Pharmacie clinique en oncologie pédiatrique

T. Bauters UZ Gent, Belgique

Cancer is the second leading cause of death in children, surpassed only by accidents. About 1 child in 650 develops cancer by 15 years of age.

A clinical pharmacist involved in paediatric oncology encounters many challenges. One of the most important problems is the lack of medicines that are licensed for children. Most of the paediatric medicines (50-90%) have not been tested or evaluated and are used off-label or unlicensed. This increases the risk of adverse effects, inefficacy,... Furthermore, there are some aspects of pharmacy practice that are particularly challenging or specific to the paediatric population, e.g. palatability of medicines, dosing frequency, compounding aspects, smaller volumes,…

The benefits and responsibilities of a clinical pharmacist are well described in literature. They interact with the patient (or parents) to optimize pharmacotherapy, safety, adverse drug events and safe handling ; with the multidisciplinary team (drug information, guidelines, training, education) and with the community (pharmaco-economics). Due to the specialized skills needed in paediatric oncology, additional training in chemotherapy, haematology and oncology on a national level is required, but -so far- however, is still lacking.

At the Paediatric Hemato-Oncology Department of the Ghent University hospital, a clinical pharmacist is involved in patient rounding, process improvement and acts an integral part of a larger medical team. He/she contributes to the knowledge of therapeutic drug monitoring, pain management, management of adverse events, education of nurses, medical and pharmacy students,… Drug safety monitoring to prevent paediatric medication errors remains an essential task.

Although physicians have a good knowledge of pharmacotherapy in the field of paediatric oncology, pharmacy interventions are necessary to enhance the quality of prescribing. So far, different types of interventions include : provision of information (26%), clinical interventions (68%), provision of a specific product (4%), and identification of a process fault (2%). The overall degree of acceptance is 95.3%. These results highlight the clinical importance of the pharmacist in optimizing drug therapy. It must be mentioned that the pharmacist still remains involved in daily routine pharmacy practices, which enhances the liaison function with the ward.

In conclusion : a clinical pharmacist with extra expertise in paediatric oncology might have a positive impact on prescription behaviour and consequently, on patient care. With the advent of decentralised pharmacy services, the clinical pharmacist provides a unique set of skills to encourage a safe and rational pharmacotherapy in the field of paediatric oncology.

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