Elbeddini 

et al.
Journal of Pharmaceutical Policy and Practice (2021) 14:98
https://doi.org/10.1186/s40545-021-00379-8

COMMENTARY Open Access

Importance of medication reconciliation

in cancer patients
Ali Elbeddini1*  , Anthony To2, Yasamin Tayefehchamani2 and Cindy Xin Wen2 

Abstract 
Cancer patients are a complex and vulnerable population whose medication history is often extensive. Medication
reconciliations in this population are especially essential, since medication discrepancies can lead to dire outcomes.
This commentary aims to describe the significance of conducting medication reconciliations in this often-forgotten
patient population. We discuss additional clinical interventions that can arise during this process as well. Medication
reconciliations provide the opportunity to identify and prevent drug–drug and herb–drug interactions. They also
provide an opportunity to appropriately adjust chemotherapy dosing according to renal and hepatic function. Finally,
reconciling medications can also provide an opportunity to identify and deprescribe inappropriate medications. While
clinical impact appears evident in this landscape, evidence of economic impact is lacking. As more cancer patients
are prescribed a combination of oral chemotherapies, intravenous chemotherapies and non-anticancer medications,
future studies should evaluate the advantages of conducting medication reconciliations in these patient populations
across multiple care settings.
Keywords:  Medication reconciliation, Oncology, Cancer

Introduction patients, it is essential to ensure their medications are

Cancer patients have many risk factors that character- optimized to achieve the best patient care outcome.
ize them as a vulnerable population. A large portion of A top priority across all health care settings is provid-
cancer patients are elderly, a population with higher inci- ing patient-centered care. When making patient care
dence rates of multiple comorbidities. Polypharmacy, decisions, it is important to gather a complete medical
frequently defined as the use of 5 or more medications, history that can be shared across all health care provid-
is also more prevalent in cancer patients. With polyphar- ers involved to ensure a seamless transition across dif-
macy, there is also an increased risk of drug interactions ferent settings. In complex patients who have multiple
as well as adverse drug reactions. In addition to existing comorbidities and are taking several medications, it is
medications, cancer patients are frequently administered especially crucial to identify discrepancies and to ensure
chemotherapy, hormone therapy, biological agents and medication safety. Medication reconciliation is a pro-
supportive therapies, thereby causing polypharmacy in cess that specifically seeks to improve medication safety
this population. Moreover, cancer is heavily taxing on across different points of care. It consists of obtaining a
the body and can cause organ failure and systemic dete- comprehensive list of all medications taken by a patient
rioration, increasing the risk of complications through- and comparing it to the current drug regimen to identify
out its progression. Due to the complex nature of cancer and resolve any discrepancies. Although many health-
care professionals can offer assistance in the process,
pharmacists are often considered the best suited role to
*Correspondence: [email protected]
1
Chairman of the Pharmacy Department, Winchester District Memorial perform the medication reconciliation. Current literature
Hospital, 566 Louise Street, Winchester, ON KK0C2K0, Canada surrounding the benefit of medication reconciliations is
Full list of author information is available at the end of the article disproportionate as there are many studies done in other

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Elbeddini et al. Journal of Pharmaceutical Policy and Practice (2021) 14:98 Page 2 of 10

