Retrospective Analysis of the Dose Banding Technique in a Public Hospital in the Agreste of Pernambuco
DOI:
https://doi.org/10.32635/2176-9745.RBC.2025v71n4.5177Keywords:
Antineoplastic Agents/ administration & dosage, Economics, Pharmaceutical, Hospitals, Public, Pharmaceutical PreparationsAbstract
Introduction: The dose banding technique standardizes doses of anticancer drugs, rounding them into predefined bands. This approach aims to optimize resources, reduce waste, and ensure safety in the preparation of chemotherapy. Created in the United Kingdom, dose banding allows doses to be prepared more quickly and economically, with controlled variations, increasing the supply of services without increasing costs to the health system. Agreed upon by the multidisciplinary team, this approach facilitates the management of cancer treatment, maintaining its efficacy and safety. Objective: Analyze the sample using the dose banding technique in a public hospital located in the Agreste region of Pernambuco. Method: To identify the antineoplastics with dose banding most likely to impact the production service of pharmaceutical preparations, three criteria (limit of viability) indicating the possible antineoplastics to be viable products were used to consider the applicability of the technique according to logarithmic dose banding: (a) antineoplastic preparations ≥ 150 per year; (b) individualized doses ≥ 10 per dose banding; (c) total dose bands ≤ 5 covering a total of ≥ 60% of all individualized doses for a given drug. Results: A total of nine antineoplastics showed viability according to the study: cyclophosphamide, cisplatin, docetaxel, doxorubicin, fluorouracil-bolus, fluorouracil-pump, gemcitabine, irinotecan, oxaliplatin, and paclitaxel. Carboplatin results were not enough to achieve viability for production through dose banding. Conclusion: There is a need for more research on the performance of technologies and processes for the applicability of the dose banding technique
Downloads
References
Oliveira, KD, Oselame, GB, Neves, EB. Infertilidade após o tratamento oncológico. Rev Med Saúde Brasília. 2014;3(1):72-84. [Acesso 2025 fev 9]. Disponível em: https://portalrevistas.ucb.br/index.php/rmsbr/article/view/4898
Lima SF, Silva RGM, Silva VSC, et al. Representações sociais sobre o câncer entre familiares de pacientes em tratamento oncológico. Rev Min Enferm. 2016;20:e967. doi: https://doi.org/10.5935/1415-2762.20160037 DOI: https://doi.org/10.5935/1415-2762.20160037
Nacional Cancer Institute. What Is Cancer? [Internet]. Washington, DC: NCI; 2021. [Acesso 04 jul 2025]. Disponível em: https://www.cancer.gov/about-cancer/understanding/what-is-cancer#:~:text=Cancer%20is%20a%20disease%20caused,are%20also%20called%20genetic%20changes
Brum F, Feron MR, Pulga CM, et al. A radioterapia do câncer de próstata: uma revisão da literatura dos principais avanços e métodos de tratamento. Discip Sci Sér Nat Tecnol. 2020;21(1):31-44. doi: https://doi.org/10.37779/dscnt.v21n1-003 DOI: https://doi.org/10.37779/dscnt.v21n1-003
Zaimy MA, Saffarzadeh N, Mohammadi A, et al. New methods in the diagnosis of cancer and gene therapy of cancer based on nanoparticles. Cancer Gene Ther. 2017;4(6):233-43. doi: https://doi.org/10.1038/cgt.2017.16 DOI: https://doi.org/10.1038/cgt.2017.16
Roy PS, Saikia BJ. Cancer and cure: a critical analysis. Indian J Cancer. 2016;53(3):441-2. doi: https://doi.org/10.4103/0019-509x.200658 DOI: https://doi.org/10.4103/0019-509X.200658
Boscato SC. Análise farmacoeconômica de XELOX em comparação à mFOLFOX6 no tratamento do câncer colorretal na perspectiva de um hospital universitário no sul do Brasil [dissertação na Internet]. Porto Alegre: Universidade do Rio Grande do Sul; 2017. [Acesso 2025 mar 22]. Disponível em: http://hdl.handle.net/10183/166276
Kligerman J. Estimativas sobre a incidência e mortalidade por câncer no Brasil. Rev Bras Cancerol. 2002;48(2)175-9. doi: https://doi.org/10.32635/2176-9745.RBC.2002v48n2.2246 DOI: https://doi.org/10.32635/2176-9745.RBC.2002v48n2.2246
Instituto Nacional de Câncer [Internet]. Rio de Janeiro: INCA; 2022. INCA estima 704 mil casos de câncer por ano no Brasil até 2025, 2022 nov 23. [Atualizado 2022 nov 24 acesso 8 nov 2024]. Disponível em: https://www.gov.br/inca/pt-br/assuntos/noticias/2022/inca-estima-704-mil-casos-de-cancer-por-ano-no-brasil-ate-2025
