Search

In the RECOURSE trial which lead to its accreditation, Lonsurf (trifluridine/tipiracil) was shown to extend progression free survival (PFS) by 1.8 months in metastatic colorectal cancer. This Trust audit aims to assess the average quantity of cycles of Lonsurf received by participants and the length of time it extends PFS. Similarly, to identify how many participants required a dose-reduction or experienced toxicities which necessitated supportive therapies. Quantitative data was collected retrospectively from all participants who had received ≥1 cycle of Lonsurf from The Clatterbridge Cancer Centre (CCC) from 2016 until June 2020. Participant electronic patient records were accessed to identify toxicity grading, length of treatment received, the date progression was identified, if dose reductions were applied and if supportive therapies were administered. Lonsurf extends PFS in patients with metastatic colorectal cancer at CCC by 3.0 months (95% CI: 2.73–3.27) and average treatment length was 2.4 months. However, 78 participants (41.5%) received a dose reduction due to toxicities. A total of 955 toxicities were recorded by participants; the most commonly reported toxicities irrespective of grade were fatigue (33.8%), diarrhoea (13.8%) and nausea (12.3%). The most common grade ≥3 toxicities were constipation and infection. The most frequently utilised supportive therapies were loperamide (49.6%) and domperidone (49.1%). Granulocyte colony stimulating factor (GCSF) was required by patients on 5 occasions (0.3%) in total. Lonsurf extends median PFS in patients with metastatic colorectal cancer by 3.0 months. The most common grade ≥3 toxicities which necessitated supportive therapies or a dose reduction were gastrointestinal and infection. [ABSTRACT FROM AUTHOR]

Introduction and aims: The clinical indication for a prescribed medicine in secondary care is not always clear, accurate or easy to locate within patients' medical notes, making it difficult to assess the appropriateness of the medicine. This study sought to determine the impact of including clinical indications for prescribed medicines in paper and electronic prescribing systems in acute hospitals in England. Methods: This mixed-methods study involved semi-structured telephone interviews with 64 chief pharmacists, 11 focus groups with multidisciplinary healthcare teams (MDTs) from three NHS trusts and a review of medical documentation of 89 patients (who were under the care of MDTs participating in the focus groups). Results: Participants described the inclusion of a clinical indication as "helpful" or "useful". However, from a prescriber's perspective, providing an indication for all medicines would be time consuming and unrealistic, especially with pre-admission medicines where it is more of a transcribing process than a prescribing process and where accuracy may be an issue. Mandatory input of indications in electronic systems was considered impractical unless the systems assisted the prescriber. Only 4 of the 64 trusts (6%) required an indication for all medicines, while 15 trusts (23%) did not require an indication for any medicines because of governance and patient confidentiality issues. Discussion: The inclusion of clinical indications on inpatient prescriptions varies across a range of trusts, which affects clinical workflow, regulation and patient safety. Adding clinical indications to prescriptions impacted negatively on healthcare professionals' clinical workflow, but was viewed favourably in certain circumstances (e.g. for a newly initiated medicine). Conclusion: Current requirements for clinical indications on inpatient prescriptions is variable and the role of electronic systems in enforcing standards is unclear. Management and frontline practitioners recognise both the positives and negatives, but systems that force prescribers through mandatory fields to document clinical indications may be counterproductive. If incorporation of clinical indications on hospital prescriptions is to be successful, health IT systems must embrace user-centred design. [ABSTRACT FROM AUTHOR]