Empathic communication between medical professionals and patients plays a crucial role in improving medication adherence; however, few studies have examined this relationship among community pharmacists. In this study, we conducted a self-administered questionnaire survey targeting community pharmacists and their regular patients at eight pharmacies in Osaka, Japan. The survey focused on the empathy shown by pharmacists during medication counseling and its association with patients’ medication adherence. Although no significant correlation was found between patient-assessed empathy and medication adherence, empathy scores (40.04 vs 33.83) and medication adherence scores (49.94 vs 45.17) were significantly higher among patients who rated their satisfaction with medication instructions as the highest. Furthermore, pharmacists’ self-assessed empathy was negatively correlated with medication adherence (Spearman’s Rs = –0.29). These findings indicate that while empathic communication by community pharmacists may improve medication adherence through related factors, it may not be effective for all patients.

Machine-assisted support for dispensing practice may be effective in promoting task shifting and sharing of pharmacists’ practice with non-pharmacists. In April 2022, Mie University Hospital implemented the robotic picking system Drug Station^® (DS) to prevent verification errors for picking medications in the dispensing practice. This study examined the error rates, underlying factors related to the accuracy of pharmacists and non-pharmacists in picking oral and topical medications, and incident occurrence rates before and after DS implementation. The study period was divided into three periods: 4 months immediately before DS implementation (Group A), 4 months immediately after DS implementation (Group B), and 5 – 8 months after DS implementation (Group C). The DS usage rate for all prescriptions was 77.1％ in Group B and 81.3％ in Group C. The number of prescriptions picked by the non-pharmacists increased by approximately 2.4 times in Groups B and C compared with Group A. The error rates in picking medications decreased significantly from 1.01％ in Group A to 0.36％ in Group B (P = 0.0025) and 0.29％ in Group C (P = 0.0043). Regarding the self-reported influencing factor for non-pharmacists, “failure to verify” accounted for 90.7％ in Group A, whereas the percentages in Groups B and C were 51.6％ and 60.0％, respectively. Incident reports due to incorrect drugs, specifications, and picking amounts were lower in Groups B and C than in Group A. These findings suggest that DS supports accurate picking of oral and topical medications by non-pharmacists, facilitating task shifting from pharmacists to non-pharmacists.

Weight loss following chemotherapy initiation may reduce treatment tolerance and decrease survival duration. The association between weight loss and survival outcomes after FOLFIRINOX (FFX) therapy remains limited. This retrospective study investigated the impact of 5％ < weight loss (2％ < weight loss for patients with BMI < 20) 1 month after starting FFX therapy as the first-line treatment for unresectable advanced or recurrent pancreatic cancer. Among the 65 patients, 33 (50.8％) experienced weight loss 1 month after initiating FFX therapy. Patients with weight loss had significantly shorter overall survival, with a median overall survival (mOS) of 216 days compared with 384 days in patients without weight loss (P = 0.006). Similarly, validation using propensity score matching confirmed that weight loss was associated with shorter survival, with a mOS of 258 days compared with 512 days in patients without weight loss (P = 0.035). These findings indicate that early weight loss 1 month after FFX therapy initiation may be a predictor of shorter survival, underscoring the importance of implementing early interventions to manage weight loss alongside FFX treatment.

The prevalence of malignant tumors is increasing in patients undergoing dialysis. This report elucidates the case of a female patient in her 70s undergoing dialysis with synchronous double cancer involving breast cancer (pStageⅡA) and small bowel adenocarcinoma (pStageⅣ). The patient was diagnosed with hormone receptor-positive breast cancer and treated with letrozole. For small bowel adenocarcinoma, the patient received sLV5FU2 regimen as the first-line treatment and mFOLFOX6 therapy as the second-line treatment. After consultation with the doctor and pharmacist, letrozole was administered at the standard dose, whereas 5-fluorouracil (5-FU) and oxaliplatin were reduced to 80％ and 70％ of the dose, respectively. Dialysis was performed on the day before administration and on Days 2 and 4 for sLV5FU2 and mFOLFOX6 therapies. During the treatment period, the treatment was not interrupted because of myelosuppression, and adverse events were controlled at Grade 2 or lower for 20 months.

Early assessment of nutritional status and maintenance of body weight, individualized design of drug dosing, and coordination of dialysis and drug administration dates are important for patients undergoing chemotherapy for synchronous double cancer involving breast cancer and small bowel adenocarcinoma, such as the patient in this case.

To date, no study has reported a program in which people can learn about clinical research in “HIRAMEKI☆TOKIMEKI Science.” This program focused on one problem in clinical practice: skin damage caused by anticancer drug therapy. Participants analyzed the factors leading to serious skin damage using simulated data and studied the concept and methods used in clinical research. Out of the 16 high school students who participated, 15 completed the questionnaire. Because of the questionnaire, when asked “How was today’s program?” nine students answered “Very interesting” and six answered “Interesting.” When asked “Was today’s program easy to understand?” six students responded “Very easy to understand,” whereas nine responded “Easy to understand.” When asked “Have you become more interested in science?” nine students answered “Became very interested,” and six answered “Gained some interest.” Furthermore, when participants were divided into groups by reason for participating and compared with other questionnaire items, the results revealed that, in response to the question “Have you become more interested in science?” the scores for “Because I was interested in the program content” were significantly higher than those for “Because my teacher or parents recommended it.” The participating students showed interest in the clinical research program. We believe that the difficulty level was appropriate for this population; therefore, offering similar programs for high school students is feasible in the future.