Instituto Nacional do Câncer. Estimativa 2023: incidência de câncer no Brasil [Internet]. Rio de Janeiro: INCA; 2022. [Acesso 2025 jan 12]. Disponível em: https://www.inca.gov.br/publicacoes/livros/estimativa-2023-incidencia-de-cancer-no-brasil
Cidades@: Pernambuco [Internet]. Versão 4.6.101. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; ©2023. [Acesso 12 fev 2025]. Disponível em: https://cidades.ibge.gov.br/brasil/pe/panorama
Cidade Brasil. Os municípios do Estado do Pernambuco [Internet]. [Sem local]: Cidade-Brasil; ©2012-2015. [Acesso 12 fev 2025]. Disponível em: https://www.cidade-brasil.com.br/estado-pernambuco.html
Vidal TJ, Figueiredo TA, Pepe VLE. O mercado brasileiro de anticorpos monoclonais utilizados para o tratamento de câncer. Cad Saúde Pública. 2018;34(12):e00010918. doi: https://doi.org/10.1590/0102-311X00010918 DOI: https://doi.org/10.1590/0102-311x00010918
Ramos FP, Sabino IZ, Nogueira JHBMA, et al. Câncer de próstata: revisão geral da literatura acerca dos diversos aspectos da doença. In: Anais do 4 Seminário Científico do UNIFACIG [Internet]. 2018 fev 8. [Acesso 2025 jan 22]. Disponível em: https://www.pensaracademico.unifacig.edu.br/index.php/semiariocientifico/article/view/928
Huertas PP, Sola MC, Cava PE, et al. Applying dose banding to the production of antineoplastic drugs: a narrative review of the literature. Farm Hosp. 2015;39(4):210-6. doi: https://doi.org/10.7399/fh.2015.39.4.8839
Mathijssen RH, Sparreboom A, Verweij J. Determinando a dose ideal no desenvolvimento de agentes anticâncer. Nat Rev Clin Oncol. 2014;11(5):272-81. https://doi:10.1038/nrclinonc.2014.40 DOI: https://doi.org/10.1038/nrclinonc.2014.40
Pinkel D. The use of body surface area as a criterion of drug dosage in cancer chemotherapy. Cancer Res. 1958;18(7):853-6.
Reinhardt H, Trittler R, Eggleton AG, et al. Paving the way for dose banding of chemotherapy: an analytical approach. J Natl Compr Canc Netw. 2017;15(4):484-93. doi: https://doi.org/10.6004/jnccn.2017.0048 DOI: https://doi.org/10.6004/jnccn.2017.0048
Mayor S. National health service England introduces dose banding. Lancet Oncol. 2016;17(7):e271. doi: http://dx.doi.org/10.1016/S1470-2045(16)30199-1 DOI: https://doi.org/10.1016/S1470-2045(16)30199-1
Rodriguez-Reyes M, López-Cabezas C, Calvo-Cidoncha E, et al. Dose banding of intravenous ganciclovir: banding scheme proposal and audit of toxicity and efficiency. J Clin Pharm Ther. 2021;46(3):767-71. doi: https://doi.org/10.1111/jcpt.13347 DOI: https://doi.org/10.1111/jcpt.13347
Legeron R, Bougueon G, Berroneau A, et al. Long-term physicochemical stability of acyclovir 5 mg/mL solution stored in polypropylene bags as a simulated hospital stock preparation. Am J Health Syst Pharm. 2021;78(9)806-12. doi: https://doi.org/10.1093/ajhp/zxab071 DOI: https://doi.org/10.1093/ajhp/zxab071
White-Koning M, Osborne C, Paci A, et al. Investigating the potential impact of dose banding for systemic anti-cancer therapy in the paediatric setting based on pharmacokinetic evidence. Eur J Cancer. 2018;91:56-67. doi: https://doi.org/10.1016/j.ejca.2017.11.029 DOI: https://doi.org/10.1016/j.ejca.2017.11.029
Faure S. Les préparations hospitalières de médicaments anticancéreux à doses standardisées (concept de "Dose-Banding"): une nouvelle technique de fabrication au CHR de Metz-Thionville [tese na Internet]. Nancy: Université Henri Poincaré; 2010. [Acesso 2025 jan 25]. Disponível em: https://hal.univ-lorraine.fr/hal-01738808v1
Albert-Marí A, Valero-García S, Fornés-Ferrer V, et al. Exploratory analysis for the implementation of antineoplastic logarithmic dose banding. Int J Clin Pharm. 2018;40(5)1281-91. doi: https://doi.org/10.1007/s11096-018-0714-9 DOI: https://doi.org/10.1007/s11096-018-0714-9
Conselho Nacional de Saúde (BR). Resolução n° 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos [Internet]. Diário Oficial da União, Brasília, DF. 2013 jun 13 [acesso 2025 fev 26]; Seção 1:59. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/cns/2013/res0466_12_12_2012.html
MV [Internet]. Recife: MV Informática Nordeste LTDA; [data desconhecida]. [Acesso 2025 jul. 24]. Disponível em: https://mv.com.br/sobre-a-mv
Kattige A. Long-term physical and chemical stability of a generic paclitaxel infusion under simulated storage and clinical-use conditions. Eur J Hosp Pharm Sci. 2006;12(6):129-34.
