医薬品相互作用研究

Vol.41, No. 1（2017）17（17）

医薬品相互作用研究
一
般論
文
41（1） 17-25 （2017）

How hospitals collaborate in cancer care with community pharmacies
in the prescription of oral chemotherapy drugs
Kazuhiro WATANABE1)*, Hirohisa DOI1), Miyuku CHISIMA2), Youji HIRAKO3),
Keiji YOSHIKAWA3), Kazuhiro AGATA2), Miya OISHI3), Masayoshi HIROHARA1),
Michiko YAMAMOTO1), and Masayoshi KOINUMA4)
1)

Center for Education & Research on Clinical Pharmacy, Showa Pharmaceutical University
2)
Qol Co., Ltd. 3) Ain Pharmaciez Inc. 4) Teikyo Heisei University（Received May 30, 2016; Revised August 31, 2016; Accepted September 21, 2016）

The number of prescriptions issued for oral chemotherapy drugs has been increasing in recent years. In light ofthis increase, it is desirable from the standpoint of medical safety for medical facilities that issue prescriptions tocollaborate in cancer care with community pharmacies by sharing information about patients or cancer treatment
plans. Therefore, we conducted a national-scale survey with community pharmacies that fill prescriptions for oral
chemotherapy drugs to determine how facilities that issue prescriptions collaborate in cancer care with community
pharmacies, what pharmaceutical inquiries community pharmacists make, and how community pharmacists would
like hospital pharmacists at these facilities to check prescriptions. An online survey was sent to pharmacists in every
location of 2 community pharmacy chains with locations across Japan. A total number of 53 community pharmacies
that filled prescriptions for oral chemotherapy drugs responded that they collaborated in cancer care with facilities
that issue prescriptions. However, 210 pharmacies had made a pharmaceutical inquiry about an oral chemotherapy
drug to the prescribing facility. In addition, 446 pharmacies wanted hospital pharmacists at these facilities to checkoral chemotherapy drug prescriptions. These results should aid further research on how community pharmacies andmedical facilities collaborate in cancer care.
Key Words: oral chemotherapy drug, collaboration between hospitals and community pharmacies, collaboration incancer care, prescription checking, survey of actual conditions

Introductionbuilding collaborative systems for medical facilities to

In recent years, there has been a rising social need toshare patient information and information about

implement collaborative medical care systems designed

chemotherapy regimens with community pharmacies.1-7)

to ensure continuity and consistency between hospital

However, in general, the only information that mostcare and post-discharge in-home medical care. In thecommunity pharmacies use when checking andﬁeld of cancer care, the expansion of outpat ientdispensing prescriptions for oral chemotherapy drugs

chemotherapy and adoption of oral chemotherapy

is information that can be obtained by asking patientsdrugs have made systems for collaboration between

and information listed in the dosage and administration

medical facilities and community pharmacies essential

section of package inserts. This suggests that mostfor ensuring that patients undergoing chemotherapy

community pharmacies make pharmaceutical inquiries

receive safe and reliable treatment and for improving

about oral chemotherapy drugs from facilities thatpatient adherence. In the past few years, there havei s s u e p r e s c r i p t i o n s b e c a u s e t h e y h a ve d i ﬃ c u l t ybeen reports of some medical facilities and regions

gathering information about patients andCenter for Education & Research on Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen,
Machida-shi, Tokyo 194-8543, Japan
2）
Qol Co., Ltd.,3）
Ain Pharmaciez Inc.,
4）
Teikyo Heisei University*連絡著者：渡部 一宏 （E-mail: kazunabe@ac.shoyaku.ac.jp）1）

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chemotherapy regimens, for example, whether thenumber of oral chemotherapy drug prescriptions

patient has been informed that they have cancer, theirﬁlled: below the ﬁrst quartile (1 or fewer),

treatment status, patient information such as test

interquartile range (between ﬁrst and third quartiles;

results, and information about what chemotherapy

2 to 19), and above the third quartile (20 or more).

regimens the patient has undergone.

Stat ist ical test ing was performed to determine

Therefore, we conducted a national-scale survey todetermine how community pharmacies collaborate inwhether there was a diﬀerence in collaboration incancer care between these groups.

cancer care with facilities that issue prescriptions for

Stratiﬁed analysis was also performed to explore

oral chemotherapy drugs. We also sought to ascertain

the association between the location of a pharmacy

what pharmaceutical inquiries community pharmacists

and whether that pharmacy collaborated in cancer

make about oral chemotherapy drugs, and how

care with facilities that issue prescriptions.

community pharmacists would like hospital

Pharmacies were divided by location into 6 regional

pharmacists at these facilities to check prescriptionsgroups: Hokkaido, Tohoku, Kanto, Chubu, Kinki, andfor oral chemotherapy drugs.

