| Abstract | Liječenje raka dojke uzrokuje brojne nuspojave koje mogu narušiti kvalitetu života pacijentica što je jedan od glavnih razloga odustajanja od liječenja. Uslugom upravljanja farmakoterapijom (UF) moguće je umanjiti nuspojave i posljedično doprinijeti poboljšanju kvalitete života i adherencije.
Cilj ovog diplomskog rada bio je odrediti vrstu i učestalost terapijskih problema (TP) u pacijentica s dijagnosticiranim rakom dojke kojima je u Farmakoterapijskom savjetovalištu Doma zdravlja Zagreb - Centar (DZZC) pružena usluga upravljanja farmakoterapijom.
Provedeno je prospektivno intervencijsko istraživanje u DZZC u razdoblju od studenog 2022. do veljače 2024. godine. U istraživanje su bili uključene pacijentice starije od 18 godina s postavljenom dijagnozom raka dojke koje su u FTS prošle najmanje jednu konzultaciju. Sociodemografski, antropometrijski i klinički podaci prikupljeni su iz razgovora s pacijenticom te iz medicinske dokumentacije, a podaci o TP i lijekovima ekstrahirani su iz sustava za dokumentaciju. Identifikacija TP temeljila se na kategorizaciji prema Cipolle i sur., 2012.
U provedeno istraživanje bila je uključena 81 pacijentica prosječne dobi 58,19 (±12,76) godina koje su u prosjeku bolovale od 10,05 (± 7,09) komorbiditeta te koristile 6,89 (± 4,44) lijekova i 3,85 (± 3,90) dodatka prehrani. Na prvoj konzultaciji identificirano je ukupno 416 TP, od kojih su najučestaliji bili “Potreba za uvođenjem dodatne terapije” (46,63%), “Nepotrebna terapija” (13,46%), “Preniska doza” (11,78%) i “Nuspojava lijeka” (10,82%). Lijekovi kod kojih su bili najčešće identificirani TP su: kolekalciferol (13,51%), rosuvastatin (6,76%), letrozol (6,76%), topikalni kortikosteroidi (5,41%) i tamoksifen (5,41%). Dodatci prehrani kod kojih su bili najčešće identificirani TP su: vitamini B kompleksa (9,29%), beta glukani (6,56%), vaginalete za vlaženje rodnice (6,01%), magnezij (4,92%) i vitamin C (4,92%). Najčešće provedene intervencije uključivale su “Preporuka dodatka prehrani/dermatokozmetike/biljnog pripravka” (24,52%), “Uvođenje nove terapije” (16,11%), “Edukacija pacijenta (12,98%) i “Prekid uzimanja dodatka prehrani” (11,06%). Od ukupno 58 intervencija predloženih liječnicima obiteljske medicine, 89, 66% ih je bilo prihvaćeno, a od ukupno 179 intervencija predloženih pacijenticama, 91,06% ih je bilo prihvaćeno.
Veliki broj identificiranih terapijskih problema ukazuje na potrebu za uključivanjem ljekarnika u skrb pacijentica oboljelih od raka dojke. Visoka učestalost upotrebe lijekova i dodataka prehrani zahtijeva nadzor terapije, kontrolu kliničkih ishoda i osiguravanje sigurne primjene dodataka prehrani. Visok stupanj prihvaćenosti intervencija potvrđuje spremnost na suradnju i uključivanje ljekarnika u skrb onkoloških bolesnika radi sprječavanja terapijskih problema. |
| Abstract (english) | Breast cancer treatment causes numerous side effects that can deteriorate the quality of life for patients, which is one of the main reasons for treatment discontinuation. Comprehensive Medication Management services (CMM) can reduce these side effects and consequently contribute to improving quality of life and adherence.
The aim of this thesis was to determine the type and frequency of drug therapy problems (DTPs) in patients diagnosed with breast cancer who received CMM services at the Pharmacotherapy Counseling Center of the Health Center Zagreb - Centar (DZZC).
A prospective interventional study was conducted at the DZZC from November 2022 to February 2024. The study included patients over 18 years old with diagnosed breast cancer who attended at least one consultation at the Counseling Center. Sociodemographic, anthropometric, and clinical data were collected through patient interviews and medical records, while data on drug therapy problems and medications were extracted from the documentation system. The identification of drug therapy problems was based on the categorization by Cipolle et al., 2012.
The study included 81 patients with an average age of 58.19 (±12.76) years, who had an average of 10.05 (±7.09) comorbidities, used 6.89 (±4.44) medications, and 3.85 (±3.90) dietary supplements. A total of 416 DTPs were identified during the first consultation, with the most frequent being “Need for additional therapy” (46.63%), “Unnecessary therapy” (13.46%), “Dose too low” (11.78%), and “Adverse drug reaction” (10.82%). The medications most frequently associated with DTPs were: cholecalciferol (13.51%), rosuvastatin (6.76%), letrozole (6.76%), topical corticosteroids (5.41%), and tamoxifen (5.41%). The dietary supplements most frequently associated with DTPs were: B-complex vitamins (9.29%), beta glucans (6.56%), vaginal moisturizers (6.01%), magnesium (4.92%), and vitamin C (4.92%). The most common interventions included “Recommendation of dietary supplement/dermatocosmetic/herbal preparation” (24.52%), “Introduction of new therapy” (16.11%), “Patient education” (12.98%), and “Discontinuation of dietary supplement” (11.06%). Out of 58 interventions proposed to family doctors, 89.66% were accepted, and out of 179 interventions proposed to patients, 91.06% were accepted.
The large number of identified drug therapy problems indicates the need for involving pharmacists in the care of breast cancer patients. The high prevalence of medication and supplement use requires therapy monitoring, control of clinical outcomes, and ensuring the safe use of dietary supplements. The high acceptance rate of interventions confirms the readiness for collaboration and the inclusion of pharmacists in the care of oncology patients to prevent drug therapy problems. |
