Reducing drug-related problems in hospitalized pediatric cancer patients through clinical pharmacist interventions: An interventional study from Turkey

Introduction: Clinical pharmacists play a vital role in reviewing anticancer regimens, dose calculations, managing drug-related problems, and monitoring adverse drug reactions. The aim of this study was to identify, classify and reduce drug-related problems in patients with neoplastic disease hospitalized in the pediatric hematology-oncology clinic. Methods: The study was a prospective, interventional study consisting of observation and intervention periods conducted for five months, from April 2024 to August 2024. During the intervention period of the study, clinical pharmacist recommendations for drug-related problems were presented to the healthcare team. Drug-related problems was used in Pharmaceutical Care Network Version 9.1 and were classified according to their clinical significance. Results: A total of 80 patients were included in the study. The median (interquartile range) age of all patients was 7.5 years (4-12.75) and 61.3% were boy. The most common malignancies are acute lymphoblastic leukemia (32.5%) and medulloblastoma (10%). A total of 457 drug-related problems were detected in all periods, 147 of the 457 drug-related problems were related to ‘‘not clinically significant’’ drug-drug interactions. In the intervention period, the frequency of all drug-related problems decreased by 56.3% ( p < 0.001). The most common causes of drug-related problems were drug-drug interactions (47.7%), other causes (13.8%), and indication no treatment (9.1%). During the intervention period, recommendations were made for 66 of the 138 drug-related problems identified, and all of these recommendations (100%) were accepted by physicians. The intervention period recommendations were mostly in the form of drug dose change (35.3%), change in instructions for use (27.4%), drug change (11.77%) and drug paused/stopped (11.77%). 37% of patients who received chemotherapy had adverse events during and after chemotherapy, and during their hospital stay. The most common chemotherapy-related adverse events were leukopenia (20%), lymphopenia (17.5%), and neutropenia (13.8%). Conclusions: A high incidence of drug-related problems was detected in patients with neoplastic disease hospitalized in the pediatric hematology-oncology clinic. All of the clinical pharmacist's recommendations were accepted by the healthcare team.