Pediatric patients undergoing chemotherapy often need to take multiple medications. Consequently, they may experience drug-related problems (DRPs), including adverse drug reactions, drug interactions, and various medication errors.
Methods
A prospective observational study was conducted over three months in the Pediatric Haemato-oncology department of a cancer specialty hospital of Nepal following ethical approval. DRPs were identified from patient medical records and the literature and, recorded according to the Pharmaceutical Care Network Europe V9.1 tool. Data were collected and analyzed using IBM SPSS Statistics V20 and Microsoft Excel 2013 to present the findings.
Results
Among the 30 enrolled patients, 211 DRPs were identified in 28 patients (93.3%), averaging 7.5 DRPs per patient, all validated through case-by-case review. Treatment safety was the predominant DRP type (n = 131; 62.09%), followed by treatment ineffectiveness (n = 79; 37.44%). Drug selection (n = 116; 51.76%) and dispensing issues (n = 51; 22.77%) were the leading causes, with anti-infective drugs (n = 41; 35%) and antineoplastic agents (n = 24; 20.5%) most frequently implicated.
Conclusion
DRPs were prevalent among pediatric patients with cancer, with treatment safety being the most significant issue and drug selection being the primary cause. Anti-infective drugs were most frequently involved in DRPs, followed by antineoplastic and immunomodulating agents.
BrayFLaversanneMSungH, et al.Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin.2024. doi:10.3322/caac.21834
DhunganaSPathakNBasyalB, et al.Pediatric oncology services in Nepal: a special focus on pharmacy practice. J Oncol Pharm Pract2024 Mar 1; 30: 425–435.
6.
Steliarova-FoucherEColombetMRiesLAG, et al.International incidence of childhood cancer, 2001-10: a population-based registry study. Lancet Oncol2017 Jun; 18: 719–731. PubMed PMID: 28410997; PubMed Central PMCID: PMC5461370.
7.
CureAll framework: WHO global initiative for childhood cancer: increasing access, advancing quality, saving lives [Internet]. World Health Organization; 2021 [cited 2024 May 9]. Available from: https://iris.who.int/handle/10665/347370
8.
LamCGHowardSCBouffetE, et al.Science and health for all children with cancer. Science2019 Mar 15; 363: 1182–1186. PubMed PMID: 30872518.
9.
YismawMBAdamHEngidaworkE. Identification and resolution of drug-related problems among childhood cancer patients in Ethiopia. J Oncol2020 Mar 16; 2020: e6785835.
10.
MohamedMRMohileSGJubaKM, et al.Association of polypharmacy and potential drug-drug interactions with adverse treatment outcomes in older adults with advanced cancer. Cancer2023; 129: 1096–1104.
11.
OrtlandIMendel OttMKowarM, et al.Medication risks in older patients (70+) with cancer and their association with therapy-related toxicity. BMC Geriatr2022 Aug 30; 22: 16.
12.
Feyissa MechessaDDessalegnDMelakuT. Drug-related problem and its predictors among pediatric patients with infectious diseases admitted to jimma university medical center, southwest Ethiopia: prospective observational study. SAGE Open Med2020 Jan 1; 8: 2050312120970734.
13.
ErnstFGrizzleA. Drug-Related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc WashingtonDC 19962001 Mar 1; 41: 192–199.
14.
EberlSHeusPToniI, et al.The epidemiology of drug-related hospital admissions in paediatrics – a systematic review. Arch Public Health2024 Jun 4; 82: 81. PubMed PMID: 38835105; PubMed Central PMCID: PMC11149243.
15.
ZennaroMTrotterAMengatoD, et al.Improving medication safety through medication reconciliation in pediatric neurology: clinical pharmacist recommendations and physician uptake in a 13-week study. Children2025 May 12; 12: 25. PubMed PMID: 40426804; PubMed Central PMCID: PMC12110433.
16.
ZaninABaratiriFRoveratoB, et al.Polypharmacy in children with medical complexity: a cross-sectional study in a pediatric palliative care center. Children2024 Jul 4; 11: 21. PubMed PMID: 39062270; PubMed Central PMCID: PMC11274911.
17.
O’BrienMJPaulsAMCatesAM, et al.Psychotropic medication use and polypharmacy among children and adolescents initiating intensive behavioral therapy for severe challenging behavior. J Pediatr2024 Aug 1: 271. doi:10.1016/j.jpeds.2024.114056. PubMed PMID: 38615943.
18.
AdhikariRDahalPKhadkaS, et al.Assessment of Drug-Related Problems among Inpatients in a Tertiary Care Hospital of Eastern Nepal. J Karnali Acad Health Sci [Internet]2021 Apr 29 [cited 2025 Aug 6]; 4(, Available from: https://jkahs.org.np/jkahs/index.php/jkahs/article/view/450.
19.
ThapaRBDahalPKarkiS, et al.Exploration of drug therapy related problems in a general medicine ward of a tertiary care hospital of eastern Nepal. Explor Res Clin Soc Pharm2024 Oct 16; 16: 100528. PubMed PMID: 39498227; PubMed Central PMCID: PMC11532771.
