It was estimated that greater than 4.2 million new cancer would be diagnosed and 2.8 million cancer deaths would occur in China in 2018 . A non-negligible and long-standing fact is the oncologists are overload in work, which will directly result in shortened time for individual patient and reset the priority in tumor patient management. As a consequence, the treatment efficacy and survival are in high priority, however, the DRPs or other secondary problems in chemotherapy are quite possible marginalized. Polypharmacy and altered metabolic profile in tumor patients would increase the risk of drug-drug interactions, overdose and frequency of adverse drug reactions. On the other hand, the polypharmacy, comorbidity, aging might complicate the situation and contribute to under-prescribing [12, 22, 23]. In a delicate condition or more exactly a dilemma of chemotherapy the oncologists eagerly need the involvement of multi-disciplinary experts especially the role of pharmacists in patients management [24–26].
Fortunately we clinical pharmacists were trained since China’s first time introducing the MTM mode from US in 2015 [12, 27–29]. In phase I development we have established the first anti-neoplastic MTM system in Shanghai in 2018 as a result of cooperation of oncologists, clinic pharmacists and software engineers. This MTM workstation also designed to facilitate the communication and cooperation of professionals of different backgrounds, which has been proved to improve patient and physician satisfaction and coordination [30, 31]. This anti-neoplastic MTM can be viewed as an extension of hospital information system, which differs from most prevalent MTM such as in United States of America, or commercial insurance agencies [32, 33]. Up to date the a few MTM systems have concentrated on the medication record development, medication action plan development, patient follow up . We obtained a patent on anti-neoplastic MTM system. However, limited by resources available our clinic can serve patients only for half a day per week, 6–10 patients each time, at present. The ongoing phase II development is more ambitious by incorporating the MTM into the whole medical group system and will collect information through mobile terminal devices.
Five leading tumor types recorded in our anti-neoplastic MTM system were bone, lung, breast, colorectal and prostate cancer. This profile differs from the list of causes of death of China in which the lung, liver, stomach, esophageal and colorectal cancer were the first five diseases. This discrepancy might attribute to the relative advantages of department of orthopedics in our hospital. However, the tumor patients came from more than ten provinces in China. Also a broad geographic distribution will add the difficulty in following up. Our phase II development of MTM system will aim to overcome some known obstacles, facilitate the communication, integrate deeply into current systems. Also we anticipated an increased MTM clinic visit rate , the requirement of growth of pharmacists in dealing with molecular and personalized data [26, 36, 37].
Medication non-adherence would affect health outcomes and overall healthcare cost . In order to improve the patients’ adherence, we provided the MMAS–8 for those patients with serious DRPs who were more likely to be frustrated. The adherence score hence provided the clinical pharmacists a direct measurement despite of only 15% (29/190) patients indicated non-adherence. However, the non-adherence in patients might be more common [38, 39], and the involvement of clinical pharmacists would improve patients’ adherence [40, 41].
Currently, the sample size and time span are insufficient for a robust inference, the gene related data can not be incorporated into the medication action plan, avenues for communication and patient education have not integrated into MTM system, the MTM workstation has not intervene into the whole process of patient management, still we lack tools to enhance the personalized medication in short term. However, through anti-neoplastic MTM practice the clinical pharmacists are realizing their role in multiple stages of patient management. The pharmacists should be accessible to the general public and professional alike  to promote the effectiveness, safety and rational use of medications.