Shikoku/Chugoku/Kyushu/Okinawa. Stat ist ical
testing was performed to determine whether there

Methods
Study population

was a diﬀerence in collaboration in cancer care
between these groups.

This study was a cross-sectional study using aself-completed questionnaire. The participants weresupervising pharmacists at community pharmacies

2. Pharmaceutical inquiries about prescriptions
for oral chemotherapy drugs

operated by QOL Co., Ltd. and Ain Holdings, Inc., who

Regarding pharmaceutical inquiries about

had ﬁlled a hospital-issued prescription including

prescriptions for oral chemotherapy drugs,

oral chemotherapy drugs within the past year. An

respondents were asked, “Question 2: Have you everexplanation of the nature of the study and its

made a pharmaceutical inquiry about an oral

objectives was sent to the supervising pharmacist at

chemotherapy drug to the facility that issued theeach pharmacy by email. Pharmacies that consented

prescription?” They could answer “yes” or “no”.

to participate in this study submitted a

Pharmacies that answered “yes” were asked for

self-completed questionnaire online. The study

further details.

period was from June 1 to July 31, 2014.

Stratiﬁed analysis was also performed to explore
the association between the number of oral

Research instruments

chemotherapy drug prescriptions ﬁlled by a

1. Collaboration in cancer care with facilities thatpharmacy and pharmaceutical inquiries to facilities

issue prescriptions for oral chemotherapy drugs

that issue prescriptions. Pharmacies were divided

Regarding collaboration in cancer care with

into 3 groups by the number of oral chemotherapy

facilities that issue prescriptions for oral

drug prescriptions ﬁlled: below the ﬁrst quartile (1 orchemotherapy drugs, respondents were asked,

fewer), interquartile range (2 to 19), and above the“Question 1: Does your pharmacy collaborate inthird quartile (20 or more). Statistical testing wascancer care with facilities that issue prescriptions for

performed to determine whether there was aoral chemotherapy drugs (excluding pharmaceutical

diﬀerence in pharmaceutical inquiries to facilities

inquiries about prescriptions)?” They could answer

that issue prescriptions between these groups.

“yes” or “no”. Pharmacies that answered “yes” wereasked for further details.

Stratiﬁed analysis was also performed to explore
the association between the location of a pharmacy

Stratiﬁed analysis was also performed to explore

and pharmaceutical inquiries to facilities that issue

the association between the number of oralprescriptions. Pharmacies were divided by location

chemotherapy drug prescriptions ﬁlled by ainto 6 regional groups: Hokkaido, Tohoku, Kanto,

pharmacy and whether that pharmacy collaborated

C h u b u , K i n k i , a n d S h i k o k u / C h u g o k u / Ky u s h u /in cancer care with facilities that issue prescriptions.

Okinawa. Statistical testing was performed toPharmacies were divided into 3 groups by thedetermine whether there was a diﬀerence in医薬品相互作用研究

Vol.41, No. 1（2017）

pharmaceutical inquiries to facilities that issue

19（19）

5. Ethical considerationsprescriptions between these groups.

The research protocol was prepared in compliancewith ethical guidelines for epidemiological research.

3. Desire for hospital pharmacists to check

The protocol was approved by the research ethics

prescriptions against chemotherapy regimens

committee of Showa Pharmaceutical University

Regarding their desire for hospital pharmacists to(2014-6 and 2014-9).

check prescriptions against chemotherapy regimens,
respondents were asked, “Question 3: Would you likehospital pharmacists to check prescriptions against

Results
Study population

chemotherapy regimens?” They could answer “yes”

Responses were obtained from 458 pharmacies inor “no”. Pharmacies that answered “yes” were asked

2 community pharmacy chains with locations acrossfor the speciﬁc items that they would like to haveJapan. The pharmacies that responded ﬁlled achecked against chemotherapy regimens.

median of 1,500 prescriptions per month

Questions about the characteristics of the(interquartile range: 900‒2,200) and 4 prescriptions

supervising pharmacists and pharmacies thatfor oral chemotherapy drugs per month

responded were also asked at the same time.

