Journal of Oncology Pharmacy Practice最新文献

{"title":"Development and internal validation of a clinical prediction model for 90-day clinically significant medication-related harm in adults initiating oral anticancer therapy: A multicenter prospective cohort study.","authors":"Vivek Jayan, Sankiya M, Sudhakar S, Hana Zaiba Z, Aiswarya Lily Ray, Rakesh M","doi":"10.1177/10781552261485454","DOIUrl":"https://doi.org/10.1177/10781552261485454","url":null,"abstract":"<p><p>IntroductionOral anticancer therapy shifts substantial responsibility for medication administration, interaction management, toxicity recognition, and adherence to patients and outpatient teams. We aimed to quantify early clinically significant medication-related harm and develop an internally validated model to estimate individual 90-day risk at treatment initiation.MethodsA multicenter prospective inception cohort enrolled 610 adults initiating a new oral anticancer therapy across four tertiary oncology centres during 2024-2025. The primary outcome was first clinically significant medication-related harm within 90 days. Thirteen prespecified predictor parameters were entered into a Cox proportional-hazards model. Internal validation used 1000 bootstrap resamples with uniform coefficient shrinkage and baseline-survival recalibration. Discrimination, calibration, Brier score, internal-external centre validation, and decision-curve analysis were evaluated.ResultsDuring 45,048 person-days, 137 participants experienced harm. The Kaplan-Meier estimated 90-day risk was 22.9% (95% CI 19.7-26.5), and median time to first harm was 25 days (IQR 14-39); 60.6% of events occurred by day 30. Higher ECOG performance status, Charlson Comorbidity Index, organ-dysfunction severity, baseline clinically significant drug-drug interactions and medication-regimen complexity were associated with greater hazard, whereas higher health literacy was protective. The optimism-corrected C-index was 0.701, 90-day AUC 0.735 and Brier score 0.157. The shrinkage factor was 0.867. At the illustrative 20% risk threshold, sensitivity was 78.8%, specificity 60.8% and negative predictive value 90.6%.ConclusionsClinically significant medication-related harm was common and concentrated early after initiation of oral anticancer therapy. A model based on routinely available baseline clinical and medication factors provided moderate discrimination and useful risk stratification after internal validation. Independent external validation is required before clinical implementation.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"10781552261485454"},"PeriodicalIF":1.3,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal comparison of serum creatinine, estimated glomerular filtration rate, and blood urea nitrogen-to-creatinine ratio after initiation of palbociclib or abemaciclib: A single-center retrospective study.","authors":"Yuichi Koizumi, Masanori Fujitani, Yuki Nishii, Takaki Tsunoda, Takuya Kamio, Shunji Ishiwata","doi":"10.1177/10781552261488583","DOIUrl":"https://doi.org/10.1177/10781552261488583","url":null,"abstract":"<p><p>IntroductionAbemaciclib inhibits renal tubular creatinine secretion and can increase serum creatinine without a true reduction in glomerular filtration rate. Direct real-world comparisons with palbociclib using routinely available laboratory markers are limited.MethodsWe conducted a single-center retrospective study of 56 women with advanced or recurrent hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer who initiated palbociclib (n = 29) or abemaciclib (n = 27). Data from January 1, 2018, to June 30, 2026, were extracted. Serum creatinine, creatinine-based estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), and the BUN/creatinine ratio were evaluated at baseline and Days 14, 28, 42, and 56 using adjusted generalized estimating equations.ResultsDrug-by-time interactions were significant for serum creatinine (<i>P</i> = 0.004), eGFR (<i>P</i> < 0.001), and the BUN/creatinine ratio (<i>P</i> = 0.001), but not BUN (<i>P</i> = 0.080). At Day 14, the adjusted between-group difference in change (abemaciclib minus palbociclib) was 0.180 mg/dL for serum creatinine and -11.4 mL/min/1.73 m² for eGFR. The BUN/creatinine ratio difference was not significant at Day 14 but was significant at Days 28 (-5.12), 42 (-4.11), and 56 (-3.83). Sensitivity analyses yielded consistent interaction results.ConclusionsAbemaciclib showed greater and more persistent changes in serum creatinine, creatinine-based eGFR, and the BUN/creatinine ratio than palbociclib. Serial BUN and BUN/creatinine ratio measurements may provide supportive context for creatinine elevations but cannot exclude true kidney injury.