News

Press

Still Using Paper and Pen?

By Brent Clough January 2009

Source: Oncology Business Review

With thousands of therapy options available and, exponentially, more potential drug combinations being written, it could be assumed that some nurses and pharmacists rely on their own experience to correctly deci­pher a patient’s prescribed course of treatment. Although unusual, this type of scenario can create the poten­tial for overdosing or under-dosing. Even in large oncology practices where chemotherapy orders are checked by five or more professionals, mistakes can happen.

Although the proliferation of drugs creates new opportunities for cure, confusion for any given caregiver can ensue if an order is clearly not understood. In manually-created che­motherapy orders, the combination of handwritten and fill-in-the-blank documents can be especially prone to error and misinterpretation.

Three Common Oncology Treatments

Three of the most common treat­ments used in medical oncology today that could be considered to have the most frequent or common risks in dosing include:

»FOLFOX+BEVACIZUMAB

According to our research at IntrinsiQ, in 2007, 24,000 patients in the US received this therapy for col­orectal cancer. It includes an infusion of one drug over two days. The infu­sion is prepared, and the patient is sent home with a portable I.V. This kind of ‘continuous infusion’ is com­mon, however, it can be toxic, and the schedule can be considered complex by some.

In the fast-paced environment of an oncology practice, there is the slightest possibility that a mistake when writing or interpreting the pre­scription can occur. Hopefully, an experienced nurse recognizes the script written as “2400 mg over two days,” and knows that doesn’t mean 2400 mg daily over two days.

»DOSE DENSE AC-TAXOL+HERCEPTIN

This therapy was administered to 44,000 US breast cancer patients in 2007, according to our data, and has become a standard of care for adju­vant therapy in HER2-positive breast cancer. The traditional chemotherapy regimen is lengthy—usually given over 6 to 12 months.

Sometimes the patient will not be able to tolerate a full dose every week across the course of treatment so the dose levels of Taxol are frequently adjusted. In addition, Herceptin requires a loading dose as well as sub­sequent maintenance doses, which introduces new potential for error every time it is administered.

»TAXOL+CARBOPLATIN

This combination is less common in the treatment of non-small cell lung cancer than it was just a few years ago, but it was still given as the pre­ferred first-line therapy to 38,000 US patients in 2007. While Taxol plus carboplatin is commonly prescribed, it is also known for its need for pre-medi­cations. Carboplatin itself requires an area-under-the-curve dosing calcula­tion which can introduce the potential for dosing errors.

Tracking Treatments with an Electronic System

Experienced technology users who practice with electronic clinical appli­cations see the many benefits of the electronic approach. With the help of a computerized physician order entry (CPOE) system, detailed tracking of complex treatment cycles is an excel­lent way for physicians to keep up and detail their patients’ dosing schedules and reduces the potential for dosing errors.

According to a 2007 practice bench­marking study conducted by Oncology Metrics, 45% of practice respondents (n=271) said they use an electronic health record system. Of those who did not use an electronic system 55% (n=179) said that they plan to use one in the next 12 to 18 months (see Fig. 1).