(interquartile range: 1‒20). They employed a medianof 3 pharmacists (range: 2‒5). The responding

4. Statistical analysis

community pharmacies were located in 35

Data analysis was primarily performed using

prefectures across Japan. There were 45 in

descriptive statistics. The chi-square test was used to

Hokkaido, 52 in Tohoku, 222 in Kanto, 77 in Chubu,

compare the results of stratiﬁed analysis. A two-sided

39 in Kinki, and 23 in Chugoku/Shikoku/Kyushu/

signiﬁcance level of 5% was used. IBM SPSS Statistics

Okinawa (Table 1).

20.0 was used for statistical analysis.

Table 1. Respondent characteristics (n = 458)All(n=458)

Variable
Characteristics of respondents’ pharmacies
Median number of prescriptions filled per month ― no. (ICQ)

1,500 (900–2,200)

Median number of oral chemotherapy drug prescriptions filled per month ― no. (ICQ)

4 (1–20)

Median number of pharmacists employed (full-time) ― no. (ICQ)

3 (2–5)

Community pharmacy location (region)
Hokkaido ― no. (%)

45 (10)

Tohoku ― no. (%)

52 (11)

Kanto ― no. (%)

222 (48)

Chubu― no. (%)

77 (17)

Kinki ― no. (%)

39 (9)

Chugoku / Shikoku / Kyushu / Okinawa ― no. (%)

23 (5)

ICQ： Interquartile range

Research instruments

w ith facilit ies that issue prescript ions for oral

1. Collaboration in cancer care with facilities thatchemotherapy drugs (excluding pharmaceuticalissue prescriptions for oral chemotherapy drugs

inquiries about prescriptions), 12% of pharmacies (nWhen asked if they collaborated in cancer care= 53) answered “yes” and 88% (n = 405) answered20（20）

医薬品相互作用研究“no”.

Vol.41, No. 1（2017）exchanged information about pharmacotherapy (e.g.,

Of the 53 pharmacies that answered “yes”, 26

about chemotherapy regimens) with facilities thatshared patient information through prescription

issue prescriptions for oral chemotherapy drugs (Fig.

records or drug management summaries and 29

1).

Question 1 : Does your pharmacy collaborate in cancer care with facilities
issuing prescriptions for oral chemotherapy drugs (excluding pharmaceuticalinquiries about prescriptions)?
n=458
Yes
12%

No
88%

n=53
Specific description of the nature of that collaboration
We share patient information through prescription records or drug
management summaries

NumberWe exchange information about pharmacotherapy(e.g., about chemotherapy regimens) with facilities issuingprescriptions for oral chemotherapy drugs

26

29

Other

9
Multiple selections allowed

Fig. 1. Collaboration in cancer care with facilities that issue prescriptions for oral chemotherapy drugs

The results of stratiﬁed analysis on the association

0.008).

between the number of oral chemotherapy drug

The results of stratiﬁed analysis to explore theprescriptions ﬁlled by a pharmacy and whether thatassociation between the location of a pharmacy andpharmacy collaborated in cancer care withwhether that pharmacy collaborated in cancer careprescribing facilities are shown in Table 2. There waswith prescribing facilities are shown in Table 3.

a signiﬁcant diﬀerence in collaboration in cancer

There was no signiﬁcant diﬀerence in collaboration

care between the 3 groups divided by the number ofin cancer care between the 6 groups divided byoral chemotherapy drug prescriptions ﬁlled (location ( = 0.06).

=

Table 2. Association between number of prescriptions for oral chemotherapy drugs
ﬁlled and collaboration in cancer care with facilities that issue prescriptions

Number of oral chemotherapy drugprescriptions filled per month (no.)

Collaboration Yes
incancer careNo<=1

2 - 19> = 20

7
(5%)

16
(9%)

30
(23%)

144
(95%)

159
(91%)

102
(77%)

p value0.008**： p <0.05
Independent chi-square test

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Table 3. Association between pharmacy location and collaboration in cancer care withfacilities that issue prescriptions

Community pharmacy location( Region )Hokkaido Tohoku

Collaboration Yes
incancer care
No

Kanto

Chubu

Kinki

Chugoku / P value
Shikoku /Kyushu /Okinawa

2
(4%)

12
(23%)

21
(9%)

10
(13%)

6
(15%)

2
(9%)

43
(96%)

40
(77%)

201
(91%)

67
(87%)

33
(85%)

21
(91%)

0.06

*： P<0.05
Independent chi-square test

2. Pharmaceutical inquiries about prescriptions

248) answered “no”.
Among the 210 pharmacies that answered “yes”,

for oral chemotherapy drugs
When asked if they had ever made a pharmaceuticalthe most common topics of inquiry regarding oral

inquiry about an oral chemotherapy drug to thechemotherapy drugs were “rest period” at 132,

facility that issued the prescription, 46% of“administration period” at 122, and “dosage andpharmacies (n = 210) answered “yes” and 54% (n =administration” at 116 (Fig. 2).

