Lattard Claire, Herledan Chloé, Reverdy Thibaut, Antherieu Gabriel, Caffin Anne-Gaelle, Cerfon Marie-Anne, Maire Magali, Rivat Marine, France Stéphanie, Ghesquières Hervé, You Benoit, Freyer Gilles, Ranchon Florence, Rioufol Catherine
Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, 69495 Pierre-Bénite, France.
Université Lyon 1, EA 3738, CICLY, Lyon, 69921 OULLINS Cedex, France.
Oncologist. 2025 Feb 6;30(2). doi: 10.1093/oncolo/oyae241.
Healthcare professionals are faced with the new challenges of preventing and managing drug-related problems (DRPs) with oral anticancer therapy (OAT): side-effects, drug-drug interactions (DDIs), non-adherence, or medication errors. This study aims to assess the impact of ONCORAL, a real-life multidisciplinary care plan for cancer patients based on community and hospital follow-up, for the first OAT cycle.
A prospective cohort study was conducted between October 1, 2021 and October 1, 2022 including all outpatients starting OAT treatment. During the first OAT cycle, the program consists of 6 weekly scheduled face-to-face or phone consultations to prevent and manage DRPs. Nurse and pharmacist interventions (NPIs) are realized to optimize treatments (primary outcomes). Secondary outcomes included the relative dose intensity (RDI) of the first cycle.
A total of 562 NPIs were performed by the ONCORAL team: that is, 87.1% of the 209 patients included, for a mean of 3.1 ± 2.2 NPIs/patient. NPIs-concerned DRPs detected by the nurse and pharmacist (346, 61.6%), symptoms and/or adverse effects reported as PROs by the patient or family (138, 24.6%), or pathway issues (78, 13.9%). Seventy-three DDIs were detected and managed during medication review, in a quarter of patients (n = 54/209), leading to the discontinuation of a daily concomitant medication in 30 cases. The mean RDI at the end of the first cycle, calculated for 209 patients, was 83.1 ± 23.9% (17.56-144.23).
In these ambulatory cancer patients, the interest in tailored monitoring of DRPs as a whole, including the prevention and management of drug interactions in addition to symptoms and adverse effects, is highlighted.
医疗保健专业人员在预防和管理口服抗癌治疗（OAT）相关的药物问题（DRP）上面临新挑战，这些问题包括副作用、药物相互作用（DDI）、不依从或用药错误。本研究旨在评估ONCORAL（一种基于社区和医院随访的针对癌症患者的现实生活多学科护理计划）对首个OAT周期的影响。
于2021年10月1日至2022年10月1日进行了一项前瞻性队列研究，纳入所有开始OAT治疗的门诊患者。在首个OAT周期中，该计划包括每周6次定期的面对面或电话咨询，以预防和管理DRP。实施护士和药剂师干预（NPI）以优化治疗（主要结局）。次要结局包括首个周期的相对剂量强度（RDI）。
ONCORAL团队共进行了562次NPI，即纳入的209例患者中的87.1%，平均每位患者3.1±2.2次NPI。护士和药剂师检测到的与NPI相关的DRP（346例，61.6%）、患者或家属作为患者报告结局（PRO）报告的症状和/或不良反应（138例，24.6%）或路径问题（78例，13.9%）。在药物审查期间检测并管理了73例DDI，四分之一的患者（n = 54/209）出现，其中30例导致每日伴随用药停用。对209例患者计算的首个周期末平均RDI为83.1±23.9%（17.56 - 144.23）。
在这些门诊癌症患者中，强调了对DRP进行整体定制监测的重要性，包括除症状和不良反应外对药物相互作用的预防和管理。
