International Journal of Clinical Pharmacy

, Volume 40, Issue 2, pp 386–393 | Cite as

The differences in the assessments of side effects at an oncology outpatient clinic

  • A. Bayraktar-EkinciogluEmail author
  • E. Kucuk
Research Article


Background There is a growing interest in the use of targeted and immunotherapies in oncology. However, the assessment of side effects can be different due to interpretation of patients’ health status by healthcare professionals in oncology outpatient clinics. Objective To demonstrate the differences in the assessments of side effects conducted independently by a clinical pharmacist and nurses in patients who receive targeted therapies at an oncology outpatient clinic. Setting The study was conducted at the University Oncology Hospital in an outpatient clinic from October 2015 to March 2016. Method Patients receiving ipilimumab, nivolumab, pembrolizumab, bevacizumab, panitumumab or cetuximab during study period were included. The assessment of side effects was conducted by a pharmacist and nurse independently using the NCI-CTCAE version-2. Main outcome measure To compare the severity assessments of side effects between a clinical pharmacist and nurses in an outpatient clinic. Results During the study, 204 visits for 43 patients with a total of 5508 side effect assessments were recorded where 1137 (20.64%) assessments were graded differently. Out of 1137 assessments, 473 of them were graded higher by a clinical pharmacist whereas 664 were graded higher by nurses. Statistically significant differences were detected in the assessment of vomiting, taste changes, sense changes, alopecia, fatigue, mood changes, anxiety, hearing impairment, and allergic reactions. Conclusion An assessment of side effects by healthcare providers in patients with cancer may be challenging due to an increased workload in clinics and undistinguishable symptoms of side effects and cancer itself. Therefore, a new care model which increases an interprofessional communication may improve pharmaceutical care in oncology outpatient clinics.


Assessment Immunotherapy Nurse Pharmacist Side effects Targeted therapy Turkey 



The authors wish to thank all clinic nurses, medical oncology consultants (Professor Kilickap and Professor Erman from the Hacettepe University Cancer Institute) and the pharmacist, Kelleci-Cakir (Hacettepe University, Department of Clinical Pharmacy) for their greatly appreciated support in this study.


This work was funded by Hacettepe University Scientific Research Coordination Unit. Project Number: TKG-2016-11039.

