Authors (including presenting author) :
Cheung PW (1) Wong KM (1) Cheng MY (1) Zhou KR (2)
Affiliation :
(1) Department of Pharmacy, Queen Elizabeth Hospital (2) School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong
Introduction :
In October 2022, a pharmacist led day 15 (D15) tyrosine kinase inhibitor (TKI) clinic was introduced as part of the integrated model or systemic anticancer therapy (IMSACT) clinic. Patients who were newly prescribed with an epidermal growth factor receptor (EGFR)- TKIs will be meeting a pharmacist at treatment day 15 for the management of any adverse drug reaction (ADR). Recent research has shown that most ADRs, predominantly acneiform skin rash, are observed around two weeks (15 days) after treatment initiation. Furthermore, patients who present with acneiform skin rashes generally have better overall survival (OS) and progression-free survival (PFS). Therefore, the management of ADRs has become crucial for patients receiving TKIs.
Objectives :
This study aims to assess the impact of the clinic in the early detection and reduction of ADRs presented in subsequent follow-ups. Primary endpoints include the number of ADR detected and the number of patients requiring treatment modifications due to ADRs. Some of the secondary endpoints include number of referrals due to ADRs, changes in the severities of the ADRs from D15 to the first oncology follow-up.
Methodology :
Patients attended the clinic between October 2022 and March 2023 were recruited in the study. For some of the study endpoints, a historical control group is adopted. Details regarding each consultation were collected retrospectively through the Electronic Patient Record (ePR) platform. Fisher Exact Test will be used for the statistical comparison with historical control.
Result & Outcome :
59 patients attended the D15 TKI clinic, 125 incidents of ADR were reported at day 15, and 12 patients were referred to a doctor by the pharmacist. With the D15 TKI clinic, 50% of patients taking Gefitinib, 94% of patients taking Osimertinib, and 82% of patients taking Erlotinib showed improved or maintained severity of their ADRs. Furthermore, as compared with the historical control, the number of patients requiring treatment modification was decreased by 10%, and unplanned medical attention due to ADR was decreased by 6.7%. To sum up, improvements in the severity of ADRs and better treatment outcomes were observed due to sufficient patient education and prompt management of abnormalities in the D15 TKI clinic. Additionally, reduced preventable hospital admissions could alleviate the hospital burdens and lead to lower operational costs.
