title: EPICC study: evaluation of pharmaceutical intervention in cancer care.
abstract: OBJECTIVE
  In cancer care, clinical pharmacists contribute to improving prevention and management of drug-related problems (DRPs). The 3-year EPICC study (Evaluation of Pharmaceutical Intervention in Cancer Care) aimed to collect and analyse pharmaceutical interventions (PIs) in oncology.
  
  
  METHODS
  The free online version of the French Society of Clinical Pharmacy (SFPC) coding system, ACT-IP, was used, supplemented by a standardized dedicated cancer-care decision tree.
  
  
  RESULTS
  A total of 29,589 medication orders (77,004 anticancer drug preparations) were analysed. Eight hundred and ninety-four PIs were recorded. ACT-IP identified 54·1% of DRPs as concerning over- or underdosage. The standardized dedicated cancer-care decision tree identified the three principal causes of dosage problems: 50·2% due to miscalculation, 20% to omission of dose adjustment and 12% to poor choice of antineoplastic regimen. About 13·8% of DRPs were adverse effects and 3·9% were drug-drug interactions. The decision tree showed that 22% of adverse events could be circumvented by a switch within the same drug family and 72% of drug-drug interactions would have led to increased neoplastic toxicity.
  
  
  CONCLUSIONS
  Pharmaceutical analysis of prescription forms contributes to medication safety in cancer care, and the present dedicated decision tree highlights additional information about DRPs and PIs. The DRP rate (3% of prescriptions) was consistent with the literature. The pharmacist has a role to play in optimizing the management of patients with cancer in terms of dose adjustment, drug toxicity management, improvement of administration and drug-drug interactions.
  
  
  CONCLUSIONS
  This study, highlighting PIs in cancer care, is the first of this scale in terms of number of prescriptions analysed (nearly 30 000). Results demonstrated the specificity of DRPs and PIs for patients with cancer and the value of a dedicated coding system in cancer care.
authors.affiliation: Clinical Oncology Pharmacy Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, Pierre Bénite, France.
authors.forename: N
authors.initials: N
authors.lastname: Vantard
authors.forename: F
authors.initials: F
authors.lastname: Ranchon
authors.forename: V
authors.initials: V
authors.lastname: Schwiertz
authors.forename: C
authors.initials: C
authors.lastname: Gourc
authors.forename: N
authors.initials: N
authors.lastname: Gauthier
authors.forename: M-G
authors.initials: MG
authors.lastname: Guedat
authors.forename: S
authors.initials: S
authors.lastname: He
authors.forename: E
authors.initials: E
authors.lastname: Kiouris
authors.forename: C
authors.initials: C
authors.lastname: Alloux
authors.forename: B
authors.initials: B
authors.lastname: You
authors.forename: P-J
authors.initials: PJ
authors.lastname: Souquet
authors.forename: G
authors.initials: G
authors.lastname: Freyer
authors.forename: G
authors.initials: G
authors.lastname: Salles
authors.forename: V
authors.initials: V
authors.lastname: Trillet-Lenoir
authors.forename: C
authors.initials: C
authors.lastname: Rioufol
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D009369:Neoplasms / Q000188:drug therapy*; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data*
chemical_list: D000970:Antineoplastic Agents
keywords: cancer care; clinical pharmacy in oncology; drug-related problems; pharmaceutical intervention