Commonly, striking a balance between the risks and benefits of cancer chemotherapy for malignant tumor is important. Avoiding or reducing cancer chemotherapy-induced adverse reactions can increase the benefits of chemotherapy. This increase maintains patients’ quality of life and prevents the discontinuation or dose reduction of cancer chemotherapy. Pharmacists can conduct clinical pharmacy researches aimed at avoiding or reducing cancer chemotherapy-induced adverse reactions and transfer clinical questions to research questions in clinical practice. This review focuses on cancer chemotherapy-induced nausea and vomiting (CINV) as well as venous pain. In recent years, there has been remarkable development in antiemetic treatment, which has resulted in abundant evidence on CINV prophylaxis and multiple national and international guidelines on antiemetic use. However, clinicians or researchers frequently overlook cancer chemotherapy-induced venous pain as it does not directly affect the treatment continuation of patients. Consequently, there is scarce evidence on countermeasures of venous pain with no supportive therapy such as antiemetics, antibiotics, and granulocyte-colony stimulating factor formulations. Taken together, this review describes the clinical questions encountered by pharmacists on current issues of CINV and gemcitabine-induced venous pain, as well as outcomes driven from clinical pharmacy researches led by pharmacists because clinical questions translate to clinical pharmacy researches aimed at avoiding or reducing CINV, and gemcitabine-induced venous pain in a clinical setting.

Nivolumab has a period to determine the therapeutic effect, and the first therapeutic effect is evaluated by the sixth dose. Several studies have indicated that the neutrophil-lymphocyte ratio (NLR) is a predictor of efficacy. These studies reported that patients with low levels of NLR had shown favorable therapeutic responses. The continuous administration of levothyroxine may be essential after the development of nivolumab-induced hypothyroidism; therefore, the elucidation of predictors associated with the development of hypothyroidism will be helpful during nivolumab treatment. This study investigated whether the NLR at the sixth dose of nivolumab could be applied as a management index in the patients who received six or more doses of nivolumab to predict the occurrence of hypothyroidism. Of the 90 patients treated with nivolumab, those (36％, n = 47) who received six or more doses of nivolumab had a significantly higher incidence of hypothyroidism than those (9％, n = 42) who received less than six doses (P < 0.01). However, the incidence of hypothyroidism did not increase based on the cumulative dose. Among 47 patients who received nivolumab six or more times, the incidence of hypothyroidism (44％) in patients with NLR < 5 was significantly higher than the incidence (9％) in patients with NLR ≥ 5 (P < 0.05). The deterioration of thyroid function needs to be monitored because patients with low levels of NLR (less than 5) at the sixth dose are more prone to developing hypothyroidism.

Currently, checking the use of unapproved pharmaceuticals is required. Similarly, checking the use of contraindicated drugs is also necessary. We used a system to check the contraindications for the combined use of drugs for pregnant women and patients with allergies prior to prescription. Recently, we established a management structure involving the combination of a mechanical check system and subsequent pharmacist confirmation of contraindications for clinical conditions. In this study, we assessed the usefulness of this system. For one year, 41,431 contraindications for patients were mechanically extracted, and 24,861 contraindications were manually identified by pharmacists. These checks led to 51 prescription inquiries by pharmacists to doctors and to the modification of 18 prescriptions. Assuming that all unchanged prescriptions may have caused adverse events, the cost reduction was estimated to be 4,713,830 yen from a medically economic perspective. The combination of comprehensive automatic checks by the mechanical system and subsequent manual confirmation by pharmacists is beneficial for the management of contraindications and is expected to reduce the costs from a medically economic perspective.

In this practical research, we assessed the effectiveness of “Protocol-based Pharmacotherapy Management” (PBPM) by community pharmacists and the Nagasaki University Hospital with the cooperation of the Nagasaki Pharmaceutical Association and Nagasaki City Pharmaceutical Association. This study was implemented from July 1 to December 15, 2018. We targeted outpatients prescribed anticancer drugs (the combination drug tegafur/gimeracil/oteracil (S-1) or capecitabine) from Nagasaki University Hospital. Community pharmacists confirmed the presence of adverse reactions in patients by follow-up phone calls throughout the medication period or drug withdrawal period, and reported patients’ situation to their attending doctors according to the protocol. Telephone support by community pharmacists was provided to 17 and seven patients for S-1 and capecitabine, respectively. The number of telephone support times was 45 (2.9 times per patient) and 20 (2.7 times per patient) for S-1 and capecitabine, respectively. There were several instances of adverse skin reaction and whole-body weariness, and hand-foot syndrome was confirmed with a particularly high frequency. Community pharmacists followed compliance with recommended methods of skin care and the usage of prescribed medications. The telephone support for patients included “extension of the drug withdrawal period for S-1” and “reduction of the dosage of capecitabine”, which contributed to the safe discontinuation of drug treatment. This report is a valuable study that indicates PBPM between community pharmacists, hospital pharmacists and medical doctors through cooperation between key hospitals and regional pharmaceutical associations effectively achieved seamless medical cooperation.