populations, while only a few done in oncology patients. results, where only a subgroup of cancer patients had
The aim of this commentary is to provide an overview of a reduction in hospital readmissions [8]. However, in
the importance of conducting medication reconciliations a meta-analysis by Mekonnen et  al. medication recon-
in an often-forgotten patient population, cancer patients. ciliations conducted in adult hospitalized patients from
various units were associated with a significant reduc-
Significance of conducting medication reconciliation tion in hospital readmissions and emergency depart-
in cancer patients ment visits [9]. Further evaluations are necessary to
Medication reconciliation is an essential process that determine if this association can be validated specifi-
provides value in clinical practice. Its clinical impact on cally in the cancer population.
cancer patients was recently evaluated in a systematic The economic impact of conducting medication
review by Herledan et  al. [1]. They evaluated 14 studies reconciliations in cancer patients is currently lack-
and found that medication reconciliation practices iden- ing. One study, reviewing gynaecological oncology
tified discrepancies and other drug-related problems in patients, does show promising results although it was
up to 88% and 94% of patients, respectively [1]. The most not a comparative evaluation. Son et  al. conducted a
frequent discrepancies and medication errors identified cost–benefit analysis surrounding the use of medica-
were drug omission, drug additions, and dosage errors tion reconciliations at admission [4]. Benefits were
[1]. A few studies also reported that discrepancies were described as cost savings estimated from unused drugs
found to be more frequent in cancer patients. Kraus et al. from deprescribing and avoided hospitalizations due to
found that of 63.6% of cancer patients (n = 33) presented prevented adverse drug events, while costs were associ-
with at least one discrepancy compared to 52.5% in the ated with pharmacist labour cost [4]. They calculated a
overall study population (n = 200) [2]. Another study benefit:cost ratio of 2.31:1 associated with conducting
found that the incidence of at least one discrepancy at medication reconciliations [4]. More economic evalua-
admission was 80% in hospitalized patients admitted for tions, ideally comparative studies, should be conducted
cancer-related causes, compared to 53.6% for surgical to support the standardized use of medication recon-
causes, 74.1% for organ dysfunction, and 57.3% for other ciliations in cancer patients.
causes [3]. These studies highlight the increased risk of A limitation in the medication reconciliation process
medication discrepancies in cancer patients and the need is the inconsistencies surrounding its methodology in
to focus on this population to ensure medication safety. practice. The systemic review by Herledan et  al. found
Medication reconciliations are vital at all interfaces of that some practices only conducted medication recon-
care from admission to discharge and in both hospital ciliations at discharge but not at admission, some did
and ambulatory cancer patients. Clinical benefits have not specify sources of information used to complete
been described in multiple settings. In a study with medication lists, and some did not interview patients at
short-term hospitalized cancer patients, 64 interven- all to obtain medication histories [1]. To establish uni-
tions were performed after medication reconciliations formity across practices, health care providers should
were conducted in 95 patients [4]. In an ambulatory refer to the Standard Operating Protocol for Medica-
oncology setting, Weingart et  al. detected discrepan- tion Reconciliations that the World Health Organiza-
cies in medication lists, such as medication errors and tion (WHO) developed [10]. This protocol is created
omissions, in as many as 81% of patients [5]. One study in accordance to the High 5s Project, which aims to
compared conducting medication reconciliations in standardize activities to ensure patient safety around
each of three chemotherapy cycles to only conducting a the world [10].
single reconciliation in the third cycle. They found that Nevertheless, medication reconciliations have been
conducting medication reconciliations at each cycle consistently shown to effectively reduce medication
resulted in a 26% reduction in reconciliation errors errors in cancer patients in a variety of care settings.
that reached the patient (4% vs 30%) [6]. Conducting The current literature also emphasizes that medication
medication reconciliations were also shown to have reconciliations enable pharmacists to perform addi-
positive outcomes on patient discharge readiness from tional interventions, such as providing education on
hospital. In the study by Duffy et  al. patient readiness adverse drug reactions and appropriate use of medica-
for discharge into a home hospice was higher when a tions [1]. This commentary describes other opportuni-
care initiative involving medication reconciliations was ties that can also be provided by conducting medication
conducted [7]. Regarding long-term effects of medica- reconciliations to optimize medication therapy in can-
tion reconciliations, studies in the cancer population is cer patients, namely, identifying and preventing drug
limited. One study by Nguyen et al. found inconclusive interactions, adjusting chemotherapy dosing as well as
initiating deprescribing (Fig. 1).
 Elbeddini et al. Journal of Pharmaceutical Policy and Practice (2021) 14:98 Page 3 of 10

