Clear guidelines on oral chemotherapy needed
Current practices around the use of oral chemotherapy in US cancer centres need to be improved, say doctors in a study on bmj.com.
Common malignancies can be treated with oral chemotherapy - a treatment which is increasingly used across the USA and internationally.
Researchers from Boston set out to analyse the guidelines and practices used by comprehensive cancer centres for the provision of oral chemotherapy. Forty-two centres took part in the study. Variations in practice emerged in the prescribing methods, consent requests and the coordination and monitoring of treatment. They found that few of the safeguards which are routinely used for infusion chemotherapy were adopted for oral chemotherapy treatment.
Most of the 42 organisations which took part in the study had no required elements for prescribing oral chemotherapy and few requested patients' written consent for off protocol prescribing. Only one in three organisations required a clinician to note the body surface area or calculation of dose on the prescription, and only one in four required the patients' diagnosis or protocol.
Nearly a quarter of the centres had no formal process for monitoring patients' adherence. In the past year respondents at 10 centres reported at least one serious adverse drug event related to oral chemotherapy and respondents at 13 centres reported a 'serious near miss'.
The authors conclude that "prescribing, monitoring and coordination, pharmacy practices and education of patients for oral chemotherapy vary substantially. Despite clinicians' concerns about oral chemotherapies, there is no apparent consensus among oncology professionals about safe practices for these drugs. The oncology community must define safe medication practices appropriate for oral chemotherapy, develop practice guidelines and accelerate their adoption."