Day 2 :
University of Illinois Hospital & Health Sciences, USA
Sandra Cuellar is a Clinical Assistant Professor in the Department of Pharmacy Practice at the University of Illinois at Chicago (UIC) College of Pharmacy. She has been active in the field of hematology/oncology for 13 years. She is the Coordinator and Clinical Assistant Professor for Oncology Therapeutics. She has completed a Pharmacy Practice Residency at University of Kentucky Chandler Medical Center. Following her residency, she has completed a Specialty Oncology Residency at MD Anderson Cancer Center in Houston, Texas. She currently is the Clinical Pharmacist in the Out-Patient Cancer Center and is also the Director of the Oncology Specialty Residency program at UIC. She is an Editor for Journal of Hematology Oncology Pharmacy and is involved in research, consulting and publications in the field of hematology/oncology. Currently, she is a Member of the ASHP educational steering committee and serves as an ASHP Oncology Surveyor.
Major therapeutic strides have been accomplished in oncology. Perhaps one of the best has been in breast cancer. Approximately, 3 million women are breast cancer survivors. However, there is a dark side to that statistic. Instead of women dying of breast cancer, data suggest that these women are dying of cardiovascular disease. Depending on the type of therapy, women can be up to 7 times more likely to develop cardiomyopathy compared to women who doesn’t receive cardiotoxic therapy. The epidemiology data and clinical research are changing the paradigm of cardiotoxicity in cancer therapy. Recently, the American Society of Clinical Oncology published recommendations on the prevention and management of cancer patients undergoing cardiotoxic therapies. Risk factor assessment, imaging and biomarkers have emerged as new strategies to assess and manage these patients. Perhaps, the most intriguing data that has been published in this arena is the use of global longitudinal strain (GLS). Measurement of GLS has demonstrated the ability to predict negative cardiac outcomes. It has the ability to detect subclinical damage to the heart. This concept is radically different than our historic methods of detecting cardiotoxicity. Historically, the preferred and most accepted imaging has been the multigated acquisition or MUGA. However, this time of imaging has limitations, in particular, the ability to detect subclinical cardiotoxicity. It can only detect cardiotoxicity that has already resulted in decline in ejection fraction. This presentation will discuss the epidemiology of cardiotoxicity in cancer patients and discuss the emerging strategies to detect, prevent and manage cardiotoxicity.
- Hospital Pharmacy | Industrial Pharmacy | Community Pharmacy | Clinical Pharmacy Activities and Prescriptions
Location: Prague Room
University of Illinois Hospital & Health Sciences, USA
Khoula Hospital, Oman
Zainab Said Muhammed Al Hashimy is a Senior Specialized Pharmacist in Plastic and Hand surgery wards. She has developed her skills in Pharmacy Management since 2006 in running the OPD Pharmacies in the Tertiary Care Hospital, Khoula Hospital in Oman. She is a Member in Education and Training in Pharmacy Department. She has interest in bacterial resistance and antimicrobial stewardship. She is performing research in the uses of antibiotic in surgical prophylaxis.
The aim of this study was to review the changes in distribution of bacterial populations and their antibiotic sensitivity over 12 years in a tertiary care burn unit. Understanding the periodic variation of isolated microorganisms and their antibiotic sensitivity helps in selecting the appropriate antimicrobial therapy before culture and sensitivity is reported. It also aids the design of antibiotics protocols. The study was retrospective. The data were obtained from the computerized hospital medical record system and the burn unit records. Overall, Pseudomonas aeruginosa was the most commonly isolated microorganism followed by Staphylococcus aureus, Meticillin-resistant Staphylococcus aureus (
University of Campinas, Brazil
Lais S Amaral has completed her Bachelor’s degree in Pharmacy from University of Campinas, Brazil and is currently a Master's student at Pharmacology at School of Medical Sciences, University of Campinas, Brazil. Her research interests include pharmaceutical care in oncology, adverse drug reactions and biomarkers for adverse events.