Conflicts of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Partridge AH, Rumble RB, Carey LA, Come SE, Davidson NE, Di Leo A, et al. Chemotherapy and targeted therapy for women with human epidermal growth factor receptor 2–negative (or unknown) advanced breast cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2014;32(29):3307–29.CrossRefPubMedGoogle Scholar
  2. 2.
    Vanneman M, Dranoff G. Combining immunotherapy and targeted therapies in cancer treatment. Nat Rev Cancer. 2012;12(4):237–51.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Bonifazi M, Rossi M, Moja L, Scigliano VD, Franchi M, La Vecchia C, et al. Bevacizumab in clinical practice: prescribing appropriateness relative to national indications and safety. Oncologist. 2012;17(1):117–24.CrossRefPubMedGoogle Scholar
  4. 4.
    Garon EB, Rizvi NA, Hui R, Leighl N, Balmanoukian AS, Eder JP, et al. Pembrolizumab for the treatment of non-small-cell lung cancer. N Engl J Med. 2015;372(21):2018–28.CrossRefPubMedGoogle Scholar
  5. 5.
    Gettinger SN, Horn L, Gandhi L, Spigel DR, Antonia SJ, Rizvi NA, et al. Overall survival and long-term safety of nivolumab (anti-programmed death 1 antibody, BMS-936558, ONO-4538) in patients with previously treated advanced non-small-cell lung cancer. J Clin Oncol. 2015;33(18):2004–12.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Giusti RM, Shastri KA, Cohen MH, Keegan P, Pazdur R. FDA drug approval summary: Panitumumab (Vectibix™). Oncologist. 2007;12(5):577–83.CrossRefPubMedGoogle Scholar
  7. 7.
    Ibrahim EM, Abouelkhair KM. Clinical outcome of panitumumab for metastatic colorectal cancer with wild-type KRAS status: a meta-analysis of randomized clinical trials. Med Oncol. 2011;28:S310–7.CrossRefPubMedGoogle Scholar
  8. 8.
    R Liang, L Zheng. The efficacy and safety of panitumumab in the treatment of patients with metastatic colorectal cancer: a meta-analysis from five randomized controlled trials. Drug Des Dev Therapy. 2015;9:4471.Google Scholar
  9. 9.
    McDermott DF, Drake CG, Sznol M, Choueiri TK, Powderly JD, Smith DC, et al. Survival, durable response, and long-term safety in patients with previously treated advanced renal cell carcinoma receiving nivolumab. J Clin Oncol. 2015;33(18):2013–20.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    O’Day SJ, Maio M, Chiarion-Sileni V, Gajewski TF, Pehamberger H, Bondarenko IN, et al. Efficacy and safety of ipilimumab monotherapy in patients with pretreated advanced melanoma: a multicenter single-arm phase II study. Ann Oncol. 2010;21(8):1712–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Reck M, Rodríguez-Abreu D, Robinson AG, Hui R, Csőszi T, Fülöp A, et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med. 2016;375(19):1823–33.CrossRefPubMedGoogle Scholar
  12. 12.
    Taugourdeau-Raymond S, Rouby F, Default A, Jean-Pastor MJ. Bevacizumab-induced serious side-effects: a review of the French pharmacovigilance database. Eur J Clin Pharmacol. 2012;68(7):1103–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Topalian SL, Sznol M, McDermott DF, Kluger HM, Carvajal RD, Sharfman WH, et al. Survival, durable tumor remission, and long-term safety in patients with advanced melanoma receiving nivolumab. J Clin Oncol. 2014;32(10):1020–30.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Weber JS, Dummer R, de Pril V, Lebbé C, Hodi FS. Patterns of onset and resolution of immune-related adverse events of special interest with ipilimumab. Cancer. 2013;119(9):1675–82.CrossRefPubMedGoogle Scholar
  15. 15.
    Zhang D, Ye J, Xu T, Xiong B. Treatment related severe and fatal adverse events with cetuximab in colorectal cancer patients: a meta-analysis. J Chemother. 2013;25(3):170–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Park M-H, Jo C, Bae EY, Lee E-K. A comparison of preferences of targeted therapy for metastatic renal cell carcinoma between the patient group and health care professional group in South Korea. Value Health. 2012;15(6):933–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Atkinson TM, Li Y, Coffey CW, Sit L, Shaw M, Lavene D, et al. Reliability of adverse symptom event reporting by clinicians. Qual Life Res. 2012;21(7):1159–64.CrossRefPubMedGoogle Scholar
  18. 18.
    Mulders M, Vingerhoets A, Breed W. The impact of cancer and chemotherapy: perceptual similarities and differences between cancer patients, nurses and physicians. Eur J Oncol Nurs. 2008;12(2):97–102.CrossRefPubMedGoogle Scholar
  19. 19.
    Basch E, Iasonos A, McDonough T, Barz A, Culkin A, Kris MG, et al. Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: results of a questionnaire-based study. Lancet Oncol. 2006;7(11):903–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Common Toxicity Criteria: Version 2.0. In: Institute NC, editor. 1999.Google Scholar
  21. 21.
    Papastavrou E, Charalambous A, Vryonides S, Eleftheriou C, Merkouris A. To what extent are patients’ needs met on oncology units? The phenomenon of care rationing. Eur J Oncol Nurs. 2016;21:48–56.CrossRefPubMedGoogle Scholar
  22. 22.
    Ribed A, Romero-Jiménez RM, Escudero-Vilaplana V, Iglesias-Peinado I, Herranz-Alonso A, Codina C, et al. Pharmaceutical care program for onco-hematologic outpatients: safety, efficiency and patient satisfaction. Int J Clin Pharm. 2016;38(2):280–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Periasamy U, Mohd Sidik S, Rampal L, Fadhilah SI, Akhtari-Zavare M, Mahmud R. Effect of chemotherapy counseling by pharmacists on quality of life and psychological outcomes of oncology patients in Malaysia: a randomized control trial. Health Qual Life Outcomes. 2017;15(1):104.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Walter C, Mellor JD, Rice C, Kirsa S, Ball D, Duffy M, et al. Impact of a specialist clinical cancer pharmacist at a multidisciplinary lung cancer clinic. Asia-Pac J Clin Oncol. 2016;12(3):e367–74.CrossRefPubMedGoogle Scholar
  25. 25.
    Berglund CB, Gustafsson E, Johansson H, Bergenmar M. Nurse-led outpatient clinics in oncology care—patient satisfaction, information and continuity of care. Eur J Oncol Nurs. 2015;19(6):724–30.CrossRefPubMedGoogle Scholar
  26. 26.
    Fortner B, Baldwin S, Schwartzberg L, Houts AC. Validation of the Cancer Care Monitor items for physical symptoms and treatment side effects using expert oncology nurse evaluation. J Pain Symptom Manag. 2006;31(3):207–14.CrossRefGoogle Scholar
  27. 27.
    Abueg KD. Interprofessional management of toxicities related to cancer precision medicine. Semin Oncol Nurs. 2017;33(4):376–83.CrossRefPubMedGoogle Scholar
  28. 28.
    Ibraheem AF, Awolude OA, Habeebu M-M, Sowunmi AC, Olaniyi PA, Olopade OI, et al. Formal assessment of teamwork among cancer health care professionals in 3 large tertiary centers in Nigeria. J Clin Oncol. 2017;35(15_suppl):e18126-e.Google Scholar
  29. 29.
    Lee CT, Doran DM, Tourangeau AE, Fleshner NE. Perceived quality of interprofessional interactions between physicians and nurses in oncology outpatient clinics. Eur J Oncol Nurs. 2014;18(6):619–25.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical Pharmacy, Faculty of PharmacyHacettepe UniversitySihhiyeTurkey

Personalised recommendations