Fig. 1  Importance of medication reconciliations in cancer patients

Opportunity to identify and prevent drug interactions estrogen antagonist that is used for the treatment of
Polypharmacy has been reported to be prevalent in breast cancer in women with estrogen receptor posi-
11–96% of elderly oncology patients [11]. Cancer patients tive tumors. Tamoxifen is generally used for 5–10 years,
may be exposed to chemotherapy, hormonal therapy, and where it has shown to decrease disease recurrence as
supportive agents in addition to their medications used well as death due to breast cancer [12, 13]. Tamoxifen
to treat existing medical conditions. The use of multi- is converted to its active metabolite, endoxifen, by the
ple medications is associated with an increased risk of highly polymorphic cytochrome P450 isoenzyme 2D6
drug–drug interactions. Now, with over 25% of all can- (CYP2D6) to exert its therapeutic effects [14]. Con-
cer treatments administered orally, it is imperative to also sequently, it is hypothesized that drugs that inhibit
maintain optimal medication safety in the community CYP2D6, such as SSRIs, may interfere with the bioacti-
setting [6]. Medication reconciliations provide an oppor- vation of tamoxifen and result in reduced clinical benefit
tunity to detect drug interactions with cancer treatments and treatment failure. This is concerning, since up to 25%
and to make appropriate clinical interventions to ensure of breast cancer patients report a depressive disorder and
medication safety. We will explore some common drug– 24–40% of tamoxifen users are concurrently prescribed
drug interactions with chemotherapies and hormonal an antidepressant [15, 16]. The current literature evalu-
therapies in cancer patients that may be detected during ating the clinical significance of this interaction appear
medication reconciliations. to have mixed conclusions. One population cohort study
found that breast cancer patients taking tamoxifen and
Drug–drug interactions with anticancer agents paroxetine concomitantly had increased risk of death
One particularly controversial and important interac- [17]. Other SSRIs with milder CYP2D6 inhibitor poten-
tion involves tamoxifen and selective serotonin reup- tial did not show this association [17]. Another study
take inhibitor (SSRI) antidepressants. Tamoxifen is an involving 14,532 women with breast cancer found no
Elbeddini et al. Journal of Pharmaceutical Policy and Practice (2021) 14:98 Page 4 of 10

