Diyabetli Kanser Hastalarında Kemoterapiyle İlişkili Problemler Üzerine Eczacı Önerilerinin Etkisi

Marmara Pharmaceutical Journal 21/3: 603-611, 2017 DOI: 10.12991/marupj.323286 RESEARCH PAPER Influence of Pharmacist Recommendations for Chemotherapy-Related Problems in Diabetic Cancer Patients Fikret V. Izzettin, Anmar Al-taie, Mesut Sancar, Mehmet Aliustaoğlu ABSTRACT Drug related-problems pose additional worse outcomes in cancer patients treated with chemotherapy. A vital role of the clinical pharmacist is the detection and prevention of drugrelated problems. The provision of patient education is an important step to reduce and prevent drug-related problems during chemotherapy administration. The objective of this study was to assess the occurrence of drug-related problems and the importance of effective provision of patient education and appropriate recommendations by the clinical pharmacist in reducing and solving of these problems in diabetic patients suffering from cancer. A prospective study carried out on 50 diabetic patients as a single group with new diagnosis of diverse cancer types eligible for chemotherapy adminitration recruited between September 2014 and April 2015 at the oncology unit in one of the Teaching and Research Hospital (Istanbul-Turkey). Drug-related problems were evaluated, and proper patient education alongside pharmacist recommendation regarding chemotherapy was provided during the required chemotherapy protocol schedule. (n=65) of the drug-related problems were contributed to inappropriate IV fluid selection; (n=33) were attributed to low drug dose prescribed, and (n=30) to high drug dose prescribed. Drug-related problems totally solved due to clinical pharmacist recommendations were 69.57% (n=80). There was a significant increase in the occurrence of paleness (P=0.0001); urinary frequency (P=0.003); loss of appetite (P=0.0001), nausea (P=0.0001), vomiting (P=0.0001); and numbness (P=0.0001). A significant decrease in the occurrence and severity of chemotherapy-related adverse effects was observed as a mild urinary frequency (P=0.0001) and mild vomiting (P=0.0001) after the clinical pharmacist recommendations and provision of patient education. Results of this study revealed that diabetic cancer patients are definitly prone to the occurrence of drug-related problems and adverse drug reactions. Clinical pharmacist is expected to provide a well-defined education and care to those patients and the outcomes of pharmacist recommendations may diminish and prevent many drug-related problems and adverse drug reactions and by this, influence patients’ desire to complete the course of chemotherapy. Keywords: Clinical Pharmacist Recommendations, Diabetes Mellitus, Drug-Related Problems, Adverse Drug Effects Introduction Fikret V.Izzettin, Anmar Al-taie, Mesut Sancar Clinical Pharmacy Department, Faculty of Pharmacy, Marmara University, Istanbul, Turkey Mehmet Aliustaoğlu Oncology Center, Dr. Lütfi Kırdar Kartal Teaching and Research Hospital, Istanbul, Turkey Corresponding Author: Anmar Al-taie E-mail: Submitted / Gönderilme: 18.01.2017 Accepted / Kabul: 12.04.2017 Revised / Düzeltme: 06.04.2017 Diabetes mellitus (DM) and cancer are considered to be the most common severe conditions with worse effects on general health (1). According to the Pharmaceutical Care Network Europe (PCNE) classification, drug related-problem is defined as ‘an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes’ (2). Drug related-problems (DRPs) include many issues such as adverse drug reactions (ADRs), unnecessary drug therapy, inappropriate choice of drugs, and untreated conditions. Drug related-problems are associated with a prolonged hospitalization, increased economic burden, and an almost 2-fold increased risk of substantial morbidity and mortality. It also affects the patient’s recovery and is a major limitation in providing healthcare to the patient (3-5). 603 604 Izzettin et al. Influence of Pharmacist Recommendations for Chemotherapy-Related Problems in Diabetic Cancer Patients Rational and safe drug use is greatly important since patient´s health is majorly influenced by the occurrence of adverse drug reactions. Adverse drug reactions are considered one of the main problems as they can increase the rate of morbidity and mortality. In addition, they can impose a remarkable financial burden on healthcare systems (6,7). Adverse drug reaction is defined as a response to a drug which is a noxious and unintended, and occurs at doses normally used for the prophylaxis, diagnosis, or therapy of disease (8). Cancer chemotherapies are associated with numerous adverse drug complications which often result in dose reductions or treatment delays leading to compromising clinical outcomes or even mortality (9). Despite these facts, ADRs still do not consider as a relevant problem by a large proportion of healthcare professionals (10). Patients and healthcare professionals should have a profound attention to prevent unnecessary drug treatment and subsequent ADRs (11). The most important step of the clinical pharmacist is a reduction and effective management of ADRs in cancer therapy. This is done by the provision of sufficient and essential prechemotherapy education including those about the possible occurrence of side effects and the proper ways for selfcare management (12). Many studies indicate that patient education can decrease certain treatment-related issues, improve physical and psychosocial outcomes, influence patients’ desire to complete the course of chemotherapy and finally improve patients´quality of life (12-14). Aim of the study The objective of this study was to evaluate the occurrence of DRPs during chemotherapy administration and the importance of effective provision of patient education and appropriate reccommendations offered by the clinical pharmacist on the occurrence of these problems in diabetic patients suffering from cancer. Methods Marmara Pharm J 21/3: 603-611, 2017 A total of 50 out of 59 diabetic patients with new diagnosis of diverse types of cancers eligible for different chemotherapeutic protocols were recruited after meeting the inclusion criteria at the oncology unit. Inclusion criteria included patients over the age of 18 years, diabetic patients with new diagnosis of cancer eligible for chemotherapy. Patients who expressed willingness to take part and to abide by this study’s rules. Were provided with additional written information and were asked to sign the study consent form. Exclusion criteria included patients with neoadjuvant chemotherapy, patients who were receiving radiotherapy concomitantly, and patients who expressed willingness to withdraw from the study. Basically, patient data were collected from the medical records of the patients. Any further information requied for this study were collected by the researcher clinical pharmascist via face-to-face interview with the patients for reporting details involving patients’ sociodemographic data, knowledge (...truncated)