Comprehensive Evaluation of Drug-Related Problems and Pharmacotherapy Patterns in Non-Hodgkin�s Lymphoma Patients in Yemen

Abstract

Background: Drug-related problems (DRPs) are critical challenges in oncology practice, particularly among patients with non-Hodgkin lymphoma (NHL), due to complex regimens and high toxicity potential. Purpose: This study aimed to identify, classify, and evaluate the prevalence of DRPs and associated factors, and explore the pattern of chemotherapy prescribing for NHL patients. Methods: A cross-sectional study was conducted from November 2022 to September 2023 at National Oncology Centre (NOC), Al-Jomhouri Teaching Hospital. Adult NHL patients undergoing chemotherapy were enrolled, with a final sample of 279 patients. DRPs were identified and classified using the validated Pharmaceutical Care Network Europe (PCNE) and cross-checked against National Comprehensive Cancer Network (NCCN) guidelines. Potential drug-drug interactions (DDIs) were evaluated using the Lexicomp� drug interactions database. Data was collected from patients� interviews, treatment charts and medical records. Descriptive statistics and linear regression were used for analysis. Results: Among the 279 NHL patients included in the study, a total of 1870 DRPs were identified (average 6.7 per patient). Advanced-stage disease was observed in 79.6% of patients, and 63.4% received rituximab-containing regimens. The R-CHOP regimen being the most frequently used, which was associated with 52.7% of all DRPs. The most frequent DRPs involved dosing issues, including drug doses too low (26.5%) and incorrect or missing dose calculations (13.1%). DDIs contributed to 13% of the total identified DRPs, with the majority classified as mild interaction. Multivariate regression analysis identified comorbidities, lymphoma subtype, and number of chemotherapy cycles as significant predictors of DRP occurrence. Conclusion: A high number of DRPs were identified among NHL patients in Yemen, with an average of 6.7 DRPs per patient, predominantly due to dosing issues. Integration of clinical pharmacy services, guideline-based prescribing, and systematic medication reviews are essential to minimize DRPs and improve treatment outcomes.