20.
ChapagainSPathakNSubediK, et al.Drug-related problems among type 2 diabetic patients in sunwal municipality of western Nepal. PLOS ONE2024 Nov 21; 19: e0309781.
21.
ZhuYLiuCZhangY, et al.Identification and resolution of drug-related problems in a tertiary hospital respiratory unit in China. Int J Clin Pharm2019 Dec 1; 41: 1570–1577.
22.
AbdulkadirSAWettermarkBHammarT. Potential drug-related problems in pediatric patients—describing the use of a clinical decision support system at pharmacies in Sweden. Pharmacy2023 Feb; 11: 1.
23.
HoraceAEAhmedF. Polypharmacy in pediatric patients and opportunities for pharmacists’ involvement. Integr Pharm Res Pract2015 Aug 21; 4: 113–126.
24.
NguyenPMNguyenKTPhamST, et al.Pharmacist-Led interventions to reduce drug-related problems in prescribing for pediatric outpatients in a developing country: a randomized controlled trial. J Pediatr Pharmacol Ther JPPT2023 Jun 2; 28: 12. PubMed PMID: 37303771.
25.
SutherlandAPhippsDLTomlinS, et al.Mapping the prevalence and nature of drug related problems among hospitalised children in the United Kingdom: a systematic review. BMC Pediatr2019 Dec 11; 19: 86.
26.
NguyenTHLeVTTQuachDN, et al.Drug-Related problems in prescribing for pediatric outpatients in Vietnam. Healthcare2021 Mar; 9: 3.
27.
ValenteP. Censuses: current approaches and methods. In: WrightJD (eds) International encyclopedia of the social & behavioral sciences (second edition) [internet]. Oxford: Elsevier, 2015 [cited 2024 Oct 16], pp.296–301. Available from: https://www.sciencedirect.com/science/article/pii/B9780080970868410068 doi:10.1016/B978-0-08-097086-8.41006-8.
28.
CipolleRJStrandLMMorleyPC. Pharmaceutical care practice: the clinician’s guide. 2nd ed. New York: McGraw-Hill, Medical Pub. Division, 2004, 394 p.
29.
HeplerCDStrandLM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm1990 Mar 1; 47: 533–543.
30.
ASHP Guidelines on a standardized method for pharmaceutical care. Am J Health Syst Pharm.1996 Jul 15; 53: 1713–1716.
31.
MeyboomRHBLindquistMEgbertsACG. An ABC of drug-related problems. Drug Saf2000 Jun 1; 22: 415–423.
AlhajoriFSMakkawiMHAlasmariSZ, et al.Estimating the prevalence of pediatric hematological malignancies in al-madinah al-munawwarah, Saudi Arabia. Saudi Med J2023 May 1; 44: 504–508. PubMed PMID: 37182917.
40.
ZhangPLvDZhaoJ, et al.Evaluation of pharmacists’ interventions on drug-related problems and drug costs in patients with cancer pain. Int J Clin Pharm2021 Oct; 43: 1274–1282. PubMed PMID: 33625653.
41.
VenugopalJS SARKarnanD. Drug-related problems in cancer patients: a systematic review. J Oncol Pharm Pract2024 Apr 1; 30: 562–571.
42.
WorkalemahuGAbdelaOAYenitMK. Chemotherapy-Related adverse drug reaction and associated factors among hospitalized paediatric cancer patients at hospitals in north-west Ethiopia. Drug Healthc Patient Saf2020 Nov 3; 12: 195–205.
43.
Ayalew SisayE. Drug Related Problems in Chemotherapy of Cancer Patients. J Cancer Sci Ther2015; 07(. doi:10.4172/1948-5956.1000325
44.
BalkTEvan der SijsIHvan GelderT, et al.Drug–drug interactions in pediatric oncology patients. Pediatr Blood Cancer2017; 64: e26410.
45.
AshrafizadehHRassouliM. Traditional, complementary, and alternative medicine in cancer care: challenges and opportunities. Asia-Pac J Oncol Nurs2023 Oct 19; 11: 100321. PubMed PMID: 38111680; PubMed Central PMCID: PMC10727935.
46.
HillJMillsCLiQ, et al.Prevalence of traditional, complementary, and alternative medicine use by cancer patients in low income and lower-middle income countries. Glob Public Health2019 Mar 4; 14: 418–430. PubMed PMID: 30325704.
47.
WiranataJAHutajuluSHSuryaniND, et al.Patterns of complementary medicine utilization in patients with breast cancer and colorectal cancer: a cross-sectional study at a tertiary referral hospital in yogyakarta, Indonesia. JCO Glob Oncol2025 Mar; 11: e2400408.
48.
ChoiSJKunworSKImHB, et al.Traditional and complementary medicine use among cancer patients in Nepal: a cross-sectional survey. BMC Complement Med Ther2022 Mar 15; 22: 70.
49.
WolfCPJGRachowTErnstT, et al.Complementary and alternative medicine (CAM) supplements in cancer outpatients: analyses of usage and of interaction risks with cancer treatment. J Cancer Res Clin Oncol2022 May 1; 148: 1123–1135.