Statement of the Problem: Capecitabine (CAP) and Sorafenib (SOR) are oral antineoplastics indicated for colorectal (CR) and gastric (ST) cancer and hepatocellular carcinoma (HCC), respectively. If not taken properly, the treatment may be at risk. The pharmacist develops an important role to guarantee the adherence to oral antineoplastics ensuring the right information which directly influences in treatment. The purpose of this study is to describe the patients in use of CAP and SOR, the incidence of hand-foot syndrome (HSF), adherence to therapy and quality of life (QoL).
Methodology & Theoretical Orientation: This is a prospective, longitudinal and observational study. The patients were followed up during three cycles of chemotherapy and analyzed for HFS incidence based on self-observation; knowledge to therapy with MedTake test; adherence to treatment with Morisky-Green test. QoL was analyzed before the first and after the third cycle of chemotherapy through the general EORTC-QLC-30 and specific questionnaires EORTC-QLC-ST-022 for ST, EORTC-QLC-CR-29 for CR for patients in treatment with CAP and, before and after the first cycle of chemotherapy through the general EORTC-QLC-30 and specific questionnaire EORTC-QLC-HCC-18 for patients in treatment with SOR for HCC.
Findings: The patients were male (CAP 53.85%; SOR 93.33%) Caucasian (CAP 76.92%; SOR 86.67%) and tumors were in advanced stages (CAP 53.85% stage IV; SOR 60.00% BCLC C). MedTake indicated a high knowledge to therapy and, in both cases; medicine dosage was the most common mistake. Morisky-Green also indicated a high adherence to both therapies but patients frequently forgot to take their medicines and were careless about the timetable. The QoL decreased in both cases and the HFS was common in patients taking CAP at the second and third cycles of chemotherapy.
Conclusion & Significance: QoL decreased despite the fact that the adherence to therapies was high.
Marilia B Visacri has received her Bachelor’s degree in Pharmacy from the University of Campinas, Campinas, Brazil, in 2011 and MSc degree in Medical Sciences from the same university in 2013. She is currently pursuing her PhD degree in Sciences at School of Medical Sciences, University of Campinas, Brazil. Her research interests include clinical pharmacy, pharmaceutical care, adverse drug reactions, oncology, oxidative stress biomarkers and biomarkers for adverse events.
Statement of the Problem: Cisplatin chemotherapy induces oxidative stress and therefore has consequent toxicities. The main dose-limiting side effect of cisplatin is nephrotoxicity. The protective antioxidant role of acetylcysteine (NAC) on nephrotoxicity due to cisplatin has been reported in experimental models; however, its efficacy in patients has not been elucidated. The aim of this study was to evaluate the possible protective effect of low-dose oral NAC on cisplatin-induced nephrotoxicity in patients with head and neck cancer.
Methodology & Theoretical Orientation: This is a randomized double-blind placebo-controlled pilot trial conducted with 57 patients undergoing treatment with at least one of the three cycles of high-dose cisplatin chemotherapy, concomitant to radiotherapy. Patients were randomly assigned and were given: (1) NAC syrup, 600 mg orally once a day at night for 7 consecutive days (two days before the chemotherapy, on the day of chemotherapy and 4 days after chemotherapy), n=28; or (2) Placebo, administered similarly to NAC, n=29. Plasma levels of creatinine were monitored to assess nephrotoxicity. Creatinine clearance was estimated using the Cockroft-Gault formula. Severity was classified by Common Toxicity Criteria for Adverse Events (version 4, grade 0 to 4).
Findings: Patients from both groups had similar demographics and clinical characteristics (p>0.05). Throughout the treatment, elevated creatinine was observed in 55.2% of patients in placebo group (grade 1+2: 34.5%; grade 3: 20.7%) and 64.3% in NAC group (grade 1+2: 46.4%; grade 3: 17.9%) [Chi-square test, p=0.6517]. Moreover, reduced creatinine clearance was observed in 96.6% of patients in placebo group (grade 1+2: 75.9%; grade 3+4: 20.7%) and 96.4% in NAC group (grade 1+2: 82.1%; grade 3+4: 14.3%) [Fisher's exact test, p=0.8620].
Conclusion & Significance: Low-dose oral NAC did not attenuate cisplatin-induced nephrotoxicity. Further studies should be conducted to test other oral doses of NAC.