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"10781552261488583"},"PeriodicalIF":1.3,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncovering drug-related problems in hospitalised cancer patients and their association with hospital readmission: A prospective study at South Kerala.","authors":"Gopika Roshin, Nisam Meladath, Gayathri Roshin","doi":"10.1177/10781552261487990","DOIUrl":"https://doi.org/10.1177/10781552261487990","url":null,"abstract":"<p><p>BackgroundDrug-related problems (DRPs) are common among cancer patients owing to complex chemotherapy regimens, polypharmacy, narrow therapeutic indices, and treatment-related organ dysfunction.ObjectiveTo determine the prevalence, types, and causes of DRPs among hospitalised adult cancer patients and whether DRPs were independently associated with 30-day all-cause hospital readmission.MethodsA prospective observational study was conducted over 12 months in the medical oncology and haematology-oncology wards of a tertiary care teaching hospital. Adults (≥18 years) with confirmed malignancy receiving antineoplastic or supportive-care medication were enrolled consecutively. DRPs were identified using the Pharmaceutical Care Network Europe (PCNE) Classification System V9.1 through chart review, medication reconciliation, and ward rounds. Patients were followed for 30 days after discharge. Multivariable logistic regression was used to identify factors independently associated with 30-day readmissionResultsOf 412 enrolled patients, 386 completed follow-up. At least one DRP was identified in 268 patients (69.4%), with 517 DRPs overall (mean 1.9 ± 1.2 per patient). Treatment effectiveness (38.5%) and treatment safety (33.7%) were the most frequent categories. Thirty-day readmission occurred in 71 patients (18.4%). On multivariable analysis, ≥2 DRPs (adjusted OR 3.42, 95% CI 1.87-6.26), polypharmacy (≥5 medications; adjusted OR 2.15, 95% CI 1.18-3.92), ECOG performance status ≥2 (adjusted OR 2.61, 95% CI 1.34-5.09), and major drug interaction (adjusted OR 1.98, 95% CI 1.02-3.86) were independently associated with readmission.ConclusionDRPs were highly prevalent among hospitalised cancer patients and independently associated with 30-day readmission. Pharmacist-led medication review warrants evaluation in future intervention studies.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"10781552261487990"},"PeriodicalIF":1.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of psychosocial determinants on chemotherapy-induced nausea and vomiting and its association with health-related quality of life among gastrointestinal cancer patients.","authors":"Chaitrashree Gururaj, Sarah Andrea Soans, Sindhoora Rao K, Sphoorthy Ramesh, Sneha Satheesh, Vijith Shetty, Shraddha Shetty","doi":"10.1177/10781552261487601","DOIUrl":"https://doi.org/10.1177/10781552261487601","url":null,"abstract":"<p><p>BackgroundChemotherapy-induced nausea and vomiting (CINV) remain a significant challenge for cancer patients, including those with gastrointestinal (GI) cancer, with negative impact on quality of life (QoL). This study aims to determine the relationship of psychosocial determinants with CINV and its impact on health-related quality of life (HR-QoL) among patients diagnosed with Gastrointestinal cancer.MethodologyA prospective observational study was conducted for six months among 80 GI cancer patients meeting the inclusion criteria, in the in-patient Department of Oncology of a tertiary care hospital. Before chemotherapy, the Distress Thermometer (DT) was used to assess emotional distress, and the Mini-Mental Adjustment to Cancer (Mini-MAC) scale was used to assess coping style. Participants were then followed up via phone call for five days after chemotherapy to record CINV. Functional Living Index for Emesis (FLIE) was used to assess the impact on CINV-related QoL.Results and DiscussionPatients who experienced CINV (47.5%) reported significant emotional distress, while those without CINV (52.5%) did not. When assessing coping styles, the Mini-MAC dimensions of Cognitive Avoidance (CA) and Anxious Preoccupation (AP) were significantly associated with vomiting (p < 0.05). Additionally, all Mini-MAC dimensions, including Hopelessness/Helplessness (H), Anxious Preoccupation (AP), Fighting Spirit (FS), Cognitive Avoidance (CA), and Fatalism (F), were significantly associated with nausea (p < 0.05). However, coping mechanisms were found to have no statistical significance with CINV-related QoL. On multivariable analysis adjusting for age, gender, cancer stage, surgery, radiation therapy, and chemotherapy emetogenicity, none of the Mini-MAC domains remained independently associated with nausea, suggesting that the univariate associations may be substantially explained by clinical and treatment-related factors.conclusionUnivariate associations between psychosocial determinants and CINV were observed, particularly for nausea, but these did not persist after adjusting for clinical and treatment-related factors. These findings should therefore be regarded as exploratory and hypothesis-generating rather than evidence that psychosocial assessment independently identifies patients at risk of CINV. Larger, adequately powered studies with multivariable adjustment are needed to confirm whether psychosocial coping style contributes independently to CINV risk and to inform the potential development of interventions to reduce the emotional burden of cancer and its treatment.