difference in mortality between those taking tamoxifen thromboembolisms (VTEs) than the general popula-
with a potent CYP2D6 inhibitor and those taking tamox- tion [27, 28]. Their increased risk may be due to specific
ifen with other SSRIs [18]. However, a limitation in this cancer types, cancer therapies, hypercoagulable state, as
study is that the follow-up time of ~ 2  years may have well as individual factors, such as advanced age [23, 29].
been too short to observe any differential survival benefit In addition, there appears to be an association with atrial
[18]. Regarding the risk of recurrence, Hague et al. found fibrillation (AF) and cancer. It is estimated that up to 25%
no increased risk of breast cancer recurrence in breast of overall AF patients have a comorbid cancer diagno-
cancer survivors who received concurrent tamoxifen and sis [29]. However, a causal relationship between AF and
antidepressants [19]. While the data may be inconclusive, cancer remains unclear. Nevertheless, cancer patients
it is advisable to still prescribe antidepressants with cau- require anticoagulants to manage VTEs and stroke pre-
tion in patients receiving tamoxifen. A guiding principle vention in AF. One important anticoagulant that can
is to selectively avoid antidepressants that are known to have interactions with chemotherapy agents is warfarin.
inhibit CYP2D6, such as paroxetine, fluoxetine, dulox- This anticoagulant works by suppressing the synthesis of
etine and bupropion. clotting factors through Vitamin K antagonism. Warfarin
Tyrosine kinase inhibitors (TKIs) are another class of is also metabolized by CYP2D9, hence medications that
oral anticancer agents that have rapidly become part of inhibit CYP2D9 are a concern. For example, warfarin has
treatment guidelines for several cancers, such as leuke- been shown to interact with tamoxifen, capecitabine, abi-
mia, renal, lung, pancreatic, etc. They work by interfering raterone, erlotinib, ceritinib, etc., whereby the interaction
with growth factor signalling which leads to tumor cell causes increased patient exposure to warfarin, which may
death. Acid suppressing agents that reduce gastric pH, lead to a higher international normalized ratio (INR) and
such as proton pump inhibitors (PPIs) and ­histamine2– increased risk of bleeding [23, 24]. Current general rec-
receptor antagonists (H2RAs), have been shown to affect ommendations for anticoagulation in cancer patients is to
the pharmacokinetics of TKIs by reducing absorption, use low-molecular weight heparins for treatment of VTE,
area under the curve (AUC), Cmax, and bioavailability and warfarin for stroke prevention in AF [29]. While war-
[20]. The fact that approximately 23% of cancer patients farin remains a high risk drug, there is emerging evidence
are reported to receive TKIs and PPIs concomitantly for the use of direct oral anticoagulants (DOACs) instead.
raises concerns around the clinical significance of this In the ARISTOTLE trial, apixaban showed superior
interaction [21]. A few reviews evaluated the clinical safety and efficacy compared to warfarin in 157 cancer
effect of this drug interaction and a similar consensus patients [30]. Similar results were seen in observational
of mixed evidence was found [22–24]. For example, one cases with rivaroxaban [31]. DOACs have less drug inter-
study showed a negative effect on survival with concomi- actions than warfarin but should be avoided with cancer
tant use of acid suppressing agents and erlotinib [25]. In therapies that are strong P-gp inducers or inhibitors [29].
another study, no association with survival was found If warfarin is necessary for certain cancer patients, it is
in patients taking acid suppressors with sunitinib [26]. important to closely monitor INR and signs of bleeding.
These studies highlight that not all TKIs may be affected When conducting a medication reconciliation, it is cru-
by acid suppressing medications and that it is difficult cial to identify potential drug interactions and to opti-
to provide concrete guidelines due to the conflicting mize anticoagulation strategies specific to each cancer
literature. Nevertheless, caution should be used when patient.
prescribing acid suppressing therapy to cancer patients.
The general consensus remains to avoid the combination Herb–drug interactions with anticancer agents
of acid suppressing agents and TKIs if possible [22]. If Complementary and alternative medication (CAM) are
there is a valid indication for an acid suppression medi- often used in cancer patients. A systematic review found
cation, there are practical recommendations to manage the prevalence of using vitamin or dietary supplements
the interaction between these agents and TKIs. Enteric was reported to be 64% to 81% in adult cancer patients
coated PPIs have a delayed onset of action of around compared to approximately 50% in the general adult pop-
3–4 h. To target this window of acidity, TKIS should be ulation [32]. Another study found that the prevalence of
taken at least 2 h before the PPI to minimize any pharma- CAM in senior adult oncology patients was 26.5% [33].
cokinetic interaction [22]. If H2RAs are to be used, TKIs In the pediatric cancer patients, one study reported the
should be taken at least 2  h before or 10  h after H2RA prevalence of CAM use to be 6–91% [34]. Since the prev-
intake [22]. alence is so high in the cancer population, Herb–drug
The management of anticoagulants in cancer patients is interactions are of great concern, especially since they
also complex. Patients with cancer have been shown to may interfere with cancer treatment regimens. Theoreti-
have a four to eightfold higher risk of developing venous cally, many herbs may interfere with anticancer agents
 Elbeddini et al. Journal of Pharmaceutical Policy and Practice (2021) 14:98 Page 5 of 10

