On 29 March 2018, the Lancet Oncology launched a second series of articles on drug safety in oncology practice. The topics discussed in this new series touch problems such as medication overuse, errors in administration, dosage and prescription, as well as trends of illicit anticancer drugs in the legal supply chains. This second series of papers follows the problems elaborated in first series of articles published in 2016 which explored the safety considerations of biosimilars and generic agents, and pharmacovigilance efforts by the US Food and Drug Administration and the European Medicines Agency.
Prof. Peter B. Bach of the Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, USA and colleagues wrote that regardless of high cost and potential side effects, the treatments for cancer could be a subject of overuse, defined as a “provision of medical services that are more likely to harm than to benefit a patient”. His team found 30 studies documenting such cases, 16 studies in term of supportive medication overuse and 17 studies of anticancer drugs overuse. However, only few agents have been assessed and none study assessed the most toxic or expensive anticancer drugs. The authors found little published evidence in term of addressing associated financial, psychological, or physical harms.
Chemotherapy errors are potentially serious risk in oncology practice. Prof. Saul N. Wiengart of the Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA and colleagues reviewed literature from 1980 to 2017 to understand the extent and nature of medication errors in oncology. They found that such errors occur at a rate of about 1 to 4 per 1000 orders. The errors affect at least 1-3% of adult and paediatric patients with cancer and occur in all stages of the medication use with oral therapy being an area of growing risk. The authors point out that additional research is needed to understand and to mitigate the risk of such errors. Their analysis has some limitations as it’s based mainly on published findings from single-institution academic studies that focus on prescriptions and pharmacy practices.
Bastiaan J. Venhuis, PhD of the National Institute for Public Health and the Environment, Bilthoven, Netherlands and colleagues wrote that falsified anticancer drugs in 2016 ranked fifth in the most commonly falsified drug category in the reports received by the Pharmaceutical Security Institute. Although the prevalence of illicit anticancer drugs in the legal supply chains is small, these drugs are difficult to detect. The authors described forthcoming countermeasures to combat the problems in high-income countries and warn on potential risk that pharmaceutical crime could quickly adapt to the protections. Furthermore, the authors warned healthcare professionals on necessity to report about non-effectiveness and unusual drug effects to improve detectability in clinical practice.
Schleicher SM, Bach PB, Matsoukas K, et al. Medication overuse in oncology: current trends and future implications for patients and society. Lancet Oncology 2018; 19(4):e200-e208. doi: 10.1016/S1470-2045(18)30099-8.
Weingart SN, Zhang L, Sweeney M, et al. Chemotherapy medication errors. Lancet Oncology 2018;19(4):e191-e199. doi: 10.1016/S1470-2045(18)30094-9.
Venhuis BJ, Oostlander AE, Di Giorgio D, et al. Oncology drugs in the crosshairs of pharmaceutical crime. Lancet Oncology 2018; 19(4):e209-e217. doi: 10.1016/S1470-2045(18)30101-3.