# Usefulness of protocol-based pharmacotherapy management by pharmacists in cancer patients: a retrospective observational study

## TL;DR

This study shows that pharmacist-led protocol-based strategies improve test compliance in cancer patients undergoing chemotherapy.

## Contribution

The study demonstrates the effectiveness of pharmacist-managed protocols in improving laboratory test compliance during cancer treatment.

## Key findings

- Compliance with HBV-DNA quantification improved significantly after implementing PBPM.
- Compliance with serum magnesium measurement increased but not significantly.
- UPC measurement compliance was already high and remained unchanged after PBPM.

## Abstract

A team-based approach is essential to provide cancer patients with high-quality treatment. To ensure the best possible care while reducing the workload of physicians, Ehime University Hospital has introduced three protocol-based pharmacotherapy management (PBPM) strategies in the field of chemotherapy. First, we introduced PBPM to avoid reactivation of hepatitis B virus (HBV) in patients receiving immunosuppressive therapy or chemotherapy. In this PBPM strategy, pharmacists added laboratory test orders for patients who require regular HBV-DNA quantification (HBV-PBPM). Second, we devised PBPM for measurement of the urine protein/creatinine ratio (UPC) in patients receiving anti-vascular endothelial growth factor therapy. Finally, we introduced PBPM for measurement of serum magnesium in patients receiving anti-epidermal growth factor receptor antibody therapy (Mg-PBPM). In this study, we evaluated the usefulness of these three PBPM strategies in outpatients receiving chemotherapy.

The study included patients treated in the outpatient chemotherapy unit between July 2021 and February 2023. Rates of compliance with laboratory tests in the 6 months before and after introduction of PBPM were compared.

Compliance with HBV-DNA quantification improved significantly from 66.3% before PBPM to 86.7% after implementation of PBPM (p = 0.002). The median duration of noncompliance was significantly shorter after initiation of PBPM (p = 0.021). Compliance with measurement of UPC was already greater than 95% before PBPM and showed no change after implementation (98.7% pre-PBPM vs 99.3% post-PBPM). Compliance with measurement of serum magnesium improved from 95.8% pre-PBPM to 99.2% after starting PBPM, but the improvement was not statistically significant.

Introduction of PBPM improves compliance with the laboratory tests required in cancer patients during chemotherapy and enables safer delivery of treatment.