Patient Safety and Quality

Few of the safeguards routinely used for intravenous chemotherapy have been adopted for oral chemotherapy at U.S. cancer centers

Some common cancers can be treated with oral instead of intravenous chemotherapy. Yet, few of the safeguards routinely used for infusion chemotherapy have been adopted for oral chemotherapy at U.S. cancer centers, according to a new study. In addition, there is currently no consensus at these centers about safe medication practices for oral chemotherapy, notes Saul A. Weingart, M.D., Ph.D., of the Dana-Farber Cancer Institute. Dr. Weingart and colleagues analyzed survey responses of pharmacy directors from 42 comprehensive cancer centers in the United States to characterize current safety practices for the use of oral chemotherapy.

Clinicians at 29 centers used handwritten prescriptions for most oral chemotherapy prescribing, 2 used preprinted paper prescriptions, and 6 used electronic systems. Only 1 in 3 centers required a clinician to note the patient's body surface area (used to calculate the correct and safe dose) or calculation of dose on the prescription for 6 commonly used oral chemotherapy drugs. Only 1 in 4 centers required the patient's diagnosis or protocol on the prescription.

An average of 10 centers required a diagnosis on the prescription, 11 required the protocol number, 4 required the treatment cycle number, 9 required double checking of the prescription by a second clinician, 14 required a calculation of body surface area, and 14 required a calculation of dose per square meter of body surface area. Yet, these are standard safeguard practices for prescribing intravenous chemotherapy.

About half the cancer centers coordinated oral with intravenous chemotherapy, and only a third requested patients' written informed consent when oral chemotherapy was given off protocol. Also, 10 centers had no formal process for monitoring patients' adherence to the therapy. Pharmacy directors at 10 centers reported at least 1 serious adverse drug event related to oral chemotherapy, and those at 13 centers reported a serious near miss in the past year.

The researchers recommend that the oncology community define safe medication practices appropriate for oral chemotherapy, develop practice guidelines, and accelerate their adoption. Their study was supported by the Agency for Healthcare Research and Quality (HS11644).

See "Oral chemotherapy safety practices at U.S. cancer centres: Questionnaire survey," by Dr. Weingart, Jonathan Flug, Daniela Brouillard, and others, in the February 2007 British Medical Journal 334, pp. 407-409.

Editor's Note: Another AHRQ-supported study (HS11644) by the same research team found that patients are able to recognize unsafe practices in outpatient oncology care. For more details, see: Weingart, S.N., Duncombe, D., Connor, M., and others (2007, February). "Patient-reported safety and quality of care in outpatient oncology." Journal on Quality and Patient Safety 33(2), pp. 83-94.

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