Abstract 1167
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.