Stabilis® (paclitaxel) [bula na Internet]. Reino Unido: Hospira UK Limited; 2015. Bula de remédio [acesso 2025 jul. 21]. Disponível em: https://www.stabilis.org/Monographie.pdf.php?Molecule=Paclitaxel%20albumin
Quebbeman EJ, Hamid AA, Hoffman NE, et al. Stability of fluorouracil in plastic containers used for continuous infusion at home. Am J Hosp Pharm. 1984; 41(6):1153-6. DOI: https://doi.org/10.1093/ajhp/41.6.1153
Macleod S, Sewell GJ. Physical and chemical stability of docetaxel infusions. Stabilis. EJHP Practice. 2011;17(2)39-43.
Dine T, Lebegue S, Benaji B, et al. Stability and Compatibility Studies of four cytostatic agents (fluorouracil, dacarbazine, cyclophosphamide and ifosfamide) with pvc infusion bags. Pharm Sci Communications. 1994;4:97-101.
Sewell G, Massimini M. Stabilis 4.0. Studies On the Stability and Compatibility of Cytotoxic Drug Infusion with the Tevadaptor System. stabilis. EJOP. 2014:8(3)26-30.
Medici AC. Custos do tratamento do cancer no Brasil: como melhorar o foco. Blog Monitor de Saúde [Internet]. 2018 [Acesso 2025 fev12];12(88):1-6. Disponível em: https://www.researchgate.net/publication/323879334
Souza RMS. A obrigatoriedade da cobertura de medicamentos de alto custo pelo Sistema Único de Saúde: uma análise a partir do diagnóstico de câncer à luz da dignidade da pessoa humana [monografia]. Salvador: Universidade Católica de Salvador, 2020.
Santos LP, Ribeiro RA, Sadoyama ASP, et al. O direito ao fornecimento de medicamento de alto custo pelo SUS para pacientes com câncer. Rev Psicol Educ Cul. 2021;25(1):156-68.
Finch M, Masters N. Implications of parenteral chemotherapy dose standardisation in a tertiary oncology centre. J Oncol Pharm Practice. 2019;25(7):1687-91. doi: https://doi.org/10.1177/1078155218812943 DOI: https://doi.org/10.1177/1078155218812943
Chatelut E, White-Koning ML, Mathijssen RHJ, et al. Dose banding as an alternative to body surface area-based dosing of chemotherapeutic agents. Br J Cancer. 2012;107(7):1100-6. doi: https://doi.org/10.1038/bjc.2012.357 DOI: https://doi.org/10.1038/bjc.2012.357
Claus B, Pourcq K, Clottens N, et al. The impact of logarithmic dose banding of anticancer drugs on pharmacy compounding efficiency at Ghent University Hospital. Eur J Hosp Pharm. 2018;25(6):334-6. doi: https://doi.org/10.1136/ejhpharm-2016-001093 DOI: https://doi.org/10.1136/ejhpharm-2016-001093
O’Leary CE, Collins A, Henman MC, et al. Introduction of a dose-banding system for parenteral chemotherapy on a haematology–oncology day ward. Eur J Hosp Pharm. 2017:25(2):351-61. doi: https://doi.org/10.1177/1078155217736376 DOI: https://doi.org/10.1177/1078155217736376
Chiumente M, Russi A, Todino F, et al. Preparation of intravenous chemotherapy bags: evaluation of a dose banding approach in an Italian oncology hospital. 2021;8(1):29-34. doi: https://doi.org/10.33393/grhta.2021.2202 DOI: https://doi.org/10.33393/grhta.2021.2202
Published
How to Cite
Issue
Section
License
Os direitos morais e intelectuais dos artigos pertencem aos respectivos autores, que concedem à RBC o direito de publicação.
This work is licensed under a Creative Commons Attribution 4.0 International License.
