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The Oncology Pharmacy Team (OPT), consisting of specialty-trained pharmacists and/or pharmacy technicians, is an integral component of the multidisciplinary healthcare team (MHT) involved with all aspects of cancer patient care. The OPT fosters quality patient care, safety, and local regulatory compliance. The International Society of Oncology Pharmacy Practitioners (ISOPP) developed this position statement to provide guidance on five key areas: 1) oncology pharmacy practice as a pharmacy specialty; 2) contributions to patient care; 3) oncology pharmacy practice management; 4) education and training; and 5) contributions to oncology research and quality initiatives to involve the OPT. This position statement advocates that: 1) the OPT be fully incorporated into the MHT to optimize patient care; 2) educational and healthcare institutions develop programs to continually educate OPT members; and 3) regulatory authorities develop certification programs to recognize the unique contributions of the OPT in cancer patient care.

Following a review of a chemotherapy medication adverse event where the incorrect medication was prepared by a pharmacy, a number of steps were taken to review the literature and best practice information related to checking processes for the preparation of parenteral chemotherapy. Concepts such as identification of critical stop check points, independent double checks, and human factors principles were reviewed and incorporated into newly designed chemotherapy preparation worksheets with embedded checklists. Usability testing and staff feedback during implementation revealed a number of key learning points that resulted in additional work to further improve the chemotherapy worksheets with embedded checklists and highlighted the need for a culture of continuous quality improvement.

Objective. The Alberta Cancer Board (ACB) Pharmacy recognized the importance of having a sound knowledge of drug interactions with anti-neoplastic agents. A pharmacy student was given the task of surveying ACB pharmacists for published literature and Internet sources used most often as sources of drug interaction information during medication order review and evaluation of patient profiles. The goal was to extract information from these sources and integrate it into a concise ACB drug interaction database, which lists the actual and potential antineoplastic drug-drug, drug-disease, drug-natural products and drug-food interactions. The antineoplastic agents identified and examined were part of the ACB Out-patient Cancer Drug Benefit Program (OCDBP) (August 2002). Equipped with this information and using their clinical expertise, pharmacists can play an important role in the medical management of patients with cancer. Data sources. The student collected information from literary and remote sources used most often by ACB pharmacists. Study selection. ACB pharmacists were surveyed for published literature and Internet sources that contained drug interaction information on antineoplastics used most often during medication order review, patient counselling sessions and when responding to drug information requests. The contributors of these information sources claim to have reviewed existing references and thus the student relied on the accurate reporting of their findings instead of collecting data from the original works. The drugs reviewed for the purpose of the study were taken from the ACB OCDBP. Data extraction. There was an extensive data collection process. Dorland’s definition of a drug interaction was adopted. The student determined a potential interaction based on the words `may’ or `risk’ found in the statement of the interaction. The student extracted the drug interaction information into tables and a sample of 10 of 87 drugs from the ACB OCDBP are presented in this paper. A complete guide of the ACB drug interaction index can be obtained from the ACB Pharmacy. Data synthesis. Actual and potential antineo-plastic drug-drug, drug-disease, drug-natural products and drug-food interactions are summarized in tables. The information collected was as current as the date that the data were extracted. The determination of clinical significance relies on the expertise of the pharmacist or other healthcare professional. Moreover, the data contained in the tables is representative of the information collected exclusively from sources used most often by ACB pharmacists and therefore is only one source of drug interaction information. Conclusion. An indepth knowledge of actual and potential interactions with antineoplastic agents is critical for pharmacists in the management of patients with cancer. The ACB drug interaction index is an attempt to promote awareness of interactions with antineoplastic drugs and to encourage clinicians to investigate drug interactions during their treatment and management protocols.

