Cancer is the second leading cause of death worldwide, characterized by uncontrolled cell growth and metastasis. In 2020, approximately 10 million people died from cancer. The most common cancer types that year were lung, prostate, breast, stomach, colon, and rectal cancers.
Cancer treatment, particularly chemotherapy, significantly increases the risk of drug-related problems (DRPs). This is mainly due to the complexity of drug regimens and polypharmacy. DRPs can lead to poor outcomes, prolonged hospitalization, higher costs, and reduced quality of life (QOL). Risk factors for DRPs include age, comorbidities, cancer stage, gender, and the use of multiple medications. Â
A recent publication in medtigo Journal of Medicine aimed to investigate DRPs in cancer treatment within real-world clinical settings by identifying their types, assessing their severity, and evaluating how they are managed. The goal of this study was to improve outcomes (reduce hospitalization and QOL) and decrease the economic burden on cancer patients and the healthcare systems. Â
A single-center observational study was carried out in Continental Hospitals, Hyderabad, India. Included patients aged 5 to 85 years who receiving chemotherapy, immunotherapy, targeted, or hormonal therapy. Infants and neonates were excluded. Data were collected from nurse notes, medication charts, clinical case sheets, and electronic medical records. Â
A total of 107 cancer patients (mean age = 54 years, males = 49%, females = 51%) were included in this study.  The highest percentage of patients received treatment with anti-metabolites (13.3%), microtubule-damaging drugs (17.2%), and platinum coordination complexes (23.9%). Â
A total of 325 DRPs were found in 88 patients (Prevalence rate = 82.2%). There were more DRPs cases observed in males (54.50%) compared to females (45.40%). Adverse drug reactions (ADRs) were the most common type (n = 265), followed by medication interactions (n = 38) and dosing errors (n = 22). A chi-square analysis showed a significant gender difference in DRPs, with males were more likely to experience DRPs compared to females (χ2 = 10.6 and p = 0.006). Out of 325 DRPs, 34.4% were treated due to being severe or life-threatening while 65.6% remained untreated.Â
A total of 78 cancer patients had ADRs that affected different organ systems. The hematological system (50.56%) and the gastrointestinal system (14.71%) had the highest percentage of ADRs, whereas the endocrine system had the lowest ADR percentage of 0.75%. The hematological ADRs included erythrocytopenia (Grade I: 8, Grade II: 5), thrombocytopenia (Grade I: 7, Grade II: 1), anemia (Grade I: 23, Grade II: 19, Grade III: 8), leukopenia (Grade I: 5, Grade II: 3, Grade III: 2), leukocytosis (Grade I: 6, Grade II: 1, Grade III: 3), and lymphocytopenia (Grade I: 2, Grade II: 5, Grade III: 7).  The endocrine system had the fewest ADRs, with only 2 cases such as hyperthyroidism (Grade II: 1) and hypothyroidism (Grade I: 1). Â
In this study, 265 ADRs with different grades were identified, with most being Grade I (54.3%), followed by Grade II (35%), Grade III (10.1%), and Grade IV (0.3%). Among the 22 dosing errors, 81.8% were underdoses and 18.1% were overdoses. The highest percentage of the 38 drug-drug interactions (DDIs) included a combination of ondansetron and oxaliplatin (6.7%). The age group of 66-67 experienced the most DRPs (101 cases), followed by the 46-55 (72 cases), whereas the 16-25 age group had no DRPs reported.
DRPs were most prevalent in stomach cancer patients with 18.1% and least in nasopharyngeal cancer patients with 0.3%. Monotherapy patients (44.4%) experienced the highest occurrence of DRPs, particularly with the use of oxaliplatin (9.5%). Approximately 16.9% of FOLFLOX (Folinic acid+fluorouracil+oxaliplatin) in combination therapy and 9.5% of ondansetron in supportive therapy were commonly associated with DRPs.  Â
In conclusion, this study highlights that cancer patients, particularly those undergoing chemotherapy, were more susceptible to DPRs. Most ADRs were self-limiting. These findings emphasize the need for optimized drug therapy and close monitoring strategies to ensure safety and efficacy in cancer treatment.Â
ReferenceÂ
Pradeep KRK, Raj KB, Shrivastava SP, et al. An Observational Study on Drug-Related Problems in the Treatment of Cancer Patients. medtigo J Med. 2025;3(2):e3062326. doi:10.63096/medtigo3062326
