医薬品相互作用研究

Vol.43, No. 2（2019）23（98）

医薬品相互作用研究
一
般論
文
43（2） 23-29 （2019）

Questionnaire survey on pharmacistsʼ provision of clinical pharmacy services
to patients receiving outpatient cancer chemotherapy
Reiko MATSUI1, 2）, Tomoya SAKURADA1）, Eriko KOBAYASHI1）, Nobunori SATOH1）
1）

Department of Social Pharmacy Graduate School of Pharmaceutical Sciences, Chiba University
2）
National Cancer Center Hospital East

（Received Nobember 27, 2018; Revised February 11, 2019; Accepted April 5, 2019）

In 2014, The Ministry of Health, Labour and Welfare established “cancer patient guidance fee 3” (“guidance fee3”) for the management of patients treated for cancer with chemotherapy. Since the introduction of "guidance fee
3," there have been few reports on the real situation regarding the fee, such as clinical pharmacy services provided
by pharmacists and information sharing with doctors. We conducted a questionnaire survey in 14 core hospitals forcollaborative cancer treatment in Chiba to clarify the real situation regarding “guidance fee 3.” We focused on oral
chemotherapy and asked questions regarding the clinical pharmacy services provided by pharmacists to patients
undergoing oral chemotherapy. The response rate was 85.7% (12/14). Seven hospitals (58.3%) were found to
calculate “guidance fee 3,” and only four calculated this fee for patients treated with oral chemotherapy. Regarding
the timing of sharing patientsʼ information with doctors, for patients treated with oral chemotherapy, only one
hospital reported carrying out this information sharing before a patient had seen the doctor. No hospitals used astandardized form for communication between medical and pharmaceutical departments. This study on the realsituation regarding “guidance fee 3” found that the fee was rarely calculated in cases of cancer chemotherapy,
especially for patients treated with oral chemotherapy. It seems necessary to create a space for consultation
between pharmacists and patients in outpatient clinics and to construct work schedules that consider the method
and timing of sharing patient information.
Key Words: outpatient, oral chemotherapy, chemotherapy, pharmacy intervention, questionnaire

gastrointestinal toxicity can also result inIntroduction
In contrast to treatments requiring hospitalization,

emergency hospitalization 4) 5). Other side effects ofoutpatient care allows patients to receive

c a n c e r c h e m o t h e r a p y, s u c h a s s k i n d i s o r d e r s ,anticancer treatment without significantly altering

hand-foot syndrome, nausea, vomiting, and1)

their living environments or quality of life . Ind i a r r h e a , m a y w o r s e n p a t i e n t sʼ q u a l i t y o f l i f e ,Japan, the number of patients treated withcause them concern, and disturb their treatment

outpat ient cancer chemotherapy has increased

schedule. Outpatient cancer chemotherapy has the

because of the approval of oral anticancer drugs

advantage of maintaining patientsʼ quality of life,

and advances in medical instruments, such as drug

but it also has disadvantages, such as the risks of2) 3). Ant icancer drugs used inoccurrence of various side effects. Therefore, it isoutpatient treatment include molecular-targetednecessary to take measures to prevent side effects

therapeutic agents and cellular anticancer drugs.

from this chemotherapy. Patients also have many

These drugs have the serious side effects ofconcerns about side effects at home, andinterstitial pneumonia, gastrointestinal perforation,communication with health professionals isand thromboembolism. Febrile neutropenia andinsufficient 6 ) 7 ) . Thus, it is necessary to educate

inject ion devices

Department of Social Pharmacy Graduate School of Pharmaceutical Sciences, Chiba University
260-8675
2）
National Cancer Center Hospital East 6-5-1, Kashiwanoha, Kashiwa, JAPAN 277-8577
Corresponding author: Reiko Matsui e-mail: rmatsui@east.ncc.go.jp
TEL: 043-226-2884 FAX: 043-226-2884
1）

1-8-1, Inohana, Chuo-ku, Chiba, JAPAN24（99）医薬品相互作用研究

Vol.43, No. 2（2019）

patients receiving outpatient cancer chemotherapy

A survey conducted by the Osaka Hospital

regarding how to handle side effects at home.