Introduction. A pilot project was established at the Cross Cancer Institute pharmacy to assess the feasibility of implementing a patient callback program to determine which patients would benefit from a callback and the impact a callback service would have on the workload of the pharmacy department. Program description/development/implementation/evaluation. A pharmacy student conducted the pilot project over a 14-week time period. Four categories of patients were selected for inclusion in the pilot. The student approached patients at the time of medication pick-up to receive verbal permission to be included in the callback program. A standardized callback form was utilized to record medication information and any recommendations made. Data were collected on the numbers of patients in each category with questions or concerns as this was felt to be indicative of patients who would most benefit from a callback. The total time spent making the telephone calls was recorded. Over the eight-week period, 530.5 minutes were spent making the telephone calls with the average length of call being 3.27 minutes. Discussion/conclusion. The student researcher proposed that three patient groups would benefit from receiving a callback: new patients or patients on new medications; elderly patients; and patients with specific disease-drug combinations. The project also provided an estimate of pharmacist time required to implement such a service and it was concluded that implementation could occur with minimal disruption to workflow.

Objective. The Alberta Cancer Board (ACB) Pharmacy conducted a timing study to determine how electronic prescription ordering impacts the workload in pharmacy in comparison to the current paper system. The objective was to compare the mean time required to review orders generated by an electronic physician order entry system to the existing paper method, and to determine whether such an implementation would decrease pharmacist intervention rates. Methods. Self-reporting and measurement by stopwatch timing were used to record the timing data on the prescription order review process on all outpatient parenteral chemotherapy orders for adults handled within the ACB’s two main tertiary centres for the month of June. The primary endpoint measured was mean pharmacist order review time for manual and electronic orders. The secondary endpoint measured was pharmacist intervention rate for manual and electronic orders. Results. Among all 836 chemotherapy orders reviewed, the mean pharmacist order review time was increased by 5.15 min with the implementation of an electronic order entry system. A total of 62 pharmacist interventions were recorded in the study. The pharmacist intervention rate was 7.14% for the electronic orders and 7.47% for the manual paper orders. Conclusions. The study showed that the implementation of an electronic physician order entry system has significant impacts on pharmacy workload without providing significant reductions in pharmacist intervention rates.

Objective. To describe the numerous pharmacy ac tivities afforded by the seven pharmacy sites that provide various levels of pharmacy services to cancer patients in cities throughout Alberta, Canada. Methods. A questionnaire for measuring phar maceutical care (PC) was developed and applied to each site to benchmark the level of PC that was offered at each institution. The survey was con structed based on elements of the PC model of Hepler and Strand et al and grouped along the lines of Cal Knowlton's ABCs of PC. Responses were graded according to what degree the site had fully, partially, or not yet incorporated the element surveyed. Results. Overall, 44% of the PC elements were fully implemented, 33% were partially implemented, and 23% were not yet implemented in the newly formed Alberta Cancer Board Pharmacy Department. The traditional areas of bottling and counseling con tinue to be areas of strength, with 79% and 77% of the elements fully implemented, respectively. More em phasis is warranted in the areas of assessment and surveillance, with only 26% and 29% of the elements fully implemented, respectively. Conclusions. The results of the survey indicate the need for continued planning to incorporate some of the elements of cognitive pharmacy services in the Alberta Cancer Board Pharmacy Department strategic plan.

Purpose: To provide a current review of the literature related to chemotherapy induced diarrhea (CID), including clinical assessment, recommended management guidelines and investigational pharmacological approaches for the prevention and treatment of CID. Data sources: A search of MEDLINE, PubMed, EMBASE, Cochrane Library, International Pharmaceutical Abstracts, and Web of Science (1996—2006) databases was conducted using terms such as: chemotherapy, diarrhea, diarrhoea, and irinotecan. Appropriate references from selected articles were also used. The search engine, Google, provided further access to information. Data extraction: The retrieved literature was reviewed to include all articles pertaining to the pathophysiology, assessment and management of CID. Data synthesis: Diarrhea is a debilitating and potentially life-threatening side effect associated with many chemotherapeutic agents. Despite the high incidence and severity of CID, it is often under recognized and poorly managed. A multidisciplinary panel recently updated recommended practice guidelines for the assessment and management of CID. Prompt and aggressive intervention is important in order to minimize the negative consequences of CID, such as dehydration, which may cause interruptions in optimal clinical outcomes or may lead to life-threatening sequelae. Further investigation into the pathophysiology of CID may allow for more directed approaches in the prophylaxis and treatment of CID. J Oncol Pharm Practice (2007) 13: 181—198.