Background. The demand for pharmacy cancer services is expected to at least double over the next 10 years, as the population ages and new treatments are introduced. Safe and efficient handling of cytotoxic products minimises risks to staff and reduces medication errors.
Objectives. To identify and describe strategies for coping safely and effectively with heavier workloads in the hospital oncology pharmacy, currently and in the future.
Methods. The PubMed database was searched for literature on approaches to safe handling of antineoplastic agents and to decreasing medication errors in the hospital pharmacy. Articles that were judged to be of prime importance to the hospital oncologist were reviewed. These safety concepts are put into the context of contemporary hospital oncology pharmacy practice through discussion of key issues, including increased demand, the role of the pharmacist in determining the hospital formulary, and growth in patient preferences for oral chemotherapy. Recommendations on best practices are also provided, based on relevant literature and author experience.
Conclusions. Efficient, safe hospital pharmacy operations can be aided by capacity planning, dose banding, and knowledge of novel products and procedures that can reduce risks to health while increasing the number of patients who are safely treated. Consideration may also be given to the economic role of oncology pharmacists in formulary development. J Oncol Pharm Practice (2010) 16: 9—18.
Ferlay J., Autier P., Boniol M., Heanue M., Colombet M., Boyle P.Estimates of the cancer incidence and mortality in Europe in2006. Ann Oncol2007; 18: 581-92.
2.
Nordlinger B. , Sorbye H., Collette L.Final results of the EORTC Intergroup randomized phase III study 40983 [EPOC] evaluating the benefit of peri-operative FOLFOX4 chemotherapy for patients with potentially resectable colorectal cancer liver metastases. J Clin Oncol2007; 25(18S): LBA5.
3.
Barone C., Nuzzo G., Cassano A., Basso M., Schinzari G., Giuliante F., D’Argento E., Trigila N., Astone A., Pozzo C.Final analysis of colorectal cancer patients treated with irinotecan and 5-fluorouracil plus folinic acid neoadjuvant chemotherapy for unresectable liver metastases . Br J Cancer2007; 97: 1035-9.
4.
de Gramont A. , Boni C., Navarro M., Tabernero J., Hickish T., Topham C., Bonetti A., Clingan P., Lorenzato C., and André T.Oxaliplatin/5FU/LV in adjuvant colon cancer: updated efficacy results of the MOSAIC trial, including survival, with a median follow-up of six years. J Clin Oncol2007; 25(18S): 4007.
5.
Schmoll HJ, Cartwright T., Tabernero J., Nowacki MP, Figer A., Maroun J., Price T., Lim R., Van Cutsem E., Park Y-S., McKendrick J., Topham C., Soler-Gonzalez G., de Braud F., Hill M., Sirzén F., and Haller DGPhase III trial of capecitabine plus oxaliplatin as adjuvant therapy for stage III colon cancer: a planned safety analysis in 1,864 patients. J Clin Oncol2007; 25: 102-9.
6.
Doloresco F. , Vermeulen LCGlobal survey of hospital pharmacy practice . Am J Health Syst Pharm2009; 66(5, Suppl 3): S13-9.
7.
Cancer Scenarios: An aid to planning cancer services in Scotland in the next decade (homepage on the Internet). Scottish Executive Health Department, Edinburgh [cited 8 July 2008]. Available at http://www.scotland.gov.uk/Publications/2001/05/9056/File-1 (accessed date October 29, 2009).
8.
Breckinridge A.Report of the working party on the addition of drugs to intravenous infusion fluids [HC(76)9][Breckenridge report]. London ; The Department of Health and Social Security, 1976.
9.
International Society of Oncology Pharmacy Practitioners Standards Committee.ISOPP standards of practice. Safe handling of cytotoxics. J Oncol Pharm Pract2007; 13(suppl): 1-81.
10.
Cousins DH, Sabatier B., Beque D., Schmitt C., Hoppe-Tichy T.Medication errors in intravenous drug preparation and administration: a multicentre audit in the UK, Germany and France. Qual Saf Health Care2005; 14: 190-5.
11.
Womer RB, Tracy E., Soo-Hoo W., Bickert B., DiTaranto S., Barnsteiner JHMultidisciplinary systems approach to chemotherapy safety: rebuilding processes and holding the gains. J Clin Oncol2002; 20: 4705-12.
Graham R.Revisiting Breckenridge. Hosp Pharm2005; 12: 186.
14.
Baker ES, Connor THMonitoring occupational exposure to cancer chemotherapy drugs. Am J Health Syst Pharm1996; 53: 2713-23.
15.
Sorsa M., Anderson D.Monitoring of occupational exposure to cytostatic anticancer agents . Mutat Res1996; 355: 253-61.
16.
Sessink PJM , Bos RPDrugs hazardous to healthcare workers. Evaluation of methods for monitoring occupational exposure to cytostatic drugs . Drug Saf1999; 20: 347-59.
17.
Dranitsaris G., Johnston M., Poirier S., Schueller T., Milliken D., Green E., Zanke B.Are health care providers who work with cancer drugs at an increased risk for toxic events? A systematic review and meta-analysis of the literature. J Oncol Pharm Pract2005 ; 11: 69-78.