through pharmacokinetic and pharmacodynamic inter- population-based study from 2007 to 2014, nearly 1 in 10
actions. For example, antioxidant supplements have the cancer patients had an incidence of AKI [43]. In another
potential to interact with certain chemotherapies [35]. study looking at CKD, 30% of cancer patients had an
Agents such as anthracyclines, platinum, and alkylating eGFR of 45 to 59 mL/min/1.73 m ­ 2, and 8.3% had an eGFR
2
agents work by generating free radicals and antioxidants of < 45 mL/min/1.73 ­m [44]. Since the incidence of kid-
could potentially counteract their effects [35]. Although ney damage is so high, many patient’s chemotherapies
clinical significance is still uncertain, patients are advised may need to be dose adjusted to reduce the risk of tox-
to avoid herbs and supplements with antioxidant effects icities and adverse reactions. Not only is it important to
during cancer treatment [26]. Other herbal products that assess kidney function and dose adjustments in patients
have potential to interact with anticancer agents include receiving intravenous chemotherapies in hospital, but
green tea, evening primrose, turmeric, ginger, and also in outpatients receiving oral chemotherapies in the
medicinal mushrooms [35, 36]. Some herbal products community. For example, guidelines from Cancer Care
have been shown to have clinically relevant interactions. Ontario (CCO) suggest that capecitabine, a common oral
One case report discussed the interaction between echi- chemotherapy agent, should be dosed at 75% if creatinine
nacea, a popular immunomodulatory supplement, and clearance (CrCL) is 30 to 50 ml/min and discontinued if
etoposide, where concomitant use decreased a patient’s CrCL < 30 mL/min [45]. If doses are not adjusted appro-
platelet count significantly compared to taking etopo- priately for capecitabine, patients may have increased risk
side alone [37]. Another case report noted an interac- of gastrointestinal, dermatological toxicity, neurotoxicity,
tion between ginseng and imatinib. A patient who has and hyperbilirubinemia [45]. This highlights the impor-
been taking imatinib for 7  years began to display symp- tance of conducting medication reconciliations during
toms of hepatotoxicity after ginseng consumption, which each cycle of chemotherapy to ensure doses are ordered
then resolved upon discontinuation of ginseng [38]. In appropriately for all cancer patients.
addition, 2 studies found that St. John’s wort, a common Acute and chronic liver damage can also be present in
herbal supplement used for depression, decreased plasma cancer patients for several reasons. Acute liver failure
concentration of imatinib by around 30%, which could can be caused by viral infection, drugs and toxins, auto-
potentially risk therapeutic failure [39, 40]. These exam- immune hepatitis, ischemia as well as tumor infiltration
ples highlight the potential risks that could occur with [46]. Chronic liver injury, commonly referred to as cir-
chemotherapy interactions. In a study by Chun et al. they rhosis, is mainly caused by alcoholic liver disease and
found that vitamins and minerals accounted for the larg- hepatitis C [47]. Hepatotoxic chemotherapies can further
est portion of additions and modifications found through decrease liver function in a dose independent manner.
pharmacist-led medication reconciliations [41]. Without The specific prevalence of hepatic impairment in cancer
medication reconciliations, it can be easy to miss herbal patients is currently unknown. Nonetheless, it is impor-
products in a patient’s medication list. It is important to tant to monitor liver function in cancer patients, since
identify the use of herbal supplements in cancer patients liver impairment can alter the pharmacokinetic profile
and to detect possible clinical interactions. Drug-interac- of chemotherapies which can lead to subtherapeutic lev-
tion databases, such Lexi-Interact and Natural Medicine, els and treatment failure or supratherapeutic levels and
a natural health product specific database, are validated drug toxicity. A liver panel, including aminotransferases
resources that may be used. As there is still uncertainty and bilirubin, should be conducted before each admin-
regarding the clinical impact of herb–drug interactions, istration of chemotherapy, since some may need dose
it is advisable to be cautious and avoid the concomitant adjustments for hepatic impairment. For example, CCO
use of anticancer agents and herbal products until fur- suggests a dose reduction of 25% if bilirubin levels are
ther research validates the safety of concomitant use. 1–2 × upper limit of normal (ULN) for daunorubicin, a
commonly used agent for leukemia [48]. If bilirubin lev-
Opportunity to adjust chemotherapy dosing els are 2–4 × ULN, a 50% dose reduction is suggested and
Kidney damage such as acute kidney injury (AKI) and if bilirubin levels are > 4 × ULN, then the dose should be
chronic kidney disease (CKD) can occur in cancer omitted for that cycle [39]. Other agents, such as doc-
patients due to cancer complications as well as chemo- etaxel, may require dose adjustments based on other liver
therapy induced nephrotoxicity. AKI has many causes, parameters, such as AST, ALT, bilirubin, and alkaline
such as volume depletion, light chain cast nephropa- phosphate levels [49]. These examples highlight the com-
thy, tumor lysis syndrome, tumor infiltration, as well plexity with dosing chemotherapies.
as thrombotic microangiopathy [42]. CKD can also The examples highlighted here are specific to chemo-
be caused by prior episodes of AKI, chronic obstruc- therapies; however, dose adjustments may be appropri-
tive nephropathy, and kidney irradiation [42]. In a ate for all drugs that may be excreted through the kidney
Elbeddini et al. Journal of Pharmaceutical Policy and Practice (2021) 14:98 Page 6 of 10

