Many thanks for this review article on medication safety in oral anti-cancer drugs (1). While one can be certain that parenteral administration means that the drug is completely infused, oral application entails many uncertainties.
I welcome the authors’ request for regular medication, side-effect, and interaction checks, professional support, and new standards and guidelines. If such quality requirements are published in Deutsches Ärzteblatt they can rapidly become normative. I would therefore have liked if the authors had also indicated how they have already implemented all this in their daily routine. Which interaction checker do they use? Is this integral to the practice/hospital software or does it have to be called up separately? Is the nationally standardized medication schedule integral part of the hospital IT system and are drug interactions automatically checked for? What were the authors’ solutions for the additional staff required and costs incurred for the professional support? And what would the authors recommend if an oncology service provider cannot offer all these services? Should they be excluded from providing oncology services altogether?
Often, however, deficiencies do not lie with the provider. How should we deal with patients who cannot follow complex oral medication plans (vulnerable adults)? How should we measure adherence, and from what degree of non-adherence on should we refuse prescribing oral cancer medication?
Complex bureaucratic systems—such as the new requirements for prescribing oral anti-cancer drugs—are well-intended but quickly become a barrier. In the Anglo-American sphere, the term “structural iatrogenesis” has been coined (2), which describes the harm caused to patients as a result of healthcare system structures. I would have welcomed it if the authors had discussed the problems that are associated with their suggestions and—even better—to report how they themselves managed to solve these problems.
Prof. Dr. med. Axel Matzdorff
Asklepios Klinikum Uckermark GmbH
Klinik für Innere Medizin II
Hämato-Onkologie und Palliativmedizin
|1.||Schlichtig K, Dürr P, Dörje F, Fromm MF: New oral anti-cancer drugs and medication safety. Dtsch Arztebl Int 2019; 116: 775–82 VOLLTEXT|
|2.||Stonington S, Coffa D: Structural Iatrogenesis—a 43-year-old man with „opioid misuse“. N Engl J Med 2019; 380: 701–4 CrossRef|