The rapid growth of the internet and the World Wide Web has led to the development of pharmacoinformatics technologies to assist oncology healthcare professionals in delivering optimum pharmaceutical care and health-related outcomes. The proliferation of online health information has also empowered patients with cancer with the knowledge to better participate in the management of their own condition. This chapter introduces the evolving roles of pharmacoinformatics in oncology and discusses some problems that have arisen due to these technologies. Various pharmacoinformatics channels for practitioners and patients are described together with drug interaction parameters that are clinically relevant to oncology clinicians. Additionally, this chapter addresses certain quality issues associated with online anticancer drug interactions and proposes several design principles for developers of pharmacoinformatics tools. Finally, readers will be given an insight as to how pharmacoinformatics can be harnessed for the future improvement of pharmaceutical care in patients with chronic diseases such as cancer.
TopIntroduction
The practice of pharmaceutical care forms the cornerstone of any health science discipline which concerns itself with the rational use of drugs. Its concept combines a careful blend of caring orientation with specialized therapeutic knowledge, experiences, and judgments, so as to ensure optimal medication-related outcomes (American College of Clinical Pharmacy, 2005; American Society of Hospital Pharmacists, 1993). These outcomes include the prevention or cure of diseases, elimination or reduction of symptoms, and slowing or arresting of disease processes (American Society of Hospital Pharmacists, 1993). Healthcare professionals, particularly clinical pharmacists, apply their knowledge and understanding of evidence-based therapeutic guidelines, evolving sciences and relevant ethical, social and economic principles so as to provide optimal medication therapy management in direct patient care settings. Clinical researchers, on the other hand, aim to contribute to new knowledge which improves the patients’ health and quality of life (American College of Clinical Pharmacy, 2005).
Pharmaceutical care is essential in helping patients make the best use of their medications, and is applicable and achievable in any practice setting. It involves identifying, solving and preventing potential or actual drug-related problems with regards to a patient’s drug therapy (American Society of Hospital Pharmacists, 1993; Westerlund, Almarsdóttir, & Melander, 1999). There are a number of definitions to drug-related problems, but in essence, they can be easily understood as events or circumstances involving drug therapies that can actually or potentially interfere with the desired health outcomes for patients (American Society of Hospital Pharmacists, 1993; van Mil, Westerlund, Hersberger, & Schaefer, 2004). The Pharmaceutical Care Network Europe Foundation classifies drug-related problems in terms of problems and causes (Table 1) (Pharmaceutical Care Network Europe, 2006). The former classification identifies the drug-related problems in terms of dosing, drug use and drug choice problems, as well as potential drug-drug, drug-food or drug-herb interactions, and adverse drug reactions. On the other hand, drug-related problems can also be due to the drug/dose selection and process, or patient-related and pharmacy logistics issues. A lack of knowledge or misinterpretation of information about the drug and its use can contribute to such drug-related problems, leading to patient non-compliance, and the patients’ safety and quality of life can be significantly compromised if they are not treated effectively and appropriately.
Table 1. Classification of drug-related problems (adapted with modification from the Pharmaceutical Care Network Europe, 2006)
| Drug-related problem | Meaning |
| Classification by Problems |
| Adverse reaction(s) | Patient suffers from an adverse drug event. |
| Drug choice problem | Patient gets or is going to get a wrong or no drug for his/her disease and/or condition. |
| Dosing problem | Patient gets more or less than the amount of drug he/she requires. |
| Drug use problem | Wrong or no drug taken/administered. |
| Drug Interactions | There is a manifest or potential drug-drug, drug-food or drug-herb interaction. |
| Other | Other types of drug-related problems. |
| Classification by Causes |
| Drug/dose selection | Cause is related to selection of drug and/or dosage schedule. |
| Drug use process | Cause is related to the way patient uses the drug, in spite of proper dosage instructions on the label. |
| Information | Cause is related to an absence or misinterpretation of information. |
| Patient | Cause is related to personality or behavior of patient. |
| Logistics | Cause is related to the logistics of the prescribing or dispensing mechanism. |
| Other | Other causes of drug-related problems. |