Pharmacist-Led Medication Reconciliation Can Improve Cancer Treatment

A recent study found that medication reconciliation decreased the incidence of reconciliation error that reached the patient (RERP) in cancer therapy.

Many experts agree that medication reconciliation can help increase the safety of medication use, but little research has been conducted that measures the effects on RERP in cancer patients, according to the study, published in the Journal of Managed Care & Specialty Pharmacy.

Medication reconciliation is defined as the formal and standardized process of obtaining the full list of drugs previously used by a patient, comparing them with the current drug regimen, and analyzing and solving any discrepancies, the study noted.

Although these programs reduce reconciliation errors (REs) by 42 to 90%, the true effectiveness has not been established due to the heterogeneity nature in the programs process, according to the study.

The researchers conducted a randomized, controlled, open label, clinical trial with patients who started or changed chemotherapy in an outpatient setting and received at least 1 additional outpatient medication.

The primary endpoint of the study was to identify the portion of patients with at least 1 RERP.

Participants were placed into either the intervention group (medication reconciliation) or control group (standard practice). Patients in the intervention group were entered into a pharmacist-led medication reconciliation program developed for cancer patients during their first chemotherapy cycle.

A prespecified analysis was conducted of Eastern Cooperative Oncology Group performance (ECOG) status, Charlson Comorbidity Index (CCI) score, and the degree of polymedication, which are all factors capable of influencing the occurrence of RE in oncological patients.

The trial took place between February and September 2013 and included 147 randomized patients, 76 participants in the intervention group, and 71 in the control group.

The results of the study showed that 3 (4%) patients in the intervention group reached RERP, while 21 (30%) did in the control group (relative risk [RR] = 0.13, 95% confidence interval [CI] = 0.04-0.43; P = 0.0009). The protocol intervention reduced RERP incidence by 26% (95% CI = 14%-37%; P < 0.0001).

The results of the prespecified analysis found that the effects of the CCI score were unrelated to RE occurrence. However, the risk of RE was found to be greater in patients with ECOG ≥ 2 (RR = 2.18, 95% CI = 1.4-3.4; P = 0.018) and in patients with major poly-medication (RR = 2.49, 95% CI = 1.52-4.09; P < 0. 001).

When comparing the effects of medication reconciliation to the standard practice in cancer patients who received chemotherapy, researchers found a noticeable decrease in RERP incidence. Although the factors that influence RE occurrence in oncological patients is not fully established, areas such as poly-medication and performance status could play a role.

The findings reveal that pharmacist-led medication reconciliation programs need to be implemented for cancer patients, the study concluded.