Factors responsible for DRPs.

IntroductionBreast cancer is the leading cancer among women globally, and its management typically involves surgery, radiotherapy, and chemotherapy. This combination of complex treatment increases the risk of drug-related problems (DRPs), which can negatively impact the quality of life as it prolongs the hospital stays, increases healthcare costs, and leads to morbidity and mortality. Research on DRPs in the context of breast cancer patients in Nepal is limited; therefore, this study aimed to identify DRPs, assess their prevalence, and examine their associated factors, while emphasizing the importance of pharmaceutical care.MethodsA cross-sectional study was conducted at Bhaktapur Cancer Hospital, Nepal, from February to May 2024. The medical records of 92 patients were reviewed to identify DRPs using the Pharmaceutical Care Network Europe V9.1 tool, along with related scientific literatures and evidence-based guidelines, and verified by two independent medical oncologists. Descriptive statistics were used to summarize the patient characteristics, while the chi-square test was used to evaluate the associations between socio-demographic and clinical characteristics with the presence of DRPs, with a p-value ResultsDRPs were identified in 91 of 92 patients (98.9%), totaling 104 events. Most DRPs (87.5%) concerned treatment safety, while 12.5% involved treatment effectiveness. Patient-related factors (43.4%) and drug selection (33.3%) were primary causes. Common adverse effects included alopecia (88.0%) and anorexia (84.8%). A significant association was observed between adverse drug reactions (ADRs) and DRPs (Fisher’s exact p-value = 0.011).ConclusionDRPs were highly prevalent among breast cancer patients, mainly due to safety issues, with ADRs significantly contributing to it. Findings highlight the need for larger multicentric and cohort studies, and integration of oncology pharmacy services to optimize pharmaceutical care and minimize DRPs.

引言
乳腺癌是全球女性中发病率最高的恶性肿瘤，其临床治疗通常采用手术、放射治疗与化学药物治疗联合方案。这类复杂的联合治疗会提升药物相关问题（drug-related problems, DRPs）的发生风险，而药物相关问题可通过延长住院时长、增加医疗负担、提升发病率与死亡率等途径，对患者生活质量造成负面影响。目前针对尼泊尔乳腺癌患者的药物相关问题研究较为匮乏，因此本研究旨在明确尼泊尔乳腺癌患者的药物相关问题类型、评估其患病率，并分析相关影响因素，同时强调药学监护的重要性。

方法
本研究于2024年2月至5月在尼泊尔巴克塔普尔肿瘤医院开展横断面研究。研究人员通过欧洲药学监护网络（Pharmaceutical Care Network Europe, PCNE）V9.1工具，并结合相关科学文献与循证指南，对92例患者的病历资料进行回顾分析以识别药物相关问题，并由两名独立的肿瘤内科医师对结果进行复核。采用描述性统计方法对患者基线特征进行汇总分析，使用卡方检验评估社会人口学特征与临床特征与药物相关问题发生情况的相关性，以p值

结果
92例患者中共有91例检出药物相关问题，检出率达98.9%，共计发生104起药物相关问题事件。其中绝大多数药物相关问题（87.5%）与治疗安全性相关，剩余12.5%涉及治疗有效性。患者相关因素（43.4%）与药物选择（33.3%）为主要诱因。常见不良反应包括脱发（88.0%）与食欲减退（84.8%）。研究发现药物不良反应（adverse drug reactions, ADRs）与药物相关问题存在显著相关性（Fisher确切概率法p值=0.011）。

结论
乳腺癌患者群体中药物相关问题患病率极高，且多与治疗安全性问题相关，药物不良反应对其发生具有显著促进作用。本研究结果提示，未来需开展更大规模的多中心队列研究，并整合肿瘤药学服务体系，以优化药学监护、降低药物相关问题的发生风险。