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"10781552261487601"},"PeriodicalIF":1.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI adoption among French oncology pharmacists: A national survey.","authors":"Wakil Azouza, Régine Chevrier, Jean-François Tournamille, Bertrand Pourroy","doi":"10.1177/10781552261485826","DOIUrl":"https://doi.org/10.1177/10781552261485826","url":null,"abstract":"<p><p>BackgroundLarge language model (LLM)-based generative artificial intelligence (AI) tools have rapidly entered clinical practice. In oncology pharmacy, a specialty marked by high technical complexity, strict regulatory constraints, and an expanding clinical role spanning cytotoxic compounding, antineoplastic prescription validation, clinical pharmacy activities (medication reconciliation, pharmaceutical consultations, patient education), and advanced therapy medicinal product management, AI adoption carries specific risks and opportunities that remain poorly documented, and no national data exist for France. No national survey has characterized AI knowledge, use, or professional expectations among French oncology pharmacists.MethodsCross-sectional, anonymous web-based survey of French Society of Oncology Pharmacy (SFPO) members, conducted from March 30 to April 26, 2026. The 23-item questionnaire covered respondent profile, AI knowledge and tool awareness, current use and institutional framework, task-specific priorities and expectations, and barriers and governance needs. Descriptive statistics were applied to quantitative items; open-text responses underwent thematic coding.ResultsOf 374 SFPO members, 78 responded (response rate 20.9%; completion rate 71.8%, n = 56), predominantly senior pharmacists (92.2%) in public hospitals (75.3%), with 41.6% reporting more than 10 years of oncology experience. AI adoption was nearly universal (94.7%); 50.7% used a tool at least several times weekly. However, 65.3% operated within a shadow AI framework, while only 17.3% had access to fit-for-purpose validated tools. Email and administrative management dominated, cited by roughly 40% in the open-text time-allocation item and ranked first in the weighted prioritization exercise (weighted score 6.05; 26.2% ranking it first). The primary expectation was time savings on repetitive tasks (83.9%). Key barriers were the fear of erroneous outputs, in particular hallucinations (64.3%) and concerns over patient data confidentiality (62.5%; mean security concern score 3.21/4). A governance charter was supported by 96.4% of respondents, and 98.2% expressed interest in SFPO-organized specialty-specific training.ConclusionsAI adoption among French oncology pharmacists is already extensive but almost entirely unregulated, creating a critical governance gap with direct patient safety implications. The data reveal a pragmatic, specialty-specific demand for validated use-case libraries, integrated tools, and institutional governance frameworks. Governing this transition is an urgent task for hospital administrations and learned societies alike.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"10781552261485826"},"PeriodicalIF":1.3,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prioritizing quality of life over thrombotic risk: Thromboprophylaxis in multiple myeloma - an interview study.","authors":"C Codreanu, T D Siezen, W W H Roeloffzen, H A M Kooistra, K Meijer","doi":"10.1177/10781552261485966","DOIUrl":"https://doi.org/10.1177/10781552261485966","url":null,"abstract":"<p><p>IntroductionMultiple myeloma (MM) is associated with an increased venous thromboembolism (VTE) risk despite the existence of current thromboprophylaxis guidelines. Although most patients have an indication for low-molecular-weight heparin (LMWH) based on additional risk factors for VTE, aspirin is still widely prescribed as thromboprophylaxis in newly diagnosed patients with MM. It is unclear why current guidelines are not implemented in daily practice. This qualitative interview study aims to identify which factors influence the choice of thromboprophylaxis in MM.MethodsFifteen Dutch physicians experienced in treating patients with MM were interviewed about the factors influencing their choice of thromboprophylaxis. We conducted semi-structured individual interviews. Participant inclusion was discontinued after reaching data saturation. We performed a thematic analysis using an inductive approach. The findings are reported according to the Consolidated Criteria for Reporting Qualitative Research.ResultsThree main themes influencing MM thromboprophylaxis were identified. The first theme, \"Perception of Patient Experience\", indicated that physicians perceive LMWH as a significant burden for patients. The second theme, \"Thrombotic Risk Appraisal\", describes how the VTE risk is often underestimated in clinical practice. The third theme, \"Medical System-Level Constraints and Enablers\", highlights how automatic aspirin prescription and the need for clearer guideline recommendations on direct oral anticoagulants (DOACs) influence decision-making.ConclusionThe preference for aspirin thromboprophylaxis may be explained by physicians prioritizing patient quality of life, underestimation of VTE risk, and the influence of current guidelines and hospital systems. From a physician's perspective, DOACs could offer a good solution as they represent a potential patient-friendly alternative. However, robust comparative evidence regarding their efficacy and safety is lacking. This study underscores the urgent need for large observational studies or randomized controlled trials evaluating DOACs in MM to guide patient-appropriate thromboprophylaxis in clinical practice.