Pharmacy practice in many emerging countries such as Nepal is still in the development phase. The evidence on pharmacy practice targeted to cancer patients in Nepal is very limited. There is little research on oncology pharmacy practice after Khanal et al. published an article oncology pharmacy practice in a teaching hospital in Nepal in 2008.They highlighted a simple pragmatic model of pharmacy practice or cancer patients. They highlighted provision of drug information services, pharmacovigilance, and pharmacists’ participation in a clinical ward round with other healthcare professionals to study medication-related problems as the basic activities which can be carried out in Nepalese context. Adding to this, Shrestha et al. argues that’s there is the financial burden associated with the management of adverse drug reactions (ADRs( besides their impact on human life.
With limited human and capital resources, these activities cannot be sustained; as such, a team of medical oncologists and pharmacists at a Nepal Cancer Hospital, initiated a cancer hospital-based regional pharmacovigilance center, with those activities described briefly herein. In the field of oncology and antineoplastic agents, pharmacovigilance studies are important, as it means a significant instrument to oversee drug safety. Antineoplastic agents usually involves complex regimens. These antineoplastic agents have high toxicity and narrow therapeutic windows and therefore account the patient much susceptibility to ADRs.3 In oncology, ADRs are being acknowledged as an unavoidable component of treatment. ADRs are ordinary and expectable.
Consequently, the idea of onco-pharmacovigilance was developed, which can be categorized as a subsystem of monitoring drugs which is derived from pharmacovigilance to screen, assess, and manage ADRs due to cytotoxic antineoplastic drugs.
Pharmacists specialized in oncology oversee a wide variety of functions of pharmacovigilance, including monitoring, notifica tion, prevention, and management of reactions associated with chemotherapy which can be develop a bridge between medical oncologists and patients.6 After an establishment of pharmacovigilance in a cancer hospital of Nepal, few ADRs like nausea, vomiting, diarrhea, constipation, skin rashes, pxaliplatin-induced neuropathic pain, macula erythematous rash due to temozolomide,7 fluorouracil-induced mucositis, etc. are reported within a month, which was unsatisfactory. The risk-benefit analysis was done in the management of the ADRs by the team of clinical pharmacists and medical oncologists. In some cases, there was a desensitization in the chemotherapy protocol. After the identification of ADRs, ADR alert stickers are attached to the front page of a patient’s medical file.
So, practicing a multidisciplinary approach is necessary, and one-on-one training is being provided to nurses and pharmacists. Financial support is required to fuel a pharmacovigilance center in any organization, and it should have an officially approved guaranteed source, which is immune to political governance and economic fluctuations, to direct a steady flow of funds so that the progress of work on pharmacovigilance is not hindered. In Nepal, the practicality of practice of national pharmacovigilance depends especially on the dynamic interest of health professionals. More data on chemotherapy-induced ADRs will be useful for making a national database. Different activities and endeavors are being prepared for supporting medical oncologists, doctors, nurses, pharmacists and other health professionals to report every antagonistic response, including suspected ones, keeping in mind the end goal to enhance the utilization of medications. Our tentative plans are to advance the idea of pharmacoviligance, detailing and reporting of ADRs and to lead widescale training in onco-pharmacovigilance.
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