Pharmacist Association on member hospitals foundReports from hospitals offering clinical pharmacy

that fewer than 35.5% of hospitals providing

services for patients treated with outpatient cancer

clinical pharmacy services (38 of 107) calculated

chemotherapy indicate that these services“guidance fee 3” 13). However, the clinical pharmacy

provided by pharmacists may result in the early

services provided by pharmacists for patients

detection of side effects, prevention of serious side

receiving oral chemotherapy, the timing of sharing

effects, improvement of quality of life, anda pat ientʼs informat ion between a do ctor and amanagement of the risk of medical error8) 9). It has

pharmacist, and information sharing with doctors

also been reported that clinical pharmacy services

were not investigated in the Osaka Hospitalfor patients treated with oral chemotherapy haveP h a r m a c i s t A s s o c i a t i o n s u r ve y. T h e r e f o r e , t h econtributed to reducing side effects andpresent study conducted a questionnaire survey of

prolonging the treatment period 10) 11).

the core hospitals for collaborative cancer

A questionnaire survey completed on the coretreatment in Chiba to clarify the clinical pharmacy

hospitals for collaborative cancer treatment in 2014services provided by pharmacists to patientsfound that only 40% of these hospitals provided

undergoing oral chemotherapy and the realclinical pharmacy services for all patients receiving

situation regarding “guidance fee 3.”

injection chemotherapy on an outpatient basis, and14.7% of these provided these clinical pharmacy
services through the treatment period

12). The same

Methods
1. Questionnaire survey

survey found that 1.6% of these hospitals provided

The units of analysis in this study were the 14

clinical pharmacy services for all patients receiving

core hospitals for collaborative cancer treatment in

outpatient oral chemotherapy, and less than 50%

Chiba. The questionnaire was sent to the directorof the hospitals provided clinical pharmacyof the pharmacy division at each hospital, andservices to any of these patients. The survey

their responses were returned by mail. These

concluded that the system of providing clinicalrespondents were informed that the survey was

pharmacy services and side effect management

anonymous and that returning a response would be

during outpatient treatment is insufficient

12)

. In

recognized as consent to participate. The survey

2014, based on such previous findings, to promote

period was from October 6 to October 21, 2017.

support for patients with cancer, the Ministry ofThis study was approved by the research ethics

Health, Labour and Welfare established “cancer

committee of the Graduate School ofpatient guidance fees 1, 2, and 3” to manage thePharmaceutical Sciences, Chiba University.

psychological care of patients with cancer, monitort h e s i d e e f f e c t s o f c a n c e r c h e m o t h e r a p y, a n d

2. Questionnaire development

provide cont inuous guidance for pat ients w ith

The content of the questionnaire was as follows:cancer. “Cancer patient guidance fee 3” (hereafter（ 1 ）hospital information,（ 2 ）the real situationreferred to as “guidance fee 3”) can be calculatedr e g a r d i n g “ g u i d a n c e f e e 3 ”,（ 3 ）p h a r m a c i s t s ʼwhen a doctor or a pharmacist provides such

involvement with patients treated with outpatient

guidance. When a pharmacist is to provide thisoral chemotherapy. We developed a questionnaire

guidance, the hospital is obliged to employ athat included both multiple-choice andfull-time oncology-certified pharmacist. The

short-answer questions on the following themes:

calculation requirements for this fee include thecosts of continuous monitoring of a patientʼs side（1）Hospital information

effects, providing information to the patientʼs

Items comprised the number of beds, the number

doctor regarding side effects and drug adherence,of pharmacists, the prescription rate forand sending a proposal for prescription drugs topharmacies outside of the hospital, the number oft he pat ie ntʼ s do ctor according to th e pat ien tʼsJapanese Society of Pharmaceutical Health Caresituation.

and Sciences-certified Senior Oncology

医薬品相互作用研究

Vol.43, No. 2（2019）Pharmacists, the number of Board Certified

25（100）ResultsP h a r m a c i s t s i n O n c o l o g y P h a r m a c y, a n d t h e

The response rate was 85.7% (12/14) among thenumber of Accredited Pharmacists for Ambulant

core hospitals for collaborative cancer treatment inCancer Chemotherapy oncology-certified

Chiba.

pharmacists.

1. Hospital information（2）The real situation regarding “guidance fee 3”

Seven hospitals had 500 beds or more, four had

Items were the calculation status for patientsat least 400 but fewer than 500 beds, and one had

and the job titles of medical staff members

fewer than 400 beds. In terms of pharmacists

performing the calculation.

employed, one hospital employed 0.1 or more perbed, seven employed at least 0.05 but less than 0.1（3）Pharmacistsʼ involvement with patients treatedwith outpatient oral chemotherapy

per bed, and four employed less than 0.05 per bed.
The prescription rate for pharmacies outside of theItems were the drug administration guidance andhospital was more than 95.0% in six hospitals, atthe assessment of side effects for patients

least 90% but less than 95.0% in four hospitals,

receiving oral chemotherapy and the timing andand less than 90.0% in one hospital. Ten hospitals

method of sharing information on patients(83.3%) employed an oncology-certified

receiving oral chemotherapy with their doctors.

pharmacist (Table 1).

