Official European Society of Oncology Pharmacy Blog
Introduction: An unexpected economic resource should come from a correct management of infusional chemotherapies that are not administrated to patients of cytotoxic drugs takes place in centralized unit of the Hospital Pharmacy. In this work we analyzed the activity of the Management of Returned Chemotherapy.
Material and Methods: The study was carried out from January 2010 to December 2011. In this period patients we have dispensed infusional chemotherapies were 3.118. Over 52.701 therapies, 794 (1.51%) were returned to the pharmacy because not used. In this cases, department staff have fallowed a dedicated procedure in order to alert the pharmacists. For all therapies returned, a Delivery form has to be provided. The pharmacist records in a Returned Chemotherapy Registry data from the therapy (date, department, patient, motivation, drug, dosage) and deletes the scheduled therapy an electronic database. The pharmacist examines the therapy in order to check the correct conversation modalities and degradation’s index of the active compound. The reconstitution or post-dilution chemical and physical stability data were carried out on specific tables for each drug. These data has provided by the manufacturers, but n addition practical stability data are taken from literature and databases. In the eligible cases in which the therapy can be used for another patient, the pharmacists approved the reuse dose in the Registry. Then, the pharmacist puts the data of the reused preparation in a worksheet in order to send the information to the technician. In case of negative outcome of the previous steps, the preparation will be eliminated.
Result and Discussion: The cost of drugs not administrated between 2010 and 2011 is Euros 269.396. The 56.7% of returned therapies were fully or partially recovered for an estimated budget of Euros 205.822. Incidence of returned therapy was calculated for each department in our Hospital. For Oncology Division data show this distribution: Day Hospital (DH) of Penne 3.12%, DH of Pescara 1.86%, DH of Popoli 0.93% and Oncology ward 0.97%. For Hematology Division of Pescara: DH 1.46%, Women’s and Children’s ward 0.66%, Men’s ward 0.56%, Haematopoietic Stem Cell Transplantation Unit 0.49%. The most reused monoclonal antibodies were: rituximab (94%), bevacizumab (76%), cetuximab (64%) and trastuzumab (58%). Some drugs were never used, such as azacitidine and penstostatin.
Conclusion: The role of the pharmacist is crucial to establish if a chemotherapy will be reused or not but may be important collaboration with the staff of Oncology and Hematology. This multidisciplinary team increases the efficiency of economic resources. The institution of day drug therapy involves a reduction of production waste, but also a greater chance of recovery made. Obviously, the result would be more relevant in terms of efficient working in dose-banding with extended infusion stability.
S Massecese, A Costantini, E D Angelo, A Mariotti
ASL of Pescara, Hospital Pharmacy, Pescara, Italy