Question 2 : Have you ever made a pharmaceutical inquiry about an oral
chemotherapy drug to the facility that issued the prescription?
n=458
Yes
46%

No
54%

n=210
Specific topics of inquiry

NumberRest period

132

Administration period

122

Dosage and administration

116

Interactions with concomitant drugs

15

Drug names

12

Confirm supportive care

6

Other

6
Multiple selections allowed

Fig. 2. Pharmaceutical inquiries about prescriptions for oral chemotherapy drugs

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The results of stratiﬁed analysis on the associationa signiﬁcant diﬀerence in the percentage of

between the number of oral chemotherapy drug

pharmacies that made inquiries to prescribingprescriptions ﬁlled by a pharmacy and whether thatfacilities between the 3 groups divided by number ofpharmacy made pharmaceutical inquiries tooral chemotherapy drug prescriptions ﬁlled (prescribing facilities are shown in Table 4. There was

0.001).

=

Table 4. Association between number of prescriptions for oral chemotherapy drugs
ﬁlled and pharmaceutical inquiries to facilities that issue prescriptions

Number of oral chemotherapy drugprescriptions filled per month (no.)
Pharmaceuticalinquiries about Yesprescriptions
for oralchemotherapy No
drugs

<=1

2 - 19> = 20

41
(27%)

82
(47%)

87
(66%)

110
(73%)

93
(53%)

45
(34%)

p value0.001**： p <0.05
Independent chi-square test

The results of stratiﬁed analysis on the association

no signiﬁcant diﬀerence in the percentage of

between the location of a pharmacy and whether thatpharmacies that made inquiries to prescribing

pharmacy made pharmaceutical inquiries tofacilities between the 6 groups divided by location (prescribing facilities are shown in Table 5. There was= 0.09).

Table 5. Association between pharmacy location and pharmaceutical inquiries to facilities
that issue prescriptions

RegionHokkaido Tohoku

Pharmaceuticalinquiries about Yesprescriptions
for oralchemotherapy
No
drugs

Kanto

Chubu

Kinki

Chugoku /p value
Shikoku /Kyushu /Okinawa

19
(42%)

28
(54%)

93
(42%)

37
(48%)

25
(64%)

8
(35%)

26
(58%)

24
(46%)

129
(58%)

40
(52%)

14
(36%)

15
(65%)

0.09

*： p <0.05
Independent chi-square test

3. Desire for hospital pharmacists to check

Among the pharmacies that answered “yes”, theprescriptions against chemotherapy regimens

speciﬁc items they indicated that they would like to be

When asked if they would like hospital pharmacists tochecked were “rest period” at 385, “administration

check prescriptions against chemotherapy regimens,

period” at 376, and “dosage and administration” at 385

97% of pharmacies (n = 446) answered “yes” and 3% (n(Fig. 3).

= 12) answered “no”.

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Question 3 : Would you like hospital pharmacists to check prescriptions against
chemotherapy regimens?
n=458
Yes
97%

No
3%

n=446
Specific topics of inquiry

NumberRest period

385

Administration period

376

Dosage and administration

385

Interactions with concomitant drugs

254

Drug names

178

Confirm supportive care

169

Other

40
Multiple selections allowed

Fig. 3. Desire for hospital pharmacists to check prescriptions against chemotherapy regimens

Discussion
In this study, we conducted a survey with pharmacies

what it means for hospital pharmacists and community
pharmacists to collaborate in cancer care.

of 2 community pharmacy chains with locations acrossStratiﬁed analysis on the association between theJapan to determine how community pharmacies

number of oral chemotherapy drug prescriptions ﬁlled

collaborate in cancer care with facilities that issue

by a pharmacy and whether that pharmacy

prescriptions for oral chemotherapy drugs, what

collaborated in cancer care with facilities that issue

pharmaceutical inquiries community pharmacists makeprescriptions revealed a diﬀerence in collaboration inabout oral chemotherapy drugs, and how community

cancer care between the 3 groups divided by thepharmacists would like hospital pharmacists at thesenumber of oral chemotherapy drug prescriptions ﬁlled.

