One of the priority issues in the oncology setting is to improve the efficacy and safety of cancer chemotherapy. Therefore, side effects that do not directly affect prognosis are frequently overlooked by healthcare professionals or investigators. The development of management methods for those side effects tends to take a backseat to priority issues, resulting in reduction of QOL in patients. We resolved those side effects focusing on olfactory impairment, phlebitis, vascular pain and through the conduct of detection, assessment, development of prophylactic methods in the clinical setting. This review summarizes our findings:
1. Investigation of actual conditions of olfactory impairment in patients receiving cancer chemotherapy
2. Assessment for olfactory impairment using objective evaluation method in patients receiving cancer chemotherapy
3. Improvement of epirubicin-induced phlebitis by switching from liquid preparation to lyophilized formulation
4. Protective effect for epirubicin-induced phlebitis by reduced infusion time and flashing after the infusion
5. Explore risk factors of gemcitabine-induced vascular pain and involvement of prostaglandin E2 to the vascular pain
These findings provide useful information for the prevention of side effects induced by cancer chemotherapy.
When hospitalized patients develop infections, it extends their hospital stay and can increase their risk of death. Preventing the onset of infection reduces the burden on patients as well as on the hospital. Controlling the amount of antibiotics used can also help to suppress drug-resistant bacteria. When the flow rate of long chain triglyceride lipid emulsion in nutritional supplementation is fast, it has been reported that it could inhibit reticuloendothelial function because artificial triglycerides accumulate in the blood. However, accumulation of artificial triglycerides can be avoided when the flow rate is less than 0.10 g/kg/hr. We examined the relationship between the presence/lack of infections and the flow rate of lipid emulsion, by studying 23 patients with body weights under 40 kg who were administered lipid emulsion intravenously for a period of 14 days or more. Of the infected group, 5 out of 13 cases (38.5%) received a flow rate less than 0.10 g/kg/hr. However, in the non-infected group, 8 out of 10 cases (80.0%) had been administered a flow rate that was less than 0.10 g/kg/hr (P = 0.046). Therefore, we believe the risk of infection can be suppressed by managing the intravenous lipid emulsion flow rate at less than 0.10 g/kg/hr.
Stable isotope ratios of nitrogen (δ15N) and carbon (δ13C) in scalp hair of elderly patients who received enteral nutrition for long periods were analyzed to assess nutritional status: the δ15N and δ13C in the hair of patients who received enteral nutrition were compared with those of healthy persons, respectively. The average values of the δ15N and δ13C in the hair of patients who received enteral nutrition (n = 19) were higher and lower than those of healthy persons (n = 17), respectively. A negative correlation was observed between the δ15N in the hair of patients and the dose of energy (r = -0.490, P < 0.05), whereas positive correlation was found between the δ13C and the dose of energy (r = 0.563, P < 0.05). The δ15N and δ13C in scalp hair may be good indicators for assessing the nutritional status of the elderly patients who received enteral nutrition for long period.
One of the serious adverse effects of the antithrombotic agents is intracerebral hemorrhage (ICH). We aimed to evaluate whether antithrombotic agents influence the outcome at the time of hospital discharge in patients with acute phase of ICH. Of the 353 patients with acute phase of ICH, 90 (25.5%) had been treated with antithrombotic agents. Modified rankin scale (mRS) at the time of hospital discharge in patients taking antiplatelet plus antithrombotic agents (combined antiplatelet and anticoagulant therapy: Combined) was higher than those taking antiplatelet agents only (single antiplatelet therapy: SAPT) or anticoagulant agents only (single anticoagulant therapy: SACT). Multiple logistic regression analysis showed that male sex [odds ratio (OR), 2.670; 95% confidence interval (CI), 1.115 - 6.392; P = 0.027)], hemodialysis (OR, 4.165; 95%CI, 1.572-11.033; P = 0.004), Combined (OR, 10.145; 95%CI, 2.520-40.849; P = 0.001), D-dimer > 1.9 μg/mL (OR, 5.271; 95%CI, 2.327-11.942; P < 0.001), NIHSS ≧ 15 (OR, 4.627; 95%CI, 1.888-11.339;P = 0.001) were associated with the death at the time of hospital discharge. This study shows that the onset of ICH taking Combined is associated with an increased risk of death.
Fall accidents, in which psychotropic polypharmacy is sometimes involved, are serious in medical safety management. We, clinical pharmacists, started to participate in the multi-disciplinary care team for inpatients at the psychiatric unit in Kyoto University Hospital in April 2012. After the patient interview on admission day, we propose a suitable prescription for the proper use of psychotropic drugs. In this study, we investigated the impacts of clinical pharmacy interventions aiming to reduce the psychotropic polypharmacy by evaluating fall accidents during hospitalization. We calculated the dosages of hypnotics, anxiolytics, antipsychotics, antidepressants and antiparkinson agents prescribed at the psychiatry unit in Kyoto University Hospital, as corresponding values, which were diazepam, chlorpromazine, imipramine and biperiden equivalents, respectively, from the computerized electronic records for the period 2011 - 2014. We found a significant reduction in the dosages of long and short-acting hypnotics, anxiolytics, typical antipsychotics (but not atypical antipsychotics) and antiparkinsonian drugs after the introduction of the pharmacist intervention. In contrast, there was a trend toward increased dosages of antidepressants. The numbers of concomitant drugs of each of hypnotics and antipsychotics were decreased significantly. Furthermore, the number of fall accidents reported in the incident reports was decreased to 43-45 from 55 accidents/year after the intervention. These results suggest that clinical pharmacist intervention could contribute to the reduction of the doses used and prevention of polypharmacy in psychotropic drug use, and might be associated with the decrease in the number of fall accidents.
Although mFOLFOX6 and FOLFIRI are both categorized as moderately emetogenic chemotherapies, they may have a different prevalence of chemotherapy-induced nausea and vomiting (CINV). The optimal strategy to prevent CINV remains uncertain when patients receive mFOLFOX6 followed by FOLFIRI. Of 100 clinical cases executed with mFOLFOX6 and FOLFIRI, we retrospectively investigated the contents of prophylactic antiemetic therapy and the incidence of CINV, and evaluated the efficacy of them when the regimen was changed. Addition of aprepitant, change of 5-HT3RA to panolosetron, or an increase of the dose of dexamethasone are defined as the intensification of the prophylactic antiemetic therapy (IAT). Around a half of patients who experienced CINV in mFOLFOX6 had intensified prophylactic antiemetic therapy, but over 60% of them experienced CINV even in FOLFIRI. In order to clearly evaluate the efficacy of IAT, patients were divided into a guideline non-adherent group in which dexamethasone was administered only on Day 1, and a guideline adherent group in which dexamethasone was administered for 3 or 4 days after chemotherapy. Without IAT, the incidence of CINV was significantly increased only by changing chemotherapy from mFOLFOX6 to FOLFIRI (30.8%, 47.6%, respectively, P = 0.048). The incidence of CINV was significantly lower in the guideline adherent group than in the guideline non-adherent group when antiemetic therapy was intensified (25.0%, 81.8%, respectively, P = 0.024). These findings suggest the necessity of IAT and the importance of adhering to the antiemetic guideline concerning the period of dexamethasone administration in patients who receive mFOLFOX6 followed by FOLFIRI.