50.
DeCampMJoffeSFernandezCV, et al.Unguru Y, on behalf of the working group on chemotherapy drug shortages in pediatric oncology. Chemotherapy drug shortages in pediatric oncology: a consensus statement. Pediatrics2014 Mar 1; 133: e716–e724.
51.
PathakNShresthaRShresthaS. Improving patient outcomes during cancer drug shortages: the role of patient education. Eur J Hosp Pharm2025 Apr 1. doi:10.1136/ejhpharm-2025-004548. PubMed PMID: 40169182.
52.
MiXZengLZhangL. Systematic review of the prevalence and nature of drug-related problems in paediatric patients. J Clin Pharm Ther2022 Jan 30; 47: 76. PubMed PMID: 35098566.
53.
AyeleYTesfayeZT. Drug-related problems in Ethiopian public healthcare settings: systematic review and meta-analysis. SAGE Open Med2021 Jan 1; 9: 20503121211009728.
54.
JoseJSaravuK. Clinical pharmacists as potential contributors in reducing drug-related problems in daily practice: a glance at Indian setup. J Datta Meghe Inst Med Sci Univ2022 Dec; 17: 1031.
BekeleFTsegayeTNegashE, et al.Magnitude and determinants of drug-related problems among patients admitted to medical wards of southwestern Ethiopian hospitals: a multicenter prospective observational study. PLoS ONE2021 Mar 16; 16: e0248575.
57.
KassahunHAyfokruT. Antimicrobial drug therapy problems among patients in the outpatient department of ataye hospital, northeast Ethiopia. Infect Drug Resist2020 Aug 5; 13: 2717–2722. PubMed PMID: 32821134; PubMed Central PMCID: PMC7417642.
58.
GideyKAregawiSHailuB, et al.Antimicrobial use-related problems among hospitalized pediatric patients: a prospective observational study. Infect Drug Resist2024 Jan; 17: 119–130.
59.
ShresthaSShresthaSKhanalS. Establishment of the first cancer hospital-based pharmacovigilance center in Nepal. Res Soc Adm Pharm2018 Nov 1; 14: 1088–1089.
MubarakNRanaFRZahidT, et al.A cross-sectional evaluation of opioid dispensing competencies in final-year pharm-D students: a multicenter study from punjab, Pakistan. Drug Healthc Patient Saf2024 Dec 28; 16: 133–144.
62.
JadhariRPathakNShresthaR, et al.Advancing opioid stewardship in low-middle-income countries: challenges and opportunities. J Pharm Policy Pract2024 Dec 31; 17: 2345219. PubMed PMID: 38845626.
63.
ShresthaSKhatiwadaAPSapkotaB, et al.What is “opioid stewardship”? an overview of current definitions and proposal for a universally acceptable definition. J Pain Res2023 Feb 10; 16: 83. PubMed PMID: 36798077.
64.
ShresthaSSapkotaSTeoh SLKCB, et al.Comprehensive assessment of pain characteristics, quality of life, and pain management in cancer patients: a multi-center cross-sectional study. Qual Life Res2024; 33: 2755–2771. PubMed PMID: 39105961; PubMed Central PMCID: PMC11452497.
65.
NishtalaPSMcLachlanAJBellJS, et al.A retrospective study of drug-related problems in Australian aged care homes: medication reviews involving pharmacists and general practitioners. J Eval Clin Pract2011 Feb; 17: 97–103. PubMed PMID: 20825538.
66.
BellJSWhiteheadPAslaniP, et al.Drug-related problems in the community setting: pharmacists’ findings and recommendations for people with mental illnesses. Clin Drug Investig2006; 26: 415–425. PubMed PMID: 17163274.
67.
CollinsJCHuJMcMillanSS, et al.Medication-related problems identified by community pharmacists: a descriptive case study of two Australian populations. J Pharm Policy Pract2023 Nov 2; 16: 33.
68.
AcharyaAPathakNShresthaS, et al.Oncology pharmacy practice in Nepal: integration, challenges, and policy directions. J Oncol Pharm Pract2025 Oct 17: 10781552251385482. doi:10.1177/10781552251385482
69.
AgnolRDdos SantosMTMichalowskiMB, et al.Pharmacists’ interventions on 2 years of drug monitoring in an oncology pediatric inpatient ward. J Oncol Pharm Pract.2022 Dec 1; 28: 1754–1762.
70.
ShresthaSShresthaSKhanalS. Polypharmacy in elderly cancer patients: challenges and the way clinical pharmacists can contribute in resource-limited settings. Aging Med2019 Feb 14; 2: 42–49. PubMed PMID: 31942511; PubMed Central PMCID: PMC6880671.
71.
ShresthaSSapkotaSTeohSL, et al.Clinical pharmacist interventions on pain management in cancer patients (PharmaCAP) in low resource settings: a multicenter feasibility-pilot randomized controlled trial. Support Care Cancer2024 Nov 27; 32: 828.