Telephone consultation is an important communication process with patients in community pharmacy. The analysis of the telephone consultation contents provides us with consideration of the problem of medical instruction at community pharmacies. In this study, we investigated the contents of telephone consultations at Gifu Pharmaceutical University Pharmacy and discussed medication instruction at the pharmacy considering the information from telephone consultations. A total of 217 telephone consultations over 4 years were investigated. Patients in a wide range of ages experienced telephone consultations and no gender difference was observed. Although a wide array of drugs was considered in telephone consultations, the consultations about the medicine for cardiovascular diseases were frequently experienced. We also investigated the detailed contents of telephone consultations. In the consultations, ‘side effects / drug-drug interactions’, ’whether it can be taken or used together’ and ‘taking or usage method’ were major topics. In many cases, patients’ lack of understanding led to the consultations, although inefficient explanation by pharmacists also caused the consultations in some cases such as sheet design changes.

Taken together, the investigation of the telephone consultations showed the difficulty of providing precise explanations about the details of drug administration to the patients. This study also showed that the analysis of telephone consultations is useful for finding improvements of medication instruction at a community pharmacy.

Several hospitalized patients have a history of medication use; consequently, there are numerous reports on the importance of pharmacists managing their own medications. Conversely, there is a lack of information about the status of patients’ medication adherence. Therefore, we collected data on medicines brought to hospital by inpatients and investigated their medication compliance status. The medication compliance status of patients visiting the Kokuho Chuo Hospital from April 2017 to March 2018 was investigated using the identification sheets of medicines brought by these patients and patients’ medical records. The number of differentiations of medicines brought to the hospital by inpatients was 1,080, and the details of 889 medicines were used in this study. The average number of medicines brought per patient was 5.6 ± 3.5, with elderly patients bringing more medicines and exhibiting a low medication compliance. Compliance with antibiotics, chemotherapeutics, and oncology drugs was good, whereas that of vitamins, peripheral nervous system agents, and drugs for treating sensory organ issues was poor. The cost of medication per patient among non-adherent patients was approximately 3,836 ± 11,078 yen, amounting to a total cost of 3,409,914 yen. The medication compliance status inferred from this study was worse among elderly patients as well as for medicines used to treat chronic diseases. Pharmacists can provide appropriate drug treatments and contribute toward reducing healthcare costs by increasing awareness regarding the family pharmacist system and improving cooperation between community pharmacies and hospitals to improve polypharmacy and medication adherence.

Despite the bioequivalence of brand-name and generic drugs, some patients have complained about diminished efficacy after consumption. We administered brand and generic name constructs for loxoprofen sodium hydrate to patients in a variety of forms, including tablets and powder. We used the visual analog scale (VAS) to investigate and examine whether efficacy differences were attributed to the drug action or to a placebo effect. The responses of the 5 patients that entered this study showed different results when the brand-name and generic drugs were taken in a state where they could be distinguished from each other, and the VAS change when they were indistinguishable. In particular, three patients yielded large VAS differences when they consumed the brand-name and generic drugs in the form of tablets, but the VAS change was smaller when the drug was pulverized and consumed in powder form. This study suggests that there is no difference in the actual efficacy between the brand-name and the generic drug forms, and that any noted differences are likely attributed to a placebo effect. The placebo effect has positive or negative effects owing to various factors. As healthcare professionals, we must strive to maximize the therapeutic effects.

In the Amami archipelago, we have established a system to introduce telephone re-examination at Oshima Hospital and support an insurance pharmacy. When a new coronavirus patient occurred on the island, 15 out of 32 facilities (47％) in the Amami Oshima Insurance Pharmacy were able to handle corona-compatible prescriptions. After 14 days, all the pharmacies in Amami Oshima had responded by telephone, and the local pharmacist association played an important role in establishing the system.