Prescribing Pattern of Anticancer Drugs in a Medical Oncology Department of a Tertiary Care Teaching Hospital
2 Pharm.D Intern, Faculty of Pharmacy, Sri Ramachandra Medical College and Research Institute, Deemed to be University, Porur, Chennai, India
3 Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Medical College and Research Institute, Deemed to be University, Porur, Chennai, India
Citation: Manichavasagam M, et al. Prescribing Pattern of Anticancer Drugs in a Medical Oncology Department of a Tertiary Care Teaching Hospital. Ann Med Health Sci Res. 2017; 7: 1-3
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Background: Study of prescribing pattern is a potential tool in ascertaining the role of drugs in society and it has to be carried out at any hospital periodically. Objective: The study is aimed to study the prescribing pattern of anticancer drugs in medical oncology department of a tertiary care hospital, Tamilnadu. Materials and Methods: Each prescription was studied for the patient’s demographic details, name of the drug, dose, dosage form, frequency, duration etc. Commonly used anticancer drugs and various types of cancer were noted and the percentage of drugs prescribed from national essential drug list was assessed. Results: The study revealed that majority of cancer cases was evident in the age groups between 55 to 65 years. Out of 328 patients, 179 were female and 149 were male patients. Breast cancer was found to be most prevalent among females followed by ovary and stomach cancer. In male, lung cancer was more common followed by stomach. The majority of drugs prescribed were alkylating agents followed by antimetabolites, plant derivatives, cytotoxic antibiotics and glucocorticoids. Conclusion: The utilization of anticancer drugs in this hospital was found to be rational and more than 70% of drugs were prescribed from the National essential drug list. Assessment of pattern of prescribing should be conducted periodically to minimize the untoward effects at least to some extent.
Prescribing pattern; Cancer; Prescription
Prescribing pattern is a potential tool in ascertaining the role of drugs in society. It greatly helps in healthcare budgets making. Prescribing pattern is a process of analysis of prescription use of drugs.  Potential hazard to the patients are led by inappropriate use of drugs. Periodic review of the drug utilization is one way to prevent such a hazards to patients and also to ensure the safety and effectiveness of treatment.  Physicians play a vital role in making healthcare related decisions about the usage of health resources. However, with respect to drugs, pharmacists are the bridging bond between the patients and their usage of drugs. By doing prescription analysis, pharmacists interact with their patients about their medications. The present study is carried out by pharmacists in analyzing the drug utilization review of anticancer drugs with the objectives (1) to analyze the classes of drugs being prescribed, (2) to study the usage of adjuvant drugs accompanied in the drug therapy, (3) to analyze the anticancer drugs prescribed from the National essential drug list.
Inappropriate use of drugs is a common problem all over the world especially in the developing countries. Due to continuous increase in the number of medicines and multiple options in the treatment provides an increase in the inappropriate use of medicine. The effect of irrational use of the drugs in the healthcare system leads to decrease in the quality of medicine or therapy which raises the morbidity and mortality and also leads to risk of untoward effects. Especially, in a developing country like India, inappropriate prescription is a common problem where this study of drug use evaluation can be useful. Most of the studies of drug use evaluation have followed effective methods to determine their outcome. 
Cancer is widely accepted as one of the most frightening the humans especially in developing countries. Cancer annually affects 10 million people and causes 6 million deaths worldwide. It is expected that 300 million new cases of cancer and 200 million deaths from the disease will occur globally in the next 25 years, with almost two third of cases arising in developing countries (WHO, 1999). Cancer is an abnormal growth of tissue which of its form commonly called as neoplasm. It can be treated by radiation therapy, chemotherapy, surgery, other therapy like immunotherapy; biological agents are routinely used in cancer treatment. Chemotherapy or chemotherapeutic agent is the medication used to destroy cancer cells. 
Material and Methods
A prospective study, cross-sectional study was conducted in the Department of Medical Oncology, Sri Ramachandra Medical Center, Sri Ramachandra University, Porur, Chennai, which is a tertiary care hospital. The patient belonged to the oncology unit of both private and government block were included. Prior permission was obtained from the department of oncology for conducting this study.
