Patient safety in cancer care: a time for action.
Retrospective chart audit studies of acute care in several countries have shown that between 3% and 16% of patients experience one or more harmful adverse events while hospitalized and that about half of these events are preventable ( 1 ). These studies indicate that medication treatment is an area of high risk. We still know relatively little about the incidence of adverse events in nonacute settings or for specific patient populations. In this issue of the Journal, Riechelmann et al. ( 2 ) begin to address this issue for cancer patients attending an outpatient oncology clinic. They surveyed patients concerning the medication that they had taken in the previous 4 weeks. From the information they received, they determined that 27% of the patients had the potential for one or more possibly serious drug interactions. The majority of these possible drug interactions involved not antineoplastic agents but rather drugs that were being administered for noncancer comorbidities. Although an incidence of 27% seems high, the results are consistent with what is known about the potential for adverse drug events in patients who have contact with several doctors. Indeed, Tamblyn et al. ( 3 ) concluded that “a single primary care physician and a single dispensing pharmacy may be ‘protective’ factors in preventing potentially inappropriate drug combinations.” This observation has been reinforced by Blendon et al. ( 4 ), who in 2002 carried out a random survey of more than 3800 adults in the United States, Australia, Canada, New Zealand, and the United Kingdom whose health had been defi ned as less than optimal based on their responses to a questionnaire. More than one-third of the 66% who regularly took one or more medications had not had their medications reviewed by the physician they relied on the most for the previous 2 years. Further, 15.8% of those seeing one or two doctors reported either a medication or medical error in the last 2 years, compared with 28.8% of those seeing three or more physicians.