facilities to check prescriptions for oral chemotherapy

Pharmacies that ﬁlled more prescriptions for oral

drugs. The survey yielded several ﬁndings.

chemotherapy drugs were more likely to collaborate in

Our ﬁrst ﬁnding was that 12% of the community

cancer care. We believe this may be because

pharmacies collaborated in cancer care with facilitiesprescribing facilities are more likely to collaborate withthat issue prescriptions for oral chemotherapy drugs.

the pharmacy that ﬁlls the most prescriptions for theirA s p a r t o f a n a n n u a l s u r ve y o n c u r r e n t h o s p i t a lfacility, which would be the pharmacy located right

pharmacy practice, the Japanese Society of Hospitaloutside the facility (called monzen-yakkyoku in

Pharmacists (JSHP) asks supervising pharmacists at

Japanese).

outpatient chemotherapy departments of hospitals

The number of medical facilities adding patient test

whether they shared information about chemotherapy

result data or chemotherapy regimen data towith community pharmacies. In 2014, the percentage

prescriptions has gradually been increasing over the8)

that responded “yes” was 31% . One reason for thispast few years, especially among university hospitals.

diﬀerence may be that the JSHP surveyed hospital

However, this increase has been regional rather thanpharmacists and we surveyed community pharmacists,

national. Facilities that issue prescriptions should

because each group may have a diﬀerent perception ofutilize government-driven information and24（24）

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Vol.41, No. 1（2017）

communication technology programs to quickly build

against chemotherapy regimens. The authors

regional networks so that they can share medical

concluded that this was because this kind of check was

information about patients and chemotherapy

a time-consuming task for hospital pharmacists 1 3 ) .

regimens with pharmacies regionally and even

However, the JSHP Guidelines for the Handling of

nationally rather than simply to the monzen-yakkyoku

High-risk Drugs ( Ver. 2.1) state that it should be

9)pharmacy or local pharmacies . However, some issues

standard protocol to check both inpatient andsuch as high cost, respect for privacy, and protection of

outpatient prescriptions for antineoplastics against

personal information will need to be resolved.

regimens, and propose that having hospital

Our second ﬁnding was that 46% of pharmacies had

pharmacists at prescription-issuing facilities check oral

made a pharmaceutical inquiry about an oral

chemotherapy drug prescriptions against

chemotherapy drug prescription to the facility thatchemotherapy regimens could be a strategy for

issued the prescription, and that the most common

nationwide collaboration in cancer care between

information requested was pharmaceutical information

facilities issuing prescriptions and community

about the rest period, administration period, andpharmacies.

dosage and administration of the chemotherapy drugs

Our study has some limitations. As we surveyed only

as they applied to a speciﬁc chemotherapy regimen.

those pharmacies operated by QOL Co., Ltd. and Ain

We believe this reﬂects that even community

Holdings, Inc., our sample may not be representative ofpharmacies are now ﬁlling more prescriptions for oral

all community pharmacies. Nevertheless, our study is

chemotherapy drugs due to factors such as recent

signiﬁcant because it provides up-to-date, nationwide

advances in medical technology for outpatient

information on how hospitals are collaborating inchemotherapy, the increased use of molecularly

cancer care with community pharmacies in thetargeted drugs and other oral chemotherapy drugs withprescription of oral chemotherapy drugs in Japan. We

new mechanisms of action. This ﬁnding, which isbelieve these results will serve as a foundation for

consistent with results from related studies, was likely

further nationwide research on collaboration in cancer

due to a lack of knowledge about chemotherapy andcare in the prescription of oral chemotherapy drugs.

chemotherapy regimens and insuﬃcient collaboration
with facilities that issue prescriptions 10-12).

Acknowledgements

Our third and last ﬁnding was that 97% ofThis study was conducted as a part of the “Heisei 26

community pharmacies wanted hospital pharmacists to

Nendo Wakate-Kenkyu-sya Jyosei” funded by Showacheck prescriptions against chemotherapy regimens.

Pharmaceutical University of Japan (No. H 26-4). We

This could also be due to a lack of collaboration in

greatly appreciate the cooperation of thecancer care with facilities that issue prescriptions, but

community-based pharmacies involved in this study.

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