Renna Catherine E, Dow Elizabeth N, Bergsbaken Jason J, Leal Ticiana A
1 Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA.
2 Department of Pharmacy, UW Health, Madison, WI, USA.
J Oncol Pharm Pract. 2019 Jun;25(4):954-960. doi: 10.1177/1078155218817937.
The development of immune checkpoint inhibitors has revolutionized cancer treatment and is now a part of the treatment paradigm for several malignancies. Although immune checkpoint inhibitors are generally well tolerated, treatment is associated with immune-related adverse events, some serious and potentially life threatening. Early identification and prompt appropriate management of immune-related adverse events are crucial to prevent morbidity and mortality. The complexity and severity of immune-related adverse events require interdisciplinary collaboration to optimize care. Patient and caregiver education and continued communication between patients and members of the oncology care team are vital for timely recognition and successful management of immune-related adverse events. The objective of this program is to provide a proof of concept; a pharmacist-led immune checkpoint inhibitor management program will increase early recognition and management of immune-related adverse events through patient and caregiver education and proactively assessing patients for toxicities.
At the University of Wisconsin Carbone Cancer Center, we developed and implemented a pharmacist-driven program, referred to as the immune checkpoint inhibitor program, which aimed to ensure patient and caregiver education and continuous monitoring of immune-related adverse events. This program utilized pharmacist-patient encounters to improve patient and caregiver education and follow-up monitoring. The design and implementation are detailed. Pharmacist interventions and patient outcomes were evaluated.
At interim analysis, 47 patients were enrolled in the program and pharmacists completed 34 interventions on 26 patients. Pharmacists are well positioned to educate patients and caregivers on immune checkpoint inhibitor therapy and provide proactive monitoring to detect immune-related adverse events. We hypothesize that the interventions made by pharmacist may lead to earlier recognition and treatment of immune-related adverse events.
免疫检查点抑制剂的发展彻底改变了癌症治疗方式，如今已成为多种恶性肿瘤治疗模式的一部分。尽管免疫检查点抑制剂总体耐受性良好，但治疗会引发免疫相关不良事件，其中一些严重且可能危及生命。早期识别并及时恰当处理免疫相关不良事件对于预防发病和死亡至关重要。免疫相关不良事件的复杂性和严重性需要跨学科协作以优化治疗。患者及护理人员教育以及患者与肿瘤护理团队成员之间的持续沟通对于及时识别和成功处理免疫相关不良事件至关重要。本项目的目标是提供一个概念验证；由药剂师主导的免疫检查点抑制剂管理项目将通过患者及护理人员教育并主动评估患者毒性来提高对免疫相关不良事件的早期识别和管理。
在威斯康星大学卡本癌症中心，我们制定并实施了一个由药剂师推动的项目，称为免疫检查点抑制剂项目，旨在确保患者及护理人员教育以及对免疫相关不良事件的持续监测。该项目利用药剂师与患者的接触来改善患者及护理人员教育和后续监测。详细介绍了设计与实施过程。对药剂师的干预措施和患者结局进行了评估。
在中期分析时，该项目纳入了47名患者，药剂师对26名患者完成了34次干预。药剂师具备良好条件，能够就免疫检查点抑制剂治疗对患者及护理人员进行教育，并提供主动监测以发现免疫相关不良事件。我们假设药剂师所做的干预可能会导致对免疫相关不良事件的更早识别和治疗。