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"10781552261485966"},"PeriodicalIF":1.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral anticancer drug administration in older adults: A review of galenic challenges, medication-related risks, and future pharmaceutical perspectives.","authors":"Sara Hajjaj, Ali Cherif Chefchaouni, Safae Alaoui, Seham El Deeb, Soufiane El Marrakchi, Badreddine Moukafih, Fatima-Zahra Bandadi, Younes Rahali, Abdeslam El Kartouti, Ismail Bennani","doi":"10.1177/10781552261486723","DOIUrl":"https://doi.org/10.1177/10781552261486723","url":null,"abstract":"<p><p>ObjectiveTo review the challenges associated with oral anticancer drug administration in older adults, focusing on dysphagia, dosage-form manipulation, medication-related risks, acceptability, and oncology-specific safety considerations.Data SourcesA narrative literature review was conducted using PubMed, Scopus and ScienceDirect. Publications from January 2000 to March 2026 were identified using keywords related to geriatric oncology, dysphagia, oral dosage forms, dosage-form manipulation, oral anticancer agents, medication safety, acceptability, and hazardous drugs. Review articles, original studies, professional recommendations and regulatory documents were included.Data SummarySwallowing disorders are common among older adults with cancer and may compromise oral anticancer therapy administration. Dosage-form manipulation practices, including tablet crushing and capsule opening, are frequently used despite their potential effects on drug stability, bioavailability, pharmacokinetics, and therapeutic efficacy. These concerns are amplified by the narrow therapeutic index of many oral anticancer agents and the risk of occupational, caregiver, and environmental exposure to hazardous drugs. Available evidence reveals gaps in standardized administration procedures and limited data supporting alternative administration strategies. A review of selected oral anticancer agents showed substantial variability in formulation constraints, manipulation practices, and supporting evidence. Emerging approaches, including dispersible and orodispersible formulations, multiparticulate systems, mini-tablets, and three-dimensional (3D) printed medicines, may improve treatment acceptability and reduce inappropriate dosage-form manipulation.ConclusionsDysphagia and dosage-form manipulation remain underrecognized challenges in geriatric oncology, with implications for treatment safety, efficacy, adherence, and hazardous-drug exposure. Addressing these issues requires multidisciplinary collaboration, standardized procedures, patient-centered formulation design, and further research to support evidence-based practice.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"10781552261486723"},"PeriodicalIF":1.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing intravenous chemotherapy administration safety using parameterised smart infusion pumps: A one-year practice implementation.","authors":"Konstantinos Ioannidis, Ioannis Scarlatinis, Katerina Nikolaou","doi":"10.1177/10781552261486712","DOIUrl":"https://doi.org/10.1177/10781552261486712","url":null,"abstract":"<p><p>ObjectiveTo standardise intravenous antineoplastic administration and reduce administration-phase discrepancies by implementing parameterised smart infusion pumps supported by a clinical pharmacist- governed drug library.Data SourcesPump alert logs and structured clinical pharmacist records of administration discrepancies collected during routine care over 12 months following go-live.Data SummaryChemotherapy administration is vulnerable to wrong infusion duration/rate selection and missed drug-specific requirements (e.g., in-line filters and light protection). A multidisciplinary team implemented parameterised smart infusion pumps with a structured library requiring selection of the exact antineoplastic agent prior to infusion. For each agent, validated infusion-time windows were mapped to safe rate ranges and enforced as locked hard limits; mandatory prompts highlighted filter and light-protection requirements where applicable. Clinical pharmacists led drug-library build, validation and change control with oncology/haematology physicians and nursing leadership, supported by staff training and standardised workflow aids. During the 12-month evaluation period, approximately 17,000 chemotherapy days and 40,000 chemotherapy infusions were assessed. Smart pump safeguards identified and enabled correction of 26 near-miss administration discrepancies before infusion initiation, corresponding to 0.15 discrepancies per 100 chemotherapy days. Parameterisation reduced programming steps and shortened set-up time by approximately 30 s per infusion, corresponding to an estimated net nursing time saving of around one hour per day.ConclusionsA clinical pharmacist-led parameterised smart pump programme strengthened standardisation at the point of administration and supported a proactive medication-safety culture in routine practice. This practice-based report provides transferable operational detail on governance and bedside safeguards for oncology pharmacy services.