药师在肿瘤患者抗凝治疗中的作用

XMLTemplate(2014)[18.11.2014–2:45pm][1–7]//blrnas3.glyph.com/cenpro/ApplicationFiles/Journals/SAGE/3B2/OPPJ/Vol00000/140095/APPFile/SG-OPPJ140095.3d(OPP)[INVALIDStage]OncologyPharmacyPracticeJournalofOriginalArticleVenousthromboembolism:Whatpharmacistsknow?Whatdotheyneed?Jean-BaptisteRey1,2,NicolasJovenin3,PierreKreit4,Je´roˆmeSicard5,DamienParent1,DominiqueHettler6,7,PhilippeNguyen8,9andJean-LucDucrocq10AbstractIntroduction:Venousthromboembolismiscommonincancer.Low-molecularweightheparinsarerecommendedforprolongedtreatment(3–6monthsormoreifthecancerisactive)andpreventionofrecurrenceofvenousthrombo-embolismincancer.Communitypharmacistsareoftenfacedwithquestionsfrompatients.Themainobjectiveofthisstudywastodescribetheorganization,practicesandknowledgeofpharmacistsincareofvenousthromboembolismincancerpatients.Methods:AdescriptivesurveywasconductedelectronicallyinOctoberandNovember2013withpharmacistsintheChampagne-Ardenneregion.Thequestionnairecollecteddataonthegeneralorganizationofthepharmacy,managementofoutpatientswithcancerandthrombosis,andthelevelofknowledgeregardingrecommendationsonthemanagementofthrombosisinpatientswithcancer.Results:Theparticipationratewas31.6%.In93%ofcases,pharmacistshadnoparticularexpertiseinoncologyand/orsupportivecare.Inaddition,96%didnotknowtheexistenceofrecommendationsfor‘‘thrombosisincancer.’’Finally,49%gavethecorrectanswertothecasereport(low-molecularweightheparins).Conclusion:Trainingsessionsonthemanagementofvenousthromboembolismincancerarecurrentlyavailabletopharmacistsintheregion.Anewassessmentofknowledgewillbeperformedattheendoftheyear2014.Thisregionalexperienceisnowextendedtoanationallevel(allFrenchregions).KeywordsPharmacists,thrombosis,cancer,recommendationsIntroductionCancerandthrombosisarefrequentlyassociated,asthiscombinationwasdescribedin1865byArmandTrousseau.1Therelativeriskofvenousthromboembol-ism(VTE)(includingdeepveinthrombosis(DVT)andpulmonaryembolism(PE))inacancerisestimatedat6.5.2Atotalof15–20%ofpatientswithVTEwerealsoafflictedwithcancer.3–7Finally,VTEisthesecondlead-ingcauseofmortalityincancer.8ManagementofVTEincancerpatientsisdescribedintherecommendationsof:theInstitutNationalduCancer—FrenchNationalCancerInstitute(INCA),9theAgenceNationaledeSe´curite´desMe´dicamentsetproduitsdesante´—Frenchdrugagency(ANSM)in2009,theAssociationFrancophonedesSoinsOncologiquesdeSupport(AFSOS)recommendations,10andthegoodclinicalpracticesinternationalrecommendationssupportedbytheGroupeFrancophoneThromboseetCancer(GFTC)in2013.1InstitutdeCance´rologieJeanGodinot,De´partementdePharmacie,France2Universite´deReimsChampagne-Ardenne,Faculte´dePharmacie–LaboratoireEA4691,France3Re´seauRe´gionaldeCance´rologieChampagne-Ardenne,France4URPSPharmaciensChampagne-Ardenne,France5PharmaciePrincipale,ChaˆlonsenChampagne,France6CHUdeReims,Pharmacie,France7ARSChampagne-Ardenne,OMEDIT,ChaˆlonsenChampagne,France8CHUdeReims,Laboratoired’He´matologie,France9Universite´deChampagne-Ardenne,Faculte´deMe´decine,France10LeoPharma,MedicalAffairs,VoisinsleBretonneux,FranceCorrespondingauthor:Jean-BaptisteRey,InstitutdeCance´rologieJeanGodinot,De´partementdePharmacie,1,rueduGe´ne´ralKoenig,51100Reims,France.Email:[e-mail]0(0)1–7!TheAuthor(s)2014Reprintsandpermissions:sagepub.co.uk/journalsPermissions.navDOI:10.1177/1078155214560639opp.sagepub.comXMLTemplate(2014)[18.11.2014–2:45pm][1–7]//blrnas3.glyph.com/cenpro/ApplicationFiles/Journals/SAGE/3B2/OPPJ/Vol00000/140095/APPFile/SG-OPPJ140095.3d(OPP)[INVALIDStage]However,theserecommendationsarelittleknownandlittleuseddespiteabroadandfreedisseminationonmediasuchastheInternetorsmartphones.Indeed,inFrance,aselsewhere,mostoftherecommendationsandstandardshavenothadthedesiredimpactonmed-icalpractices.11–13Intheserecommendations,low-molecularweightheparins(LMWH)arethetreatmentofchoiceinVTEpatientswithcanceroveraperiodof3–6months(orbeyondifcancerisactive).However,recentstudiesontheimplementationofthe‘‘throm-bosisandcancer’’recommendationsconductedinFrance14,15showedabroadunder-prescriptionofLMWHinthelongterminpatientswithVTEandcancer,around50%,regardlessofthecontinentorcountrywherethestudywasmade.Ontheotherhand,thereisawidevariabilityintherapeuticcare,whetherinthechoiceofthemoleculeorthedurationoftreatment,dependingonthetypeofpractice(hos-pitalphysicians,generalpractitioners),ormedicalspe-cialty(oncology,vascularmedicine),orevenspecifictreatmentofcancerdisease.Finally,giventheseverityofthromboemboliccomplicationsincancerpatientsandtheirverypejorativeeffectonprognosis,improveduseofLMWHattreatmentdosesinaccordancewiththerecommendationsandguidelinesappearsimperative.16Alongwiththesetwoobservations(i.e.‘‘VTE–cancer’’asacommonandseriouscombinationandnon-optimalmanagement),thecommunitypharmacistisakeyplayer.Ontheonehand,heplaysacentralroleinthemanagementofoutpatientsasaprimaryhealth-careprofessional,easilyaccessible,sincepatientsonlyhaveto‘‘pushthedoor’’ofthepharmacy.Ontheotherhand,theHPSTlaw(Loi‘‘HoˆpitalPatientsSante´Te´rritoires’’)17c