[ Vol. 10 No. 3 ] (September - December 2009 )
Pharmaceutical problems in cancer chemotherapy and nutrition support

Patrick Ball
CharlesSturt University, Wagga  Wagga, Australia


This is an enormous topic, which cannot be comprehensively covered in the time available. This presentation will highlight a range of problems, concentrate more detail on a few that are believed typically to receive less attention than they deserve, and provide reference sources for further information on the others. There are the obvious issues for all pharmacists of dosage, administration method and route, compounding, chemical compatibilities etc. For cytotoxic agents it is particularly important to concentrate on matters such as dosing by surface area and cumulative dose received for certain agents and to devise systems to prevent catastrophic mis-administrations such as intrathecal vincristine. Cytotoxic agents need safe transport systems and policies for dealing with spills. This also helps to highlight the importance of tracking what happens to all products once they leaves the pharmacy; transport time, where things are actually delivered to (do they go straight to the refrigerator or left in a side room until somebody finds them). For pharmacists, both these areas have a focus on parenteral therapy. Many things can go wrong in parenteral systems and it is important for pharmacists to understand them, and be involved in their design and the equipment used. Parenteral therapy also leads to issues around understanding routes of administration, diluents, and monitoring the total fluid and electrolyte load received by the patient from diluents, vehicles and hydration regimens. Control of infection is critical because much of this therapy is based upon products that are aseptically prepared rather than terminally sterilized. As seen in the infection control workshop yesterday, control of infection depends upon detailed study of processes and attention to detail at every step. Pharmacists have a major role advising on choice of antiseptics/disinfectants and their compatibilities with equipment. Overall a broad challenge and plenty of room for further progress.



  • Austin P, Stroud M, Prescribing Adult Intravenous Nutrition, London, Pharmaceutical Press, pp300, 2007, ISBN: 9780853696582
  • Beaney AM, (ed) Quality Assurance of Aseptic Preparation Services (4th Edition), London, Pharmaceutical Press, pp168, 2005, ISBN: 9780853696155
  • Allwood M, Stanley A, Wright P. The cytotoxics handbook (4th Edition), Oxford Ratcliffe Publishing, pp484, 2002, ISBN: 9781857755046
  • Leff, RD, Roberts RJ, Practical Aspects of Intravenous Drug Administration, American Society of Hospital Pharmacists, Bethesda, pp54, 1992, ISBN: 1879907232


PENSA 2009

“Energizing Nutrition Support Practice for Life”
June 5-7 2009, Shangri-La Hotel, Kuala Lumpur, Malaysia 
Page: 38