Saul Weingart, MD, PhD
Despite the widespread use of prescribing safeguards for infusion
chemotherapy, few of those measures have been implemented with oral
chemotherapy, according to a study led by researchers at Dana-Farber
In the Jan. 13 issue of the British Medical Journal, Saul N. Weingart, MD, PhD, vice president for patient safety at Dana-Farber, and
his colleagues report that a survey of National Cancer
Institute-designated comprehensive cancer centers found few
organizations with standardized prescribing practices for oral
"Given how quickly oral chemotherapies have become standard care for a
growing number of cancers, we were not surprised to find variations in
how organizations prescribe and monitor the use of these agents," said
Weingart. "It was surprising, however, that few of the safeguards used
with infusion chemotherapy have been adopted for oral chemotherapy."
The researchers sent a survey on the current practices for
prescribing, coordinating and monitoring, dispensing, and educating
patients about oral chemotherapy to 54 NCI-designated comprehensive
cancer centers, of which 42 centers responded.
Weingart said the survey revealed significant variations in the
manner prescriptions were generated at most centers and in the amount of
information required to complete them.
Nearly 70 percent of the centers (29) used handwritten orders for the
majority of oral chemotherapy prescriptions, five percent (2) used
pre-printed paper prescriptions, and 14 percent (6) used computed-based
prescription order entry systems.
An analysis of the information required to order prescriptions for
six oral chemotherapies found that few centers mandated the inclusion of
the patient's diagnosis (26 percent), the treatment's schedule and
duration (9 percent), or the patient's body surface area (BSA)
calculation, which is used to determine appropriate and safe drug dosage
level, and only 21 percent of the centers required a second physician
to review and approve the chemotherapy order. More than half of the
centers had no required elements for oral chemotherapy prescriptions,
noted Weingart, who is an associate professor of medicine at Harvard
The respondents also reported that between 2004 and 2005 at least one
serious adverse drug event related to oral chemotherapy occurred at 10
centers, and 13 centers experienced a 'serious near miss.'
"The growing availability of effective oral chemotherapy, especially
the new class of 'targeted biologic therapies,' is one of the wonderful
recent advances in cancer care, as it has given cancer patients
unprecedented convenience compared to intravenous infusion therapy,"
said paper co-author Lawrence Shulman, MD, chief medical officer at
Dana-Farber and an associate professor of medicine at Harvard Medical
School. "However, these findings underline the importance of forging a
consensus in the oncology field on standardized safeguards and practices
for prescribing and monitoring the use of these drugs."
The paper's other authors are Daniela Brouillard, Laurinda Morway,
EdM, Ann Partridge, MD, MPH, Sylvia Bartel, RPh, MHP, and Maureen
Connor, RN, of Dana-Farber; and Jonathan Flug, Tufts University School
of Medicine, Boston.
The research was supported by the Center for Patient Safety at Dana-Farber and the Agency for Healthcare Research and Quality.