Dose reduction owing to neutropenia is frequently required during palbociclib treatment for metastatic breast cancer. In this study, we investigated the risk factors associated with early palbociclib dose reduction and its impact on treatment efficacy in Japanese patients. Patients who received palbociclib were classified into two groups based on whether dose reduction occurred within the first 56 days of treatment. The background characteristics and time to treatment failure (TTF) were compared between the two groups. Out of the 68 patients included in the analysis, 37 (54％) required early dose reduction. Multivariate logistic regression analysis identified the co-administration of proton pump inhibitors or potassium-competitive acid blockers (odds ratio [OR]: 3.33, 95％ confidence interval [CI]: 1.08 – 10.30, P = 0.036) and a baseline neutrophil count <3,779/μL (OR: 3.14, 95％ CI: 1.09 – 9.08, P = 0.034) as significant factors associated with early dose reduction. The median TTF was 15.6 months in the early dose reduction group and 7.6 months in the standard dose group, with no statistically significant difference observed (P = 0.627). Because early dose reduction does not affect the therapeutic efficacy of palbociclib, these findings suggest that palbociclib treatment should be continued by appropriately implementing dose interruptions or reductions in accordance with standard protocols for managing neutropenia.

Proteinuria is one of the side effects to be monitored in patients receiving cabozantinib. Identifying the risk factors for its development is crucial for its early detection. Therefore, in this retrospective study, we reviewed the medical records of patients with renal cell carcinoma who received cabozantinib at Tokai University Hospital between May 2020 and December 2023, with the aim to investigate the risk factors associated with urinary protein expression in patients with renal cell carcinoma receiving cabozantinib. To identify the predictors of proteinuria ≥ grade 2, we compared the baseline characteristics at cabozantinib initiation between the two patient groups: those with proteinuria < grade 2 and those with proteinuria ≥ grade 2. Univariate analysis was performed to assess potential risk factors, and variables with P < 0.1 were further analyzed using multivariate logistic regression to calculate odds ratios (OR) and 95％ confidence intervals (95％ CI). Among the 37 participants, 12 (32.4％) developed grade 2 proteinuria. The univariate analysis showed significant differences in risk factors between diabetes medication use (P = 0.016) and baseline proteinuria grade 1 (P = 0.006) cohorts. The multivariate analysis further confirmed a significant increase in proteinuria ≥ grade 2 development in the diabetes medication use (OR: 17.50, 95％ CI: 1.41 – 218.00, P = 0.026) and baseline proteinuria grade 1 (OR: 10.40, 95％ CI: 1.63 – 67.10, P = 0.013) groups. These findings indicate that patients with risk factors at the start of cabozantinib treatment should be carefully monitored to facilitate early detection.

The pharmaceutical traceability system has been reported to be effective for managing high-cost drugs that require refrigeration. In our hospital, Cubixx^® and NOVUMN^® were introduced to reduce the inventory management burden and minimize drug loss. We evaluated the workload reduction by analyzing the emergency order rate before and after the implementation of Cubixx^® and NOVUMN^®. Furthermore, the economic impact was assessed by examining the return of high-cost drugs following their introduction. For drugs stored in refrigerators equipped with Cubixx^® or NOVUMN^®, the emergency order rate was 9.8％ in the 12 months before their implementation. In contrast, the emergency order rate decreased to 1.2％ in the 12 months following their introduction. However, their implementation increased the number of other tasks associated with inventory management, particularly in the handling of returned drugs. Within the 12 months after implementing them, 17 items and 90 units of drugs stored in these refrigerators were returned, resulting in a total refund of approximately 12,000,000 yen. Although the amount of drug loss remained unchanged during the first 12 months after implementing the traceability system because the newly purchased drugs had not yet expired, we expect that drug loss will decrease in the future. In conclusion, although the pharmaceutical traceability system may not be definitively effective in reducing workload, it contributes to drug loss prevention. The number of drugs that can be managed using the traceability system increases with the use of two distinct systems, which has the advantage of having a greater economic impact.

The prevalence of osteoporosis is increasing, and bisphosphonate (BP) medications are widely used for its treatment. Oral BP drugs carry the risk of esophageal ulcers, which can be mitigated by following the proper administration guidelines. However, cases of oral ulceration caused by misuse, such as chewing of tablets predominantly comprising alendronate sodium, have been reported globally. Herein, we report the first case of oral ulceration attributed to the misuse of sodium ibandronate.

A 92-year-old woman presented with multiple oral erosions and was hospitalized because of poor oral intake and limited mobility. The patient was on no other medication except analgesics. During an interview, she revealed her long-standing habit of crushing tablets before ingestion. The clinical history and medication use strongly suggested that the oral ulceration was caused by sodium ibandronate. Additionally, a PILL-5 assessment indicated moderate-to-severe difficulty in swallowing (score: 17). The patient’s condition improved with supportive care after discontinuing oral BP therapy, leading to pain relief, improved food intake, and discharge.

This case highlights the need for regular follow-ups to monitor medication adherence and prevent improper administration.