PHARMAWRITE AT THE 13TH ANNUAL HOPA CONFERENCE
Treatment Considerations in Special PopulationsCompiled for you by PharmaWrite
Presented Mary Mably, RPh, BCOP
University of Wisconsin Health, Madison, WI
- Special populations with cancer—including rural populations, pregnant women, patients with organ dysfunction, amputees, and obese patients, among others—may experience inadequate or suboptimal treatment
- For rural populations, lack of access to care may lead to diagnosis delays and increased morbidity
- For pregnant patients, guidelines recommend that the healthcare team work closely with them to make decisions that assess both fetal and maternal risks
- For obese populations, national guidelines (ASCO, NCCN) have been published to provide dosing recommendations
- Pharmacists can positively improve patient outcomes by increasing their knowledge, awareness, and utilization of evidence-based guidelines and best practices
This session focused on chemotherapy management for special groups, including rural populations, pregnant women, patients with organ dysfunction, amputees, and obese populations. This is an important topic because disparities exist in treatment for these populations vs standard of care in that they may experience inadequate or suboptimal treatment.
Rural populations, for example, are less likely to have access to cancer care, which may cause diagnosis delays and increased morbidity, as well as reduced access to disease specialists, investigational therapies, and/or specialty oral therapies. However, community pharmacists in rural areas can have a positive impact on improving care by improving medication adherence and providing patient counseling, monitoring, and telehealth follow-up. (Thoma 2016).
For pregnant patients, a Canadian evidence-based clinical practice guideline addresses chemotherapy safety and potential teratogenicity in pregnancy. These guidelines recommend that the healthcare team work with the patient to make decisions that assess both fetal and maternal risks (Koren 2013). There is evidence that some chemotherapy may be given relatively safely in the second and third trimesters of pregnancy, particularly when the risk of nontreatment may outweigh the risk of the chemotherapy.
For obese populations, national guidelines have been published to provide dosing recommendations and guidance for treatment. The American Society of Clinical Oncology (ASCO) (Griggs 2012) recommends that full weight-based cytotoxic chemotherapy doses should be used, especially for curative therapy. The National Comprehensive Cancer Network (NCCN) also recommends that actual body weight (for body surface area dosing) be used, especially for curative therapy.
This session summary was prepared by Ginah Nightingale, PharmD, BCOP, a member of the PharmaWrite Oncology Working Group.
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