Uncovering drug-related problems in hospitalised cancer patients and their association with hospital readmission: A prospective study at South Kerala

BackgroundDrug-related problems (DRPs) are common among cancer patients owing to complex chemotherapy regimens, polypharmacy, narrow therapeutic indices, and treatment-related organ dysfunction.ObjectiveTo determine the prevalence, types, and causes of DRPs among hospitalised adult cancer patients and whether DRPs were independently associated with 30-day all-cause hospital readmission.MethodsA prospective observational study was conducted over 12 months in the medical oncology and haematology-oncology wards of a tertiary care teaching hospital. Adults (≥18 years) with confirmed malignancy receiving antineoplastic or supportive-care medication were enrolled consecutively. DRPs were identified using the Pharmaceutical Care Network Europe (PCNE) Classification System V9.1 through chart review, medication reconciliation, and ward rounds. Patients were followed for 30 days after discharge. Multivariable logistic regression was used to identify factors independently associated with 30-day readmissionResultsOf 412 enrolled patients, 386 completed follow-up. At least one DRP was identified in 268 patients (69.4%), with 517 DRPs overall (mean 1.9 ± 1.2 per patient). Treatment effectiveness (38.5%) and treatment safety (33.7%) were the most frequent categories. Thirty-day readmission occurred in 71 patients (18.4%). On multivariable analysis, ≥2 DRPs (adjusted OR 3.42, 95% CI 1.87-6.26), polypharmacy (≥5 medications; adjusted OR 2.15, 95% CI 1.18-3.92), ECOG performance status ≥2 (adjusted OR 2.61, 95% CI 1.34-5.09), and major drug interaction (adjusted OR 1.98, 95% CI 1.02-3.86) were independently associated with readmission.ConclusionDRPs were highly prevalent among hospitalised cancer patients and independently associated with 30-day readmission. Pharmacist-led medication review warrants evaluation in future intervention studies.