Kevin W Hall

High Technology Drugs for Cancer

The management of drugs used in the treatment of cancer i s receiving increased attention because of the recent acceleration in the pace of new drug developmcni . Biotechnology prod ucts used primarily for the lreatment of cancer patients, such as aldesleukin (interleu kin-2), fi lgrastim (granulocyte colony-stimulating factor; rG-CSF) and sargramostim (granulocyte-macrophage colonystimulating fac tor; rGM·CSF). have already reached the marketplace. Antisense oligodeoxynucleotides current ly bein g studied may enable manipulation of individual nucleic ac id sequences (oncogenes) that encode fo r proteins active in the malignant process (Beardsley 1992; Heikkila et al. 1987; Szczylik et al. 1991 ). Limited trials of genetically modified cells for treatment of breast and ovarian cancer, me lanoma and brain cancer are pending as well (Erickson 1992). Although high tech nology dru gs are oflen equated with the products of biotechnology (HerfindaI1989), other new pharmaceutical technologies are a lso bei ng used t o produce innovative drugs and dosage forms for cancer therapy. Nanopartic les, microcapsules, microspheres, liposomes and polyethylene glycol covalent linkages represent new microcarrier system s that selectively deliver drug molecu les to malignant tissue or reduce toxicity in normal tissue (Gupta 1990: Ho et al. 1986: Ranade 1989). High technology drugs are very expensive to deve lop and produce. Extensive precl inical and cl inical testing are necessary before approval for marketing. As new molecular targets emerge, and as the rate o f n ew drug introductions increases, individuals, institutions and governments will have to decide w hether the benefits of these therapies merit their costs. This necessitates a structured. disciplined approach to drug evaluation, formulary selection and drug use monitoring. Incorporation of pharmacoeconomic evaluation into the drug selection process for high technology cancer drugs will undoubtedly form an important part of this process. Although some data have been generated on the pharmacoeconom ics of b iot echnology drugs (Jones-Grizzle & Boetman 1992), there are limi ted data concerni ng the pharmacoeconomics of other high technology drugs for cancer. In this article we review the approaches used t o evaluate and select cancer drugs for inclusion in the formulary, based on a survey of English language literature since 1984.

Prioritizing Pharmaceutical Activities A Simulation by Pharmacy Residents

Objectives: The primary objective was to examine the consistency of prioritization decisions made by pharmacy residents in a simulated environment where the available resources are constrained. Secondary objectives were to rank the factors that influenced their prioritization and to compare the residents’ results with those of Canadian pharmacy leaders. Methods: We have developed a prioritization exercise that aims at evaluating how pharmaceutical activities are prioritized. The simulation was conducted with hospital pharmacy residents in 2 Quebec universities in 2011. Results: Residents covered a similar number of activities in the prioritization simulation (mean 27 of 32). Teams tended to favor a broad range of services delivered less comprehensively. Participants ranked “perception of the favorable impact of the activity on health outcomes” higher than “conclusive evidence available to support the decisions.” The relative weight attributed per domain was similar between pharmacy residents and pharmacy leaders, but their ranking of factors that influenced their decisions was different. Conclusions: Pharmacy residents opted to provide a wide range of services, but at a low level of comprehensiveness. The high variation between each team’s coverage per activity in this simulation supports the observation that pharmacy residents do not agree on a core set of pharmaceutical activities that should be prioritized.

Mixed messages: The Blueprint for Pharmacy and a communication gap.

Background: More than 5 years ago, the Blueprint for Pharmacy developed a plan for transitioning pharmacy practice toward more patient-centred care. Much of the strategy for change involves communicating the new vision. Objective: To evaluate the communication of the Vision for Pharmacy by the organizations and corporations that signed the Blueprint for Pharmacy’s Commitment to Act. Methods: The list of 88 signatories of the Commitment to Act was obtained from the Blueprint for Pharmacy document. The website of each of these signatories was searched for all references to the Blueprint for Pharmacy or Vision for Pharmacy. Each of the identified references was then analyzed using summative content analysis. Results: A total of 934 references were identified from the webpages of the 88 signatories. Of these references, 549 were merely links to the Blueprint for Pharmacy’s website, 350 of the references provided some detailed information about the Blueprint for Pharmacy and only 35 references provided any specific plans to transition pharmacy practice. Conclusion: Widespread proliferation of the Vision for Pharmacy has not been achieved. One possible explanation for this is that communication of the vision by the signatories has been incomplete. To ensure the success of future communications, change leaders must develop strategies that consider how individual pharmacists and pharmacies understand the message.