The data were collected from inpatient prescription records at the hospital in a specially designed data collection form. Each prescription was critically studied for the patient’s demographic details such as patient’s name, age, gender, date of consultation etc. Name of the drug, dose, dosage form, frequency, duration were noted. The drugs prescribed in each prescription were carefully noted and the following parameter was used to assess the rationality of prescriptions, (1) Segregation of prescription in age wise, (2) Categorization of drugs prescribed with respective to gender, (3) Therapeutic category, (4) Percentage of drugs prescribed from national list of essential mediatory.
Result and Discussion
A total of 328 cancer patients’ prescription was studied. The age wise distribution of cancer patients is shown in Figure 1. The study revealed that majority of cancer cases was evident in the age groups between 55 to 65 years. The age wise distribution of the patient showed that there was higher incidence of cancer in this age group. The total incidence of the case constituted 30.7% of the total age group. The next susceptible age group of patient prone to cancer was found to be 45 to 55 years.
Several mechanisms have been proposed for explaining how vulnerability of cancer increases with age. [5-7] Aging makes an organism susceptible to cancer due to hormonal disturbance increase in number of loci of chronic proliferation, and the decline in the immune surveillance. Exposure to infectious agents or creation of pro-oncogenic tissue microenvironment with increasing age can promote the development of cancer. [8,9]
The study revealed that out of 328 patients, there were 179 female patients and 149 male patients. The greater prevalence of cancer in females can be because of the involvement of their reproductive system such as the ovarian cancer, breast cancer, and cervical cancer which occupy the major portion among all other forms of cancer. [10,11] These susceptible body parts cause greater incidence of cancer problems in females. [12,13]
Out of 179 female patients, the most affected age group was 46- 55 years which constituted about 34.23% and the least affected age group was 18-25 years which constituted only 0.74% of the total patients. Out of 179 female patients, breast cancer was found to be most prevalent which constitutes about 32.96% of the total cases. The next prevalent cancer was in ovary and stomach which constituted about 15.64% and 14.52% respectively. This observation is in accordance with Darshan et al. 
Out of 149 male patients, the most affected age group was found to be 56-65 years which constituted about 38.92% and the least affected age group was found to be 18-25 years which constituted only 1.96% of the total patients. Lung cancer was found to be most prevalent in males which constitute about 22.81% of the total cases. The next prevalent cancer was in stomach which constituted about 17.44%. Same sort of observation is reported by other authors. [15-18]
There were altogether 26 different types of cancer observed during the study period. The type of cancers observed with their corresponding number of patients is shown in Table 1. The cancers were found to be affecting every systems of the body revealing the non-specific nature of the disease.
|S. No.||Types of Cancer||No. of Patients|
|8||SQ cell CART root||3|
Table 1: Various types of cancer in study patients.
The percentage of different classes of drugs prescribed in the cancer patients is presented in Figure 2. The majority of drugs prescribed was alkylating agents followed by antimetabolites, plant derivatives, cytotoxic antibiotics and glucocorticoids.
Out of 15 anti-cancer drugs mentioned in the National essential drug list by the WHO, 12 drugs (80%) were routinely prescribed to the patients for various cancer treatments. Cancer chemotherapy includes cytotoxic medicines accompanied by adjuvant and supplementing therapeutic measures. These additional medications other than the cytotoxic medicine are for reducing the side effect seen with the cancer chemotherapy. Table 2 depicts the details of the supportive drugs used.
|S. No||Drug Category||No. of Patients||Percentages|
|4.||Proton pump inhibitors|
|Potassium chloride and magnesium sulphate||21||2.28%|
Table 2: Adjuvant therapies in the management.
The present study concludes that prevalence of cancer increased with increase in age. The prevalence of cancer is more in females than males. Carcinoma of breast and cervix are common types, alkylating agents and antimetabolites are the mostly used anticancer drug. H2 antagonists, steroids, anti-emetics, supplement therapy, analgesics, proton pump inhibitors and rehydration therapy are the adjuvant therapies given along with the anticancer drugs. 73% of the total anti-cancer drugs prescribed were in the National essential drug list.
