of oral agents being the biggest barriers to treatment.

Background: Oral chemotherapy has an ever-increasing role in the treatment of patients with cancer, but high cost increases the risk for primary nonadherence or “nonfulfillment.” Non-fulfillment is defined as failure to obtain a prescribed medication. Proven methods to decrease nonfulfillment rates for oral chemotherapy are lacking in the literature.

Multidisciplinary collaboration in cancer care is becoming the standard philosophy for treating cancer patients. However, due to varying opinions among specialists regarding patient care, not all specialists are working together.

There has recently been a paradigm shift in the treatment of patients with cancer. Traditionally, cancer chemotherapy has been given through the intravenous (IV) route. However, in the past 15 years, the number of available oral chemotherapeutic agents has more than doubled. In addition, approximately 30% to 35% of antineoplastics currently being developed are in an oral formulation.1 Oral formulations offer many advantages for patients, including convenience, potential for reduced side effects, and enhanced quality of life. Several studies have shown that between 63% and 89% of patients would prefer an oral therapy if efficacy were not compromised.2-4


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