临床药师参与肿瘤多学科会诊的实践与体会

Practice and experience of clinical pharmacists participating in multidisciplinary consultation of cancer

目的探讨临床药师在肿瘤多学科会诊中的切入点及作用,为参与肿瘤多学科会诊提供参考借鉴。方法结合笔者参与的典型多学科会诊病例,总结临床药师在肿瘤多学科会诊中的作用。结果胰腺癌合并转氨酶升高患者治疗方案的选择,临床药师建议优选肝功能损伤时无需调整剂量的吉西他滨联合顺铂方案;吞咽困难的食管癌患者,临床药师建议患者服用替吉奥胶囊水溶液;大剂量甲氨蝶呤解救时,亚叶酸钙缺货,临床药师建议使用左亚叶酸钙替代;结肠癌合并脑梗塞患者使用贝伐珠单抗,临床药师建议起始选择小剂量贝伐珠单抗治疗。结论临床药师可以在特殊肿瘤患者治疗药物的选择、药品的替代及药物剂量优化等方面发挥药学优势,与临床形成互补,在肿瘤多学科会诊中发挥积极作用。

Objective To explore the entry point and role of clinical pharmacists in the multidisciplinary consultation of cancer,and provide reference for participating in the multidisciplinary consultation of cancer.Methods Based on the author′s typical multidisciplinary consultation,the role of clinical pharmacists in the multidisciplinary consultation of cancer was summarized.Results In selecting treatment options for patients with pancreatic cancer and elevated transaminase,clinical pharmacists recommended that gemcitabine combined with cisplatin be used,which could still be used when liver function was impaired;for patients with esophageal cancer with dysphagia,clinical pharmacists recommended that patients take S-1 capsules;high-dose methotrexate-rescue-calcium folinate was out of stock,clinical pharmacists recommended using calcium levofolinate instead;for colon cancer patients with cerebral infarction who used bevacizumab,clinical pharmacists recommended low-dose bevacizumab treatment.Conclusion Clinical pharmacists can exert their pharmaceutical advantages in the treatment of patients with special tumors,including the selection of drugs,the substitution of drugs,and the optimization of drug dosages.They can complement the clinic and play a positive role in multidisciplinary consultation of cancer.