FRIDAY, Jan. 12, 2007 (HealthDay News) -- While the use of oral chemotherapy is becoming more widespread in United States, adoption of standardized safeguards of the kind routinely used for intravenous chemotherapy is lacking, researchers report.
A survey questionnaire of pharmacy directors at 42 of the 62 comprehensive cancer centers in the United States found that most didn't have standardized procedures for prescribing the oral drugs, according to a report in the Jan. 13 issue of the British Medical Journal.
"Oral chemotherapy is a new and evolving area," said lead researcher Dr. Saul N. Weingart, vice president for patient safety at the Dana-Farber Cancer Institute's Centre for Patient Safety in Boston. "There are all kinds of treatments given in the form of pills that used to involve complex intravenous regimens that were delivered exclusively in offices or cancer centers."
Weingart and his team set out to examine what safety practices were being used in prescribing such medications, and found that few of the routine safeguards used in infusion chemo had been adopted for oral chemo.
For example, the survey showed that on prescriptions for the six most common oral chemotherapies: Only 26 percent of the centers required a patient's diagnosis; only 9 percent required a patient's treatment schedule and length of treatment; and only 9 percent required a patient's body surface area calculation, which is used to determine correct and safe drug dose.
In addition, only 21 percent of the centers required a second physician to review and approve the prescription order.
More than 50 percent of the centers had no required elements for oral chemotherapy prescriptions, Weingart noted. "These are all pretty standardized for intravenous chemotherapy," he said.
"Physicians seem to write prescriptions for oral chemotherapy drugs the way they write prescriptions for an antibiotic or a blood-pressure medication," he added. "It's on a scrap of paper and handwritten, and doesn't have all the safeguards we usually think of with chemotherapy."
The researchers found that almost 70 percent of the centers used handwritten orders for most of the oral chemotherapy prescriptions, 5 percent used preprinted paper prescriptions, and 14 percent used computer-based prescription order entry systems.
In addition, the survey showed, almost a quarter of the centers had no formal process for monitoring patients adherence. From 2004 to 2005, there was at least one serious adverse drug event related to oral chemotherapy reported at 10 centers, and there was a serious near-miss at 13 centers, Weingart said.
Weingart also said that patients should be better educated on their drug usage and what risks and side effects to expect, a process that is usually done with intravenous chemotherapy. And, he added, there also needs to be better programs to ensure that patients are taking their medication.
"Many of these drugs are of sufficiently high risk that we ought to have special safeguards in mind, and we ought to translate the lessons learned for intravenous chemotherapy into oral chemotherapy," Weingart said.
One expert thinks that constant reeducation needs to be done to make sure patients comply with their regimen.
"These medications are key to the long-term survival children with cancers have," said Dr. Frank G. Keller, a pediatric oncologist at the Aflac Cancer Center of Children's Healthcare of Atlanta. "It is imperative that we make sure they are getting the medications that are prescribed and that they are prescribed the correct medications."
Keller said that, with children, it is especially important that parents are taught about the drugs their child is taking. "It takes repeated reinforcement with each clinic visit," he said. "You need to go over how it went with the medications, what medications are being taken and that the parent can demonstrate that they understand what they are doing. If not, then they need to be reeducated."
In terms of prescribing, Keller said, his hospital has safeguards that include a form listing all medications, which has to be signed by a doctor and reviewed by a pharmacist.
Where the system can breakdown is when patients have their prescription filled at the local drugstore, he said.
"Occasionally, we see errors arise in that step of the process," Keller said. "I don't know how to get around that."
Another expert thinks that cancer centers need to treat oral chemotherapy drugs in the same way they treat intravenous ones.
"We can't assume that because a drug is an oral drug it is going to be properly prescribed, properly dispensed and properly confirmed that the patient has taken it," said Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society. "This study raises the question whether we, as doctors, need to be more vigilant."
More information
The American Cancer Society can tell you more about chemotherapy.