Conflict of Interest
All authors disclose that there was no conflict of interest.
- Shalini S, Ravichandran V, Mohanty BK, Dhanaraj SK, Sraswathi R. Drug utilisation studies - An overview. Int J Pharm Sci Nanotech. 2010; 3: 803-810.
- Ayesha S, Nikhattabassum H. Drug utilization evaluation of anti-cancer drugs. American J Pharmtech Research. 2014; 4: 1-13.
- Takiar R, Nadayil D, Nandakumar A. Projections of number of cancer cases in India (2010-2020) by cancer groups. Asian Pac J Cancer Prev. 2010; 11: 1045-1049.
- Bajracharya N, Karki P, Sapkota S. Prevalence pattern of cancer and handling of cytotoxic drugs. Kathmandu Univ J Sci Eng Tech. 2006; 2: 1-17.
- Amin KA, Mohamed BM, El-Wakil MA, Ibrahem SO. Impact of breast cancer and combination chemotherapy on oxidative stress, hepatic and cardiac markers. J Breast Cancer, 2012; 15: 306-312.
- Anita R, Rajanandh MG, Thanmayee G, Merin S, Suresh S, Srinivas SK. Impact of patient counseling on medication adherence, beliefs and satisfaction about oral chemotherapies in patients with metastatic cancer at a super speciality hospital. Int J Cancer Research, 2015; 11: 128-135.
- Bener A, Ayub H, Kakil R. Patterns of cancer incidence among the population of Qatar: A worldwide comparative study. Asian Pac J Cancer Prev. 2007; 8: 19.
- Anita R, Rajanandh MG. US-FDA approved chemotherapy drugs in 2014. Indian JCancer EduResearch, 2015; 3: 27-29.
- Khan G, RajKumar T, Dewashish S. Evaluation of cancer prevalence and cytotoxic medication prescribing in central region of Nepal. Kathmandu Univ J Sci Eng Tech. 2013; 9: 189-199.
- Imran A, Wani WA, Saleem K. Cancer scenario In India with future perspectives. Cancer Ther. 2011; 8: 56-70.
- Anita R, Rajanandh MG, Vivenkanandan A, Sujitha Y, Bala-Bhaskar Y, Keerthi CK. Pattern of Complementary and Alternative Medicine Use in Cancer Patients: Prospective Analysis of Medical Oncology Unit. Academic JCancer Research, 2015; 8: 40-42.
- Khan G, Thapa R, Adhikari D, Rajbhandari M, Dwa P, Shrestha S, et al. Evaluation of cancer prevalence and cytotoxic medication prescribing in central region of Nepal. Kathmandu Univ J Sci Eng Technol. 2013; 9: 189-199.
- Mary R, Suresh AVS, Shailendra D, Subbaratnam Y, Prasuna G, Naresh DTV. Prescription pattern of anticancer drugs in a tertiary care hospital. J Evibased Med Healthcare. 2015; 20: 3001-3009.
- Darshan JD, Ajita P, Dimple VS, Agarwal S, Anil Kumar G. An analysis of utilization pattern of anticancer drugs in diagnosed cases of carcinoma in a tertiary care teaching hospital. Int J Basic Applied Med Sci. 2014; 4: 251-259.
- Kulkarni MD, Hussaini SA, Padwal SL, Khandelwal PN, Doifode SM. Drug utilization review of anticancer drugs in cancer outpatient department of the government medical college, Aurangabad. Int J Basic Clin Pharmacol. 2014; 3: 879-883.
- Rajanandh MG, Suresh S, Suganya K, Vidhyalakshmi T, Sudharsan M, Thamilselvi S. Drug utilization review of anticancer drugs in medical oncology department of a tertiary care teaching hospital. Ind J Cancer Edu Research. 2017; 5: 9-12.
- Karthik S, Seenivasan P, Rajanandh MG. Pattern of chemotherapy induced alopecia. Ind J Cancer Edu Research. 2016; 4: 45-47.
- Rajanandh MG, Ramasamy C, Imran khan A. Pattern of cardiovascular drugs use in outpatients in a tertiary care hospital. Asian J Pharma Clin Research. 2012; 5: 102-105.