or metabolized by the liver. In an oncology perspective, 26 cancer patients aged 65 and over. They identified 119
medication reconciliations provide opportunities to PIMs in total, where 73% of PIMs were deprescribed,
assess chemotherapy medications and to ensure they are such as vitamins/minerals, antihypertensives, statins,
appropriately dosed, since dosing discrepancies can have benzodiazepines, NSAIDS, and proton pump inhibitors
major consequences in this population. [57]. Afterwards, two-thirds of those patients reported
a reduction in symptoms after deprescribing [57]. This
Opportunity to deprescribe potentially inappropriate
study highlights the effectiveness of deprescribing as an
medications
intervention once PIMs have been identified. However,
As stated earlier, polypharmacy, commonly described as there are limitations to these clinical tools in the cancer
the use of five or medications, has been shown to be prev- population. Some medications identified as inappropriate
alent in 11–96% of elderly cancer patients [11]. While through the Beers Criteria may be necessary for cancer
polypharmacy may have therapeutic benefit, it is also patients. For example, medications deemed inappropri-
associated with adverse drug reactions, increased drug– ate such as metoclopramide, haloperidol, anticholiner-
drug interactions, prescribing errors, negative health out- gics and benzodiazepines may have a role in treatment
comes, frailty, functional decline, and mortality [11, 50]. of chemotherapy induced nausea and vomiting [50]. To
Taking a high number of medications also increases the address this issue, Miller et al. proposed a strategy, where
risk of being on potentially inappropriate medications clinical judgement with the MAI can be used after Beer’s
(PIMs) [51]. PIMs are described as medications that lack Criteria has been applied to assess medications that are
appropriate indications, have risks that outweigh thera- questionable [58].
peutic benefit, or those that can potentially interact with Deprescribing medications can be a challenge espe-
other medications [11]. The prevalence of PIMs has been cially in complex populations, such as cancer patients.
shown to be quite high in cancer patients, where it has As a result, this process often requires a multidiscipli-
been reported to be between 41 and 52% [52, 53]. PIMs nary team. A six-step approach to deprescribing in older
are problematic for elderly cancer patients, since they are cancer patients has been developed to assist health care
associated with postoperative delirium and readmission providers with the process (Fig. 2) [59]. Step one involves
and could potentially be associated with lower progres- determining the patient’s life expectancy and treatment
sion-free survival and higher mortality [51]. Medication goals. Step two involves gathering a comprehensive list
reconciliations provide an up-to-date comprehensive of all medications. Step three assesses each medica-
medication list, where health care providers can identify tion appropriateness according to individual life expec-
PIMs and to potentially deprescribe them appropriately tancy and treatment goals. Step four includes identifying
to optimize medication safety in cancer patients. medications to be stopped. Step five involves creating a
There are many tools available to help identify PIMs, deprescribing plan. Finally, step six entails monitoring
including the Beers Criteria, Screening Tool for Older and reviewing events following interventions. Once inap-
People’s Prescriptions (STOPP), and the Medica- propriate medications have been identified, there are sev-
tion Appropriateness Index (MAI). The Beers Criteria, eral guidelines, such as those available at www.​depre​scrib​
recently updated in 2019, provides a list of potentially
problematic medications to avoid in elderly patients 65
and older [54]. The STOPP criteria is used to identify
PIMs in the elderly, including drugs and doses to avoid
that can cause drug–drug interactions, risk of falls and
duplicate therapy [55]. Another tool is the MAI, which
uses ten questions to facilitate the use of clinical judge-
ment in assessing medication appropriateness [56]. There
is evidence that use of these tools can help identify PIMs
in cancer patients, leading to clinical interventions. In
one study, the overall prevalence of PIMs was 51% in
234 ambulatory senior cancer patients, where 38% were
identified by the STOPP criteria and 40% were identi-
fied by the 2012 Beers criteria [53]. The most prevalent
PIMs found were benzodiazepines, GI medications,
nonsteroidal anti-inflammatory drugs, and antiplatelet
medications [53]. In another study, the 2015 Beers Cri-
Fig. 2  Six-step approach to deprescribing in elderly cancer patients
teria, STOPP and MAI were used to identify PIM use in
 Elbeddini et al. Journal of Pharmaceutical Policy and Practice (2021) 14:98 Page 7 of 10

