In order to prescribe the most effective cancer therapy, doctors use formal guidelines to assist in decision-making. However, these guidelines usually do not consider cost of therapy for patients, leading to therapy decisions based solely on their doctor’s recommendations and unexpected personal financial burden.
An article posted in Bloomberg Business on 10/13/15 describes a new tool that will provide patients with information about the cost of drugs used in their treatment. The guidelines, developed by an alliance of top U.S. cancer hospitals, will be available to all, not just hospitals in the cancer network. The information is general and does not account for how much of the cost insurance will cover. Drugs are ranked on a scale of 1 to 5 for affordability, in the same way the group ranks other aspects of a therapy, such as how toxic or how effective it was in clinical trials.
Link to article Bloomberg Business (10/13/2015)
A recent article published in JAMA states that nearly 90% of patients with advanced cancer are prescribed an antimicrobial within the last week of life and 42% of patients with end-stage dementia during their final 2 weeks of life. Many of these patients reside in nursing homes with comfort as the intended goal.
According to the Centers for Disease Control and Prevention (CDC), each year up to 70% of nursing home residents receive one or more courses of antimicrobials for various infections, yet up to 75% of those prescriptions are given unnecessarily or incorrectly. Subsequent postings online in The Wall Street Journal and USA Today provide additional discussion on the need to reduce antimicrobial misuse. Patients may be prescribed antibiotics in the absence of clinical symptoms of infection as prescribers are usually not at the bedside to assess in home hospice and in nursing homes. There are also misconceptions that antibiotics are benign compared to other life-prolonging interventions such as intubation and dialysis.
The CDC targeted efforts to reduce inappropriate antimicrobial prescribing in hospitals last year and is now focused on nursing homes. Adverse outcomes include cost of therapy, drug reactions, and drug-drug interactions. More importantly, antimicrobial misuse promotes the growth of drug-resistant organisms (“super bugs”) such as Clostridium difficile, an infection that leads to 250,000 hospital admissions and 15,000 deaths every year. Infection management counseling in advance care planning for caregivers and infection control training for healthcare professionals have proven to combat misuse.
Recently, BD Medical announced to their customers that their oral plastic syringes are not FDA-cleared for storage of compounded pharmaceuticals or for the purpose of repackaging liquid medications. Storing medications in BD syringes has been shown to reduce their potency due to a drug interaction with the rubber stopper found in certain lots of syringes. Affected sizes include 1mL, 3mL, 5mL, 10mL, 20mL and 30mL. BD oral syringes may continue to be used for immediate administration purposes only. When the intention is storing compounded or repackaged medication, alternate oral syringes are recommended.
In response to this warning, Enclara Pharmacia has moved completely to NeoMed syringes for storage and for administration. The product used prior by Enclara Pharmacia was Exactamed that differs from NeoMed in available sizes and color of syringe cap as follows:
Former product, Exactamed: Sizes - 1mL, 3mL, 5mL, 10mL; Cap color - Blue
New product, NeoMed: Sizes - 1mL, 3mL, 6mL, 12mL; Cap color - Orange
For more information on this FDA warning, please click here to review.
Patients with Alzheimer's disease frequently experience agitation and other behavioral problems. With heightened awareness on the harms and lack of benefit of prescribing antipsychotics in this population, there exists a need for safe and effective alternative therapies.
A study on a novel combination medication, dextromethorphan-quinidine (Nuedexta®), recently published in JAMA describes the potential effectiveness of this medication for the management of agitation in patients with Alzheimer’s dementia. JL Cummings and colleagues led a Phase 2 randomized, multicenter, double-blind placebo-controlled 10 week trial using a sequential parallel comparison design on patients with probable Alzheimer's disease and agitation. Patients assigned to the dextromethorphan-quinidine group reported improvement in behavioral symptoms compared to those receiving placebo that was felt to be clinically significant. Although more research is needed, this two drug combination may offer relief of agitation in some patients.
Link to JAMA (09/22/2015)