Clinically relevant drug interactions between anticancer drugs and psychotropic agents

YAP K.Y.‐L., TAY W.L., CHUI W.K. & CHAN A. (2011) European Journal of Cancer Care 20 , 6–32
Clinically relevant drug interactions between anticancer drugs and psychotropic agents Drug interactions are commonly seen in the treatment of cancer patients. Psychotropics are often indicated for these patients since they may also suffer from pre‐existing psychological disorders or experience insomnia and anxiety associated with cancer therapy. Thus, the risk of anticancer drug (ACD)‐psychotropic drug–drug interactions (DDIs) is high. Drug interactions were compiled from the British National Formulary (53rd edn), Lexi‐Comp's Drug Information Handbook (15th edn), Micromedex® (v5.1), Hansten & Horn's Drug Interactions (2000) and Drug Interaction Facts (2008 edn). Product information of the individual drugs, as well as documented literature on ACD‐psychotropic interactions from PubMed and other databases was also incorporated. This paper identifies clinically important ACD‐psychotropic DDIs that are frequently observed. Pharmacokinetic DDIs were observed for tyrosine kinase inhibitors, corticosteroids and antimicrotubule agents due to their inhibitory or inductive effects on cytochrome P450 isoenzymes. Pharmacodynamic DDIs were identified for thalidomide with central nervous system depressants, procarbazine with antidepressants, myelosuppressive ACDs with clozapine and anthracyclines with QT‐prolonging psychotropics. Clinicians should be vigilant when psychotropics are prescribed concurrently with ACDs. Close monitoring of plasma drug levels should be carried out to avoid toxicity in the patient, as well as to ensure adequate chemotherapeutic and psychotropic coverage.     

Occupational health and safety of personnel handling chemotherapeutic agents in Greek hospitals

CONSTANTINIDIS T.C., VAGKA E., DALLIDOU P., BASTA P., DRAKOPOULOS V., KAKOLYRIS S. & CHATZAKI E. (2011) European Journal of Cancer Care 20 , 123–131
Occupational health and safety of personnel handling chemotherapeutic agents in Greek hospitals The expansion of chemotherapy raised concerns about the health and safety of hospital personnel. Very little is known about the conditions of handling of chemotherapeutic agents by healthcare workers in Greece and possible adverse effects related to their safety practices, as well as the safety policies adopted by the Greek hospitals. A self‐evaluation questionnaire was completed by 353 healthcare workers involved with the use of chemotherapeutic drugs in 24 Greek hospitals and the answers were statistically analysed. The majority of the healthcare workers are aware of the dangers of their work, although they had received limited training and medical surveillance. A significant percentage of them does not use personal protective equipment or use it inadequately. The safety design of their workplace is rather poor. Different health problems have been experienced, deriving from the respiratory, central nervous system, reproductive, gastrointestinal and musculoskeletal system. The improvement of safety training and procedures as well as medical surveillance seems to be a vital priority of hospital administration in Greece, in order to comply with the European guidelines and for the prevention of occupational diseases and environmental pollution.     

‘Listening to Patients’: what is the value of age‐appropriate care to teenagers and young adults with cancer?

MARRIS S., MORGAN S. & STARK D. (2010) European Journal of Cancer Care 20 , 145–151 ‘Listening to Patients’: what is the value of age‐appropriate care to teenagers and young adults with cancer? Current healthcare policy increasingly recognises the importance of patient experience in determining care. The 2005 UK National Institute for Health and Clinical Excellence Improving Outcomes Guidance encompasses caring for young people with cancer in an age‐appropriate model of care developing regional principal treatment centres for this purpose. When published this was based upon limited outcomes evidence, and only a small amount of teenage and young adult patient and parent opinion. We have systematically reviewed the literature between 1996 and 2008, examining how far the experiences of this patient group support or refute the current policy. The recent literature describes with increasing consistency that teenage and young adult cancer patients have specific care needs, and gain benefits from an age‐appropriate environment of care, including peer group support, age‐appropriate information, recreational and vocational support, and staff expert in both the cancer and care of their age group. Many patients are prepared to travel to receive such care, if services are not in place to deliver excellent shared care between principal treatment centres and services nearer home. Some of these needs are unmet in non‐specialist units. There remains, however, a paucity of rigorous comparative studies quantifying the value of specialist cancer care for this patient group.     