ing.​org, to help create a deprescribing plan. Ultimately, agents, oncology patients may also take medications dis-
to deprescribe PIMs in cancer patients, a comprehen- pensed routinely from their community pharmacy for
sive list of medications must first be obtained. This key their pre-existing conditions and supportive therapies.
step in the process highlights the importance of conduct- Patients may find themselves obtaining their medications
ing medication reconciliation in this patient population, from multiple locations, which can increase the risk of
where deprescribing can then be introduced. discrepancies in a patient’s medication record between
settings. To ensure continuity of care and patient safety,
Medication reconciliations across multiple pharmacy it is imperative to have an up-to-date medication record
settings and clear communication of decisions between a patient’s
Traditionally, chemotherapy is delivered intravenously primary oncologist, community pharmacist and other
in inpatient and outpatient hospital settings. Recently, health care providers involved. This emphasizes the
there is an increasing amount of oral chemotherapies importance of conducting medication reconciliations,
being delivered in the community setting. With so many especially in patients that are receiving medications from
regimens available to treat a variety of cancers, it is not multiple settings, such as hospitals, specialized oncol-
uncommon for oncology patients to receive concurrent ogy pharmacies and community pharmacies, to provide
intravenous and oral chemotherapies from both hospi- accurate medication management (Fig.  3). Current lit-
tals and specialized community pharmacies. For exam- erature is lacking in this topic, and future studies should
ple, a palliative chemotherapy regimen for breast cancer investigate advantages from medication reconciliations
includes oral capecitabine administered twice daily for conducted in patients taking any combination of oral
days 1–14, as well as intravenous trastuzumab on day chemotherapy, intravenous chemotherapy, and non-anti-
1 of each cycle [60]. In addition to receiving anticancer cancer medications across different pharmacy settings.

Fig. 3  Model of medication reconciliations performed across three potential care settings for oncology patients
Elbeddini et al. Journal of Pharmaceutical Policy and Practice (2021) 14:98 Page 8 of 10

Community pharmacists are in an excellent position Reviewing and Editing, Driving for the ideas and thoughts. CW: Original Manu-
script preparation, Analysis of the paper, Literature search, Data collection,
to support patients taking anticancer medications, since Writing, Reviewing and Editing, Driving for the ideas and thoughts. All authors
they are often regarded as the most accessible health read and approved the final manuscript.
care providers. However, a study reported that commu-
Availability of data and materials
nity pharmacists may face barriers to conducting medi- Data sharing does not apply to this article as no data sets were generated or
cation reconciliations during transitions from hospital analyzed during the current study.
to community care, such as limited resources and time
restrictions [61]. Community pharmacists also reported Declarations
that additional information such as hospital medication
Ethics approval and consent to participate
discharge lists as well as stop-orders for discontinued Not applicable.
medications would be beneficial when conducting medi-
cation reconciliations [61]. Similar concepts of ensur- Competing interests
No known competing interest to declare.
ing transmission of medication changes across multiple
pharmacy settings can be applied to support community Author details
pharmacists in conducting medication reconciliations in 1
 Chairman of the Pharmacy Department, Winchester District Memorial Hos-
pital, 566 Louise Street, Winchester, ON KK0C2K0, Canada. 2 Leslie Dan Faculty
oncology patients. Another barrier that community phar- of Pharmacy, University of Toronto, 144 college st, Toronto M5S 3M2, Canada.
macists may face is lack of chemotherapy knowledge. A
survey by Abbot et al. found that only 13.6% of commu- Received: 13 July 2020 Accepted: 15 July 2020
nity pharmacists felt they had received adequate oncol-
ogy education at the undergraduate level [62]. Only 24%
of pharmacists felt familiar with common doses of oral
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