Table 1. Hospital characteristics (N = 12)

2. The real situation regarding “guidance fee 3”

five hospitals and by both pharmacists and doctors

Although 10 hospitals (83.3%) employed an

at two hospitals. In no hospitals were these

oncology-certified pharmacist, only seven (58.3%)

services provided only by doctors (Fig. 1).

actually calculated “guidance fee 3.” Of these, four
hospitals calculated “guidance fee 3” for patients

3. Pharmacistsʼ involvement with patientstreated receiving either oral or injection

receiving outpatient oral chemotherapy

chemotherapy, and three calculated “guidance fee

Among the seven hospitals calculating “guidance3” only for patients treated with injection

fee 3” for patients treated with oral cancer

chemotherapy. Of the seven hospitals thatchemotherapy, two provided administrat ion

calculated the fee, the services included in

guidance and checked for side effects for all“guidance fee 3” were provided by pharmacists atpatients, but one provided guidance only for the26（101）

医薬品相互作用研究

Fig.1.

Vol.43, No. 2（2019）

The real situation regarding “guidance fee 3”

first dose. And two calculated “guidance fee 3” forRegarding the method of sharing a patientʼs

only some patients, and three had no pharmacists

informat ion w ith a do ctor, one hospital had no

involved with the patients (Table 2).

standardized form, two used a form that was

Regarding the timing of sharing patientsʼ

standardized within the pharmacy division, none

information with doctors, only one hospital did

used a standardized form for communication

this before the patient saw the doctor; thebetween medical and pharmaceutical departments,

remaining three hospitals shared patientand one hospital used electronic medical records

information after the patient had seen the doctor.

and shared orally in case of emergency (Table 3).

Table 2. Drug administration guidance and the assessment of side effects for patients
receiving oral chemotherapy(at hospitals where “guidance fee 3” was calculated, N = 7)

Table 3. The method and timing of sharing patient information (at hospital where pharmacists
provided drug administration guidance and assessed side effects for patients receiving
oral chemotherapy (N = 4)

医薬品相互作用研究

Discussion

Vol.43, No. 2（2019）27（102）outpatient clinic area where a pharmacist can

Of the 14 core hospitals for collaborative cancer

provide these patients with medication instructions

treatment in Chiba Prefecture, 12 participated ino r c o n f i r m t h e p r e s e n c e o f a d ve r s e r e a c t i o n s ,this study. Ten of these 12 hospitals employed an

hospital pharmacists are less likely to be involved

oncology-certified pharmacist, and seven (58.3%)

with these patients. This suggests the necessity ofcalculated “guidance fee 3.” The findings showedcreating a space for consultation between

that there were hospital that did not calculate thepharmacists and patients in outpatient clinics.

fee even when oncology-certified pharmacists were

Regarding clinical pharmacy services provided topresent, in addition to the hospitals that did notpatients treated with outpatient oralcalculate the fee because there were no certified

c h e m o t h e r a p y, t h e t i m i n g a n d t h e m e t h o d o fpharmacists employed. One of the calculation

sharing patientsʼ information with doctors differedrequirements is that oncology-certified

among the responding hospitals. In terms of thep h a r m a c i s t s a r e i nvo l ve d i n t h e c a l c u l a t i o n o fmethod of sharing patientsʼ information with“g u i d a n c e f e e 3 .” To e n s u r e t h a t t h e h o s p i t a l s

doctors, no hospitals used a standardized form for

employ an oncology-certified pharmacist, we

communication between medical andbelieve that it is necessary to construct anpharmaceutical departments, meaning that it iseducat ional system that supports cert ificat ion

possible that the information obtained from aacquisition. For hospitals that did not calculate thepatient and the information shared between afee even when there were oncology-certified

pharmacist and a doctor may differ depending onpharmacists employed, it seems that there may be

the specific doctor or pharmacist. There is also a

obstacles to calculating “guidance fee 3” inpossibility that information essential for patient

addition to employing such pharmacists. As acare is not shared between a doctor and areason why pharmacists may not be fully involved

pharmacist. Requirements for calculatingin the care of a patient treated w ith outpat ient

“guidance fee 3” include education on the content

cancer chemotherapy, Sakurai et al. have reportedof the medication, taking an inventory of thethat insufficient time and human resources were

pat ientʼs treatment history, and evaluat ing theindicated most frequently (80.4%), followed by thepatientʼs side effects, medication adherence, andpharmacist lacking know ledge of oncolog y andconcerns. In addition, a proposal for drugs to be

14)other reasons . This suggests that reviewing work

prescribed to treat these side effects, such asschedules to ensure time for oncology-certified

narcotic analgesics, must be provided if necessary.