Experiencing genetic counselling for hereditary cancers: the client's perspective

MENDES Á.F., SANTOS T.A. & SOUSA L. (2010) European Journal of Cancer Care 20 , 204–211 Experiencing genetic counselling for hereditary cancers: the client's perspective As genetic health care expands and genetic testing becomes more widely available, it becomes relevant to understand how individuals involved in genetic counselling are integrating this new information in health management and into their lives. This article examines the client's experiences of genetic counselling for hereditary cancers, which definitely play a major role in the assessment of their needs and also lead to improvement of the psychosocial focus in genetic counselling protocols. Methods include a semi‐structured interview, administered in two focus groups, comprising 10 (5 + 5) participants after attending genetic counselling for hereditary cancers at a Portuguese public hospital. Findings suggest an experience embedded in two dimensions: (1) instrumental (goals, needs and decision making); and (2) emotional (uncertainty regarding genetic risk screening and an emotional complex). Ambiguity plays a crucial role, especially in two moments: (1) the hiatus between genetic testing and the screening results; and (2) after being confirmed as carrying a cancer susceptibility gene mutation. The spectrum of genetic illness comprises an intensely complex emotional experience that challenges individuals and their families in terms of health management, and personal and family planning. Recommendations are included in order to enhance the services available by expanding psychosocial support.     

Anxiety,helplessness/hopelessness and ‘desire for hastened death’ in Korean cancer patients

SHIM E.‐J. & HAHM B.‐J. (2011) European Journal of Cancer Care 20 , 395–402
Anxiety, helplessness/hopelessness and ‘desire for hastened death’ in Korean cancer patients Despite a relatively high rate of suicide associated with cancer, this issue has not been explored in Korean patients. This study investigates the prevalence and factors related to ‘the desire for hastened death’ (DHD) in Korean cancer patients. A cross‐sectional survey using standardised measures, including the Schedule of Attitudes toward Hastened Death and the Hospital Anxiety and Depression Scale, was performed with 131 patients with different types of cancer. 13.7% of the participants experienced moderate DHD (Schedule of Attitudes toward Hastened Death scores 5–9) and 1.7% experienced high DHD (≥10). Socio‐demographic and disease‐associated factors of the DHD included age, overall health and shortness of breath. The majority of psychosocial variables such as sadness, distress, ‘helplessness/hopelessness’ and ‘anxious preoccupation’ had a moderate association with DHD. Patients with a clinically significant level of anxiety or depression reported higher levels of DHD. Other significant correlates included ‘meaning/peace’, a sense of burdening family, dignity impairment and suicidal thoughts after diagnosis. Helplessness/hopelessness and anxiety were the strongest predictors of DHD in multivariate analysis. In view of significant role of helplessness/hopelessness and anxiety in the DHD of cancer patients, careful monitoring and management of these factors should be an integral part of cancer care to reduce the occurrence of DHD.     

The growing role of football as a vehicle for interventions in mental health care

In recent years there has been a growing interest in the use of football as a vehicle for mental health interventions. This paper outlines some of the ways that mental health service providers have begun to develop strategies with football clubs, the Football Association and government departments that involve playing or watching football and placing mental health services in football clubs. The paper also looks at how some attempts are being made at regional and national levels to develop and bring together services that use football as a vehicle for mental health service delivery.     

Use of educational games in the health professions: A mixed-methods study of educators' perspectives in the UK

Educational games have been shown to be effective in supporting learning, especially to reinforce knowledge, and students are generally positive about the use of games. The aim of this mixed-methods study that was conducted in the UK was to explore educators' views towards the use of educational games in the health sciences. The data were collected via semistructured interviews with 13 health educators and an online survey that was completed by 97 health educators. Three factors influence the use of classroom games: reflective practice, the impact of games on students, and the impact of logistical factors. Educators assess their own performance and the impact of the games on students when planning their use; however, large classes and the need for preparation time have a negative impact on educators' willingness to use games. Similar constraints might restrict the use of active learning strategies, such as simulation, that are crucial for enabling health professionals to develop competence. These issues require consideration when planning educational methods.