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"10781552261486712"},"PeriodicalIF":1.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Supratherapeutic international normalized ratio (INR) following concomitant Ribociclib and warfarin therapy.","authors":"Melanie Maine-Timbs","doi":"10.1177/10781552261483495","DOIUrl":"https://doi.org/10.1177/10781552261483495","url":null,"abstract":"<p><p>BackgroundRibociclib, a cyclin-dependent kinase (CDK) 4/6 inhibitor used in metastatic breast cancer, is a time-dependent inhibitor of cytochrome P450 (CYP) 3A4. While interactions with direct oral anticoagulants (DOACs) are recognized, interactions with warfarin may be underrecognized.Case PresentationA woman in her late 70's taking warfarin for atrial fibrillation developed a critically elevated international normalized ratio (INR) of 16.4 and epistaxis approximately 2 weeks after initiation of ribociclib for breast cancer. She had been transitioned from apixaban to warfarin approximately 2 months earlier due to concern for a potential interaction between apixaban and ribociclib. Her INR had remained stable prior to ribociclib initiation, with a time in therapeutic range (TTR) of 78%.Management and OutcomeThe patient required reversal with vitamin K and 4-factor prothrombin complex concentrate (4F-PCC). Ribociclib-associated CYP3A4 inhibition was considered the most plausible contributing factor to the critically elevated INR. Warfarin was resumed at a reduced dose with close outpatient monitoring.DiscussionThis case highlights the risk of a clinically significant anticoagulant interaction following ribociclib initiation. Although warfarin allows monitoring via INR, insufficient early monitoring may increase patient risk. Weekly INR monitoring during the first 2 cycles of ribociclib may improve safety.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"10781552261483495"},"PeriodicalIF":1.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for unexpected hospital attendances and protocol modifications in patients on systemic cytotoxic anticancer treatments.","authors":"Bharneedharan Surendaran, Edward Won-Ho Park, Asif Muzamil, Krishna Moorthy","doi":"10.1177/10781552261482096","DOIUrl":"https://doi.org/10.1177/10781552261482096","url":null,"abstract":"<p><p>BackgroundSystemic anticancer cytotoxic therapies (SACT) often have complications that can lead to unexpected hospital attendances usage (UHA) and protocol modifications (PM). UHA have been associated with poorer median survival and increased economic burden on healthcare systems. Our study aims to identify any significant predictors for UHAs and PMs.MethodsOur single centre retrospective cohort study aims to identify any significant predictors for UHAs and PMs. Patient demographics, details of UHA and SACT regimen data were collected for each patient between March 2024 to March 2025. For our univariate analysis of possible predictors, we used chi squared for any association between categorical variables and independent t tests for continuous variables. While for multivariate analysis, binary logistic regression was conducted to identify any significant predictors.Results534 patients were analysed with 218 (40.8%) having stage IV disease. 314 patients (58.8%) had at least one UHA and 378 patients (70.8%) had PMs. There were no significant predictors for UHAs. While patients who progressed on SACT was a predictor for PMs (HR 2.514, 95%CI 1.216-5.198, <i>p</i> = 0.013). Furthermore, progression on SACT (HR 0.441, 95%CI 0.232-0.841, <i>P</i> = 0.013) and line of therapy (HR 0.719, 95%CI 0.567-0.912, P = 0.0006) were predictors for completing all SACT cycles. Finally, age (HR 1.026, 95% CI 1.002-1.051, <i>p</i> = 0.036) and line of therapy (HR 0.679, 95% CI 0.530-0.870, <i>p</i> = 0.002) were predictors for dose reduction.DiscussionLine of therapy was a predictor for patients completing their SACT and undergoing a dose reduction. Potentially, older patients could have an upfront dose reduction to improve their quality of life. Our limitations consisted of our study being a single centre and using retrospective data collection. Future multi centre prospective studies are needed to understand the scale of the problem and validate this study results.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"10781552261482096"},"PeriodicalIF":1.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}