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Survey reveals need for standardized oral chemotherapy prescribing practices, safeguards

BOSTON -- Despite the widespread use of prescribing safeguards for infusion chemotherapy, few of those measures have been implemented with oral chemotherapy, according to a study led by researchers at Dana-Farber Cancer Institute.

In the Jan. 13 issue of the British Medical Journal, Saul N. Weingart, MD, PhD, vice president for patient safety at Dana-Farber, and his colleagues report that a survey of National Cancer Institute-designated comprehensive cancer centers found few organizations with standardized prescribing practices for oral chemotherapy.

"Given how quickly oral chemotherapies have become standard care for a growing number of cancers, we were not surprised to find variations in how organizations prescribe and monitor the use of these agents," said Weingart. "It was surprising, however, that few of the safeguards used with infusion chemotherapy have been adopted for oral chemotherapy."

The researchers sent a survey on the current practices for prescribing, coordinating and monitoring, dispensing, and educating patients about oral chemotherapy to 54 NCI-designated comprehensive cancer centers, of which 42 centers responded.

Weingart said the survey revealed significant variations in the manner prescriptions were generated at most centers and in the amount of information required to complete them.

Nearly 70 percent of the centers (29) used handwritten orders for the majority of oral chemotherapy prescriptions, five percent (2) used pre-printed paper prescriptions, and 14 percent (6) used computed-based prescription order entry systems.

An analysis of the information required to order prescriptions for six oral chemotherapies found that few centers mandated the inclusion of the patient's diagnosis (26 percent), the treatment's schedule and duration (9 percent), or the patient's body surface area (BSA) calculation, which is used to determine appropriate and safe drug dosage level, and only 21 pe
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Contact: Bill Schaller
william_schaller@dfci.harvard.edu
617-632-5357
Dana-Farber Cancer Institute
11-Jan-2007


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