Comparative Study of Utilization Pattern of Chemotherapeutic Agents Among Self Funded and Government Funded Patients of Breast Cancer in a Developing Country

Abstract

ABSTRACT Aim: This study was conducted to assess and compare utilization pattern and appropriateness of anti-cancer drugs among self funded (SF) and government funded (GF) patients of breast cancer. Methods: In a prospective study medication orders of patients on chemotherapy for breast cancer were reviewed and patients were interviewed to assess treatment pattern and its appropriateness in a specialty oncology hospital having dedicated GF wards. Clinical stage of the disease, tumor characteristics, drug selection, dose, administration technique and anti-emetics used were reviewed for patients in general wards and GF wards of the study hospital, with respect to standard international recommendations to evaluate the appropriateness of the chemotherapy. Results: A total of 126 patients (SF patients (n = 68), GF patients (n = 58)) were followed over six months. A use of anthracycline based regimen was higher compared to cyclophosphamide, methotrexate and 5-fluorouracil regimen in both, SF & GF patients. Targeted therapy was prescribed to only 33% of HER2 positive SF patients and no targeted therapy was prescribed for HER2 positive GF patients (n = 7).Endocrine therapy, as either anti-estrogens or aromatase inhibitor was prescribed for 100% of SF and GF patients. Selection of chemotherapy regimen was appropriate in 94% of SF patients and 96% of GF patients. Doses of anti-cancer drugs were not calculated as per latest body surface area during subsequent cycle for 22% of SF patients and 38% of GF patients. Inappropriate administration of drugs was found due to excess dilution of drugs (In SF patients: 25%, In GF patients: 40%) and improper infusion time (In SF patients (29%), In GF patients (41%)). Choice of anti-emetics was inappropriate in 38% of SF cases and 56% of GF cases. Dose and frequency of anti-emetics were inappropriate in 28% of SF patients and 42% of GF patients. Conclusions: Selection of anti-cancer agents was observed to be well compliant with standard recommendations in both, SF and GF settings. However, lack of adherence to the prescribed chemotherapy was found higher due to inappropriate administration in both settings. Use of targeted therapy was limited due to economic considerations. Inappropriate use of anti-emetics was found more in GF patients due to limited budget. Appropriate nursing education and training can improve the delivery of chemotherapy. Disclosure: All authors have declared no conflicts of interest.