18.
Mader RM, Kokalj A., Kratochvil E., Pilger A., Rüdiger HWLongitudinal biomonitoring of nurses handling antineoplastic drugs . J Clin Nurs2008; [Epub ahead of print].
19.
Hepp R., Gentschew G.External contamination of commercially available cytotoxic drugs. Krankenhauspharmazie1998; 19: 22-7.
20.
Delporte JP , Chenoix P., Hubert PHChemical contamination of the primary packaging of 5-fluorouracil RTU solutions commercially available on the Belgian market . Eur Hosp Pharm1999 ; 5: 119-21.
21.
Nygren O., Gustavsson B., Ström L., Friberg A.Cisplatin contamination on the outside of drug vials. Ann Occ Hyg2002; 46: 555-7.
22.
Favier B., Gilles L., Gesage M., Latour JFAnalysis of cyclophosphamide in the urine of antineoplastic drug handlers . Bull Cancer2003; 90: 905-9.
23.
Connor TH, Sessink PJ, Harrison BR, Pretty JR, Peters BG, Alfaro RM, Bilos A., Beckmann G., Bing MR, Anderson LM, Dechristoforo R.Surface contamination of chemotherapy drug vials and evaluation of new vial-cleaning techniques: results of three studies. Am J Health Syst Pharm2005; 62: 475-84.
24.
Eisenberg S.Safe handling and administration of antineoplastic chemotherapy. J Infus Nurs2009; 32: 23-32.
25.
National Institute for Occupational Safety and Health.Medical Surveillance for Health Care Workers Exposed to Hazardous Drugs. Cincinnati, OH: Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; 2007: 1-4.
26.
Wick C., Slawson MH, Jorgenson JA, Tyler LSUsing a closed-system protective device to reduce personnel exposure to antineoplastic agents. Am J Health Syst Pharm2003; 60: 2314-20.
27.
Connor TH, Anderson RW, Sessink PJ, Spivey SMEffectiveness of a closed-system device in containing surface contamination with cyclophosphamide and ifosfamide in an i.v. admixture area. Am J Health Syst Pharm2002; 59: 68-72.
28.
Benizri F., Bonan B., Ferrio AL, Brandely ML, Castagné V., Théou-Anton N., Verlinde-Carvalho M., Havard L.Stability of antineoplastic agents in use for home-based intravenous chemotherapy . Pharm World Sci2009; 31: 1-13.
29.
Johnson PE, Chambers CR, Vaida AJOncology medication safety: a 3D status report2008 . J Oncol Pharm Pract2008; 14: 169-80.
30.
Bonan B., Martelli N., Berhoune M., Maestroni ML, Havard L., Prognon P.The application of hazard analysis and critical control points and risk management in the preparation of anti-cancer drugs. Int J Qual Health Care2009; 21: 44-50.
31.
Low J., Macintyre J., McIver L., Lannigan N., on behalf of the Association of Scottish Trust Chief Pharmacists.The development of a capacity planning model for pharmaceutical services to cancer patients. Pharm J2003; 270: 239-40.
32.
Plumridge RJ , Sewell GJDose-banding of cytotoxic drugs: a new concept in cancer chemotherapy. Am J Health Syst Pharm2001; 58: 1760-4.
33.
Beaney AM, Black A., Dobson CR, Williamson S., Robinson M.Development and application of a risk assessment tool to improve the safety of patients receiving injectable medicines. Hosp Pharm2005; 12: 150-4.
34.
Liu G., Franssen E., Fitch MI, Warner E.Patient preferences for oral versus intravenous palliative chemotherapy . J Clin Oncol1997; 15: 110-5.
35.
Skirvin JA, Lichtman SMPharmacokinetic considerations of oral chemotherapy in elderly patients with cancer. Drugs Aging2002; 19: 25-42.
36.
Eisen SA, Miller DK, Woodward RS, Spitznagel E., Przybeck TRThe effect of prescribed daily dose frequency on patient medication compliance . Arch Intern Med1990; 150: 1881-4.
37.
Claxton AJ, Cramer J., Pierce C.A systematic review of the associations between dose regimens and medication compliance. Clin Ther2001; 23: 1296-310.
38.
Risks of incorrect dosing of oral anti-cancer medicines (homepage on the internet) . National Patient Safety Agency, London, UK [cited 2 June 2008]. Available at http://www.npsa.nhs.uk/patientsafety/alerts-and-directives/rapidrr/risks-of-incorrect-dosing-of-oral-anti-cancer-medicines (accessed date October 29, 2009).
39.
Janknegt R. , Steenhoek A.The System of Objectified Judgment Analysis (SOJA).A tool in rational drug selection for formulary inclusion. Drugs1997; 53: 550-62.
40.
Jones S., Strange S.Controversy surrounding high-cost drug use in oncology. Hosp Pharm2002; 9: 275-7.
41.
Coombes RC, Kilburn LS, Snowdon CF, on behalf of the Intergroup Exemestane Study.Survival and safety of exemestane versus tamoxifen after 2-3 years’ tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial. Lancet2007; 369: 559-70.
