Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Dana-Farber Cancer Institute, Boston, Massachusetts.
JAMA Oncol. 2018 Jan 1;4(1):105-117. doi: 10.1001/jamaoncol.2017.0625.
With the growing use of oral chemotherapy, there is an urgent need to develop safe and effective systems to administer and manage these agents. A comprehensive synthesis of literature on oral chemotherapy care delivery programs to which clinicians can look for best practices is lacking.
To summarize the peer-reviewed and gray literature on interventions to improve oral chemotherapy care delivery toward describing best practices and identifying current gaps.
Using search terms pertaining to the concepts of oral chemotherapy, cancer, and interventions and outcomes, we performed a systematic review of PubMed, EMBASE, and CINAHL from January 1995 to May 24, 2016, to identify oral chemotherapy intervention programs. We searched the gray literature from January 1995 through February 2016 and contacted gray literature authors for further information. Four physician abstractors reviewed the titles, abstracts, and articles. Quality of the articles was assessed using SQUIRE2 guidelines. Interventions were evaluated in the categories of prescribing, preparation/dispensing, education, administration, monitoring, and storage/disposal. The population of interest included all ages and was limited to traditional cytotoxic and targeted anticancer oral agents.
From 7984 abstracts identified in the peer-reviewed literature search, 16 full-text articles met inclusion criteria representing 3612 patients. Interventions focused on prescribing (n = 1), preparation/dispensing (n = 2), education (n = 11), administration (n = 5), monitoring (n = 14), and storage/disposal (n = 1). In the 10 articles with adherence as the primary outcome, 4 evaluation methods were used. Most improvements were seen in toxic effects/safety compared with adherence. Of the 7 interventions with statistically significant improvement in the primary outcome, 3 nursing phone calls to contact patients within the first few days after treatment initiation, 2 of them with standardized toxic effects management protocols. Interventions using technology to increase touch points between care teams and patients (including video directly observed therapy, automated voice response, and text messages) were not effective.
A framework for the oral chemotherapy management process with standardized outcome definitions is needed to ensure constructive research. Existing data suggest that a monitoring program should include personal contact with patients within the first weeks of treatment. Whether such contact can be enhanced by technology is uncertain.
随着口服化疗的广泛应用，迫切需要开发安全有效的系统来管理和管理这些药物。缺乏对临床医生可用于最佳实践的口服化疗护理提供计划的文献的综合综合。
总结有关改善口服化疗护理提供计划的同行评议和灰色文献，以描述最佳实践并确定当前差距。
使用与口服化疗、癌症和干预措施和结果相关的概念术语，我们对 PubMed、EMBASE 和 CINAHL 进行了系统评价，检索时间为 1995 年 1 月至 2016 年 5 月 24 日，以确定口服化疗干预方案。我们从 1995 年 1 月至 2016 年 2 月检索了灰色文献，并联系了灰色文献作者以获取更多信息。四名医师摘要员审查了标题、摘要和文章。使用 SQUIRE2 指南评估文章的质量。干预措施分为处方、准备/分配、教育、管理、监测和储存/处置。感兴趣的人群包括所有年龄段，仅限于传统细胞毒性和靶向抗癌口服药物。
从同行评议文献检索中确定的 7984 个摘要中，有 16 篇全文文章符合纳入标准，代表 3612 名患者。干预措施侧重于处方（n=1）、准备/分配（n=2）、教育（n=11）、管理（n=5）、监测（n=14）和储存/处置（n=1）。在 10 篇以依从性为主要结局的文章中，使用了 4 种评估方法。与依从性相比，大多数毒性/安全性方面都有改善。在主要结局有统计学意义改善的 7 项干预措施中，有 3 项护理电话在治疗开始后几天内与患者联系，其中 2 项有标准化的毒性管理方案。利用技术增加护理团队和患者之间的接触点的干预措施（包括直接观察治疗视频、自动语音应答和短信）无效。
需要一个具有标准化结果定义的口服化疗管理过程框架，以确保建设性的研究。现有数据表明，监测计划应包括在治疗开始后的最初几周内与患者进行个人接触。这种接触是否可以通过技术得到加强尚不确定。