pharmacists to eng age w ith pat ients receiving

In addition to the information required for

outpatient chemotherapy may be necessary.

c a l c u l a t i n g “g u i d a n c e f e e 3 ,” i n f o r m a t i o n o n aFour of the seven hospitals that calculatedchange in a pat ientʼs quality of life and on the“guidance fee 3” calculated the fee not only forconcerns of their family members is also necessary

patients treated with injection chemotherapy but

to provide medical treatment suitable for patients,

also for patients treated with oral chemotherapy.

and this information should be shared with theThis finding made it clear that there were fewer

patientʼs doctor and other medical staff members.

h o s p i t a l s t h a t c a l c u l a t e d “g u i d a n c e f e e 3 ” f o r

To cover such a wide range of information, it is

pat ients receiving oral chemotherapy than fornecessary to create a standardized form forpatients receiving injection chemotherapy. The

communication between medical andpresent survey also found that the rate ofpharmaceutical departments and to share patientprescription for pharmacies outside of the hospital

information among medical staff members.

exceeded 90% for all of the studied hospitals,

Regarding the timing of sharing a patientʼs

indicating that patients treated with oral

information between a doctor and a pharmacist,

chemotherapy tend to receive their medicine atonly one hospital shared pat ientsʼ informat ion

pharmacies outside of the hospital without abefore a patient saw a doctor, and the otherchance to see a hospital pharmacist after being

hospitals shared it after a patient had seen a

examined by their doctor. Without a space in the

doctor. If a patientʼs information is shared with a28（103）

医薬品相互作用研究

Vol.43, No. 2（2019）d o c t o r b e f o r e t h e p a t i e n t s e e s t h e d o c t o r, t h e

http://www.mhlw.go.jp/toukei/list/10-20-kek

doctor can easily understand the patientʼska̲gaiyou.html August21 2017 access.

condition and focus on a diagnosis and a treatment３）Ministry of Health, Labor and Welfare:Statistics of Medical Care Activities in Publicplan decision.
Furthermore, in general, critical paths have been
introduced as a means of sharing information
regarding patient treatment in inpatient. It has
been reported that the intro duct ion of crit ical
paths has begun in outpatient cancer
chemotherapy in some hospitals

15) 16). In oral

Health Insurance.
http://www.mhlw.go.jp/toukei/list/26-19c.ht
ml August21 2017 access.
４）Funahashi M, Suzuki K, Okamitsu K:
Problems encountered by advanced lungcancer patients continuing outpatientchemotherapy, the utilization of critical paths as achemotherapy. Humanity and science J. themeans of sharing information on patient treatment

Faculty of Health and Welfare., 11(1),deserves further consideration.

113-124, 2011.

Because the present survey was limited to data５）Horasawa S, Matsui R, Kawasumi K,

on 14 core hospitals for collaborative cancer

Shinichiro S: The Usefulness of Outpatient

treatment in Chiba prefecture, a nationwide survey

Pharmacy Services in Adjuvant

is necessary in the future.

Chemotherapy for Gastric Cancer. Jpn J
Cancer Chemother., 43(9), 1091-1095, 2016.

Conclusion
This study on the real situation regarding６）Yahiro Y, Nakai Y, Higashi A: Literature
Review of Studies Examining the“guidance fee 3” found that less than 60% of thePsychological Aspects of Cancer Patientscore hospitals for collaborative cancer treatment in

Receiving Outpatients Chemotherapy. Journal

Chiba calculated “guidance fee 3” and that onlyof Japanese Society of Nursing Research., 35,

about 30% of these hospitals calculated this fee for129-136, 2012.

patients receiving oral chemotherapy. Because the７）Tashiro A, Terada M, Koga M, Kitagawa T,

rate of prescription for pharmacies outside of the

Kondo S: Syokai gairai gan kagakuryôhô ni

hospital exceeded 90% at all hospitals, it seems

ikôsuru kanzya no huwan ni taisuru taiinmae

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hômon no yûkôsei no kentô. Collection of

between pharmacists and patients in outpatient

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standardized form for communicat ion between８）Nozoe T,Yasunaga W,Sonoda S,Ohse

medical and pharmaceutical departments, andK,lmakiire A,Shimada M,Makisumi K: The

most hospitals shared patientsʼ information after aUsefulness of PharmacistsʼService forpatient saw a doctor. This suggests the necessity of

Outpatient Cancer Chemotherapy. J Jpn Soc

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Hosp Pharm., 47, 1305-1308, 2011.

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９）lmamura M, Nakura H, Takemoto C:
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Conflict of Interest：
The authors declare no conflicts of interest.

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10）AimonoY,

NemotoM, Satou W, Saito Y,

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