基于药物治疗管理的1例晚期肾癌患者联合门诊药学实践

Practice of physician-pharmacist joint outpatient service for a patient with advanced renal cell carcinoma based on medication therapy management

摘要:

目的 探讨医药联合门诊中临床药师对肿瘤患者进行药物治疗管理（MTM）的工作模式。方法 通过医药联合门诊，临床药师对1例晚期肾癌患者使用阿昔替尼联合替雷利珠单抗治疗所致不良反应进行MTM，包括药物治疗方案评估和干预、不良反应评估及处理、患者教育和随访等。结果 患者在基于MTM的医药联合门诊干预下，手足皮肤反应明显好转，甲状腺功能、肝功能、血脂等相关检查指标好转，顺利完成抗肿瘤治疗，疗效评估为疾病稳定，未出现严重的药物相关不良反应。结论 在医药联合门诊模式下，临床药师协助医生对肿瘤患者进行全程MTM，可有效解决患者药物治疗相关问题，保障抗肿瘤治疗的有效性和安全性，提高患者药物治疗依从性。

Abstract:

Objective To explore clinic pharmacist's practice patterns of medication therapy management (MTM) for cancer patients in the physician-pharmacist joint outpatient.Methods MTM was implemented in a patient with advanced renal cell carcinoma treated by axitinib combined with tislelizumab through the physician-pharmacist joint outpatient service, including medical treatment program evaluation and intervention, adverse reaction assessment and management, patient education and follow-up, etc.Results Under the intervention of the physician-pharmacist joint outpatient service guided by MTM, the patient demonstrated significant improvement in hand-foot skin reaction and normalization of laboratory parameters, including thyroid function, liver function, and lipid profiles. The patient successfully completed the anti-tumor treatment as planned, with efficacy assessed as stable disease, and no severe drug-related adverse reactions were observed.Conclusion Through physician-pharmacist joint outpatient service, clinic pharmacists assist doctors in the full process MTM of tumor patients. This intervention can effectively solve medication-related problems, ensure the effectiveness and safety of anti-tumor treatment, and significantly enhance the medication adherence of patients.