Liu Ding-Cheng, Hung Chuan-Lun, Chen Yi-Wen, Kuo Li-Na, Hsin Yen-Chun, Kuo Chun-Nan
School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
Department of Pharmacy, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
J Food Drug Anal. 2024 Dec 15;32(4):558-567. doi: 10.38212/2224-6614.3528.
Non-small cell lung cancer (NSCLC) is commonly treated with tyrosine kinase inhibitors (TKIs). However, adverse events from such treatment can lead to treatment discontinuation and additional medical expenditures. Ambulatory care from oncology pharmacists in patient education and symptom management can benefit patients with NSCLC. In this study, we evaluated the effectiveness of an oncology pharmacy service at a medical center in Taiwan. We retrospectively enrolled 137 patients with NSCLC who initiated treatment with afatinib, gefitinib, or erlotinib between January 2017 and December 2021; 40 of them utilized the oncology pharmacy service (intervention group), and the remaining 97 did not (nonintervention group). To determine the effectiveness of the oncology pharmacy service, we analyzed the following outcomes: adverse event rates, number of hospital visits (unexpected outpatient department visits, emergency department visits, and hospitalization), and medical expenditure. The intervention group had significantly more skin-related adverse events (acneiform rash: 75% vs. 49%; mucositis: 40% vs. 21%; dermatitis: 30% vs. 9%; and paronychia: 85% vs. 28%) but significantly fewer monthly emergency department visits (0.04 vs. 0.17) and unexpected outpatient department visits (0.15 vs. 0.34). The intervention group also had significantly lower expenditure for emergency department visits (NT$166.4 vs. NT$734.8) and nonsignificantly lower expenditure for outpatient department visits. Our findings indicate the value of pharmacist-managed ambulatory oncology care. Although this service did not reduce the incidence rates of adverse events, it reduced the number of unplanned outpatient and emergency department visits and reduced the emergency department expenditure of patients with NSCLC receiving TKIs.
非小细胞肺癌（NSCLC）通常采用酪氨酸激酶抑制剂（TKIs）进行治疗。然而，此类治疗引发的不良事件可能导致治疗中断以及额外的医疗费用。肿瘤药师在患者教育和症状管理方面提供的门诊护理能够使NSCLC患者受益。在本研究中，我们评估了台湾一家医疗中心的肿瘤药学服务的有效性。我们回顾性纳入了137例在2017年1月至2021年12月期间开始使用阿法替尼、吉非替尼或厄洛替尼进行治疗的NSCLC患者；其中40例患者使用了肿瘤药学服务（干预组），其余97例未使用（非干预组）。为确定肿瘤药学服务的有效性，我们分析了以下结果：不良事件发生率、医院就诊次数（意外门诊就诊、急诊就诊和住院）以及医疗费用。干预组出现皮肤相关不良事件的比例显著更高（痤疮样皮疹：75%对49%；粘膜炎：40%对21%；皮炎：30%对9%；甲沟炎：85%对28%），但每月的急诊就诊次数显著更少（0.04对0.17）以及意外门诊就诊次数显著更少（0.15对0.34）。干预组的急诊就诊费用也显著更低（新台币166.4元对734.8元），门诊就诊费用虽未显著降低但也有所下降。我们的研究结果表明了药师管理的门诊肿瘤护理的价值。尽管该服务并未降低不良事件的发生率，但它减少了NSCLC患者接受TKIs治疗时计划外的门诊和急诊就诊次数，并降低了急诊就诊费用。
