1499P - Evaluation of a clinical decision support system (CDSS) to optimize cytotoxic drug dosing in cancer patients with renal insufficiency

Date 09 October 2016
Event ESMO 2016 Congress
Session Poster display
Topics Supportive Care
Presenter Lisanne Krens
Citation Annals of Oncology (2016) 27 (6): 497-521. 10.1093/annonc/mdw390
Authors L. Krens, M. Damhof
  • Clinical Pharmacy, Ziekenhuisgroep Twente, 7555 BB Hengelo - Hengelo/NL

Abstract

Background

The incidence of renal insufficiency is ever increasing in cancer patients, since patients are getting older and more aggressive treatments become available. For those drugs in which renal excretion is an important determinant of elimination, dose adjustment is often required if renal function is impaired. “CS rules” is a cognitive clinical decision support system (CDSS) designed to assist clinical pharmacists in making dosing decisions for individual patients. Recommendations on chemotherapeutic dosing are consistent with the established guidelines and published evidence.

Methods

From September 2015 until January 2016 a pilot with the CDSS was performed in the ZGT Hospital in the Netherlands. Clinical rules were defined for18 cytotoxic drugs used in our hospital, for which dose reduction is required if renal function is impaired. The CDSS was run overnight and generated alerts on all newly prescribed chemotherapeutics. Alerts were analyzed by the clinical pharmacist. If a dose reduction seemed necessary, the oncologist was contacted by the pharmacist and the necessity of dose reduction was discussed.

Results

During the pilot period a total of 2681 chemotherapeutics were prescribed, the 18 active rules generated 112 alerts. Overall, 18.8 % of the generated clinical alerts resulted in an intervention by the clinical pharmacist about dose reduction. In table 1 a more detailed overview is given for the included cytotoxic drugs and the generated number of alert and interventions.

Detailed overview of number of prescription, alerts and interventions per cytostatic drug

Cytotoxic drug Prescriptions Alerts Interventions
n n %a n %b
Bortezomib 452 14 3.1 4 28.6
Cisplatin 133 27 20.3 5 18.5
Cyclophospamide 482 3 0.62 0 0
Capecitabine 429 22 5.1 4 18.2
Dacarbazine 20 0 0 0 0
Doxorubicin 395 0 0 0 0
Epirubicin 64 0 0 0 0
Etoposide 285 13 4.6 1 7.7
Fludaribine 1 4c 400 0 0
Ifosfamide 0 0 0 0 0
Hydroxycarbamide 0 0 0 0 0
Irinotecan 96 0 0 0 0
Lomustine 0 0 0 0 0
Melphalan 54 0 0 0 0
Mercaptopurine 0 0 0 0 0
Methotrexate 56 16 28.6 0 0
Pemetrexed 214 13 6.1 6 46.1
Procarbazine 0 0 0 0 0
Total 2681 112 4.1 21 18.8

a as a percentage of number of prescriptions

b as a percentage of alerts C 4 alerts were generated after a single prescription of fludarabin

Conclusions

CDSS can effectively be used in daily hospital pharmacy practice to select patients at risk of cytotoxic drug overdose due to renal impairment. The identification of patients at risk helps the clinical pharmacist and oncologist to optimize drug therapy in cancer in patient with renal dysfunction.

Clinical trial identification

Legal entity responsible for the study

ZGT Hospital

Funding

N/A

Disclosure

All authors have declared no conflicts of interest.