Stratification system for pharmaceutical care in cancer patients: Chinese expert consensus

China bears one of the world's heaviest cancer burdens, with a complex and multimodal cancer treatment environment. Currently, the absence of a standardized framework for oncology pharmaceutical care limits the quality and precision of services, highlighting an urgent need for clinical guidance.

The objective of this study was to establish an evidence- and practice-informed consensus on oncology pharmaceutical care, providing a standardized framework for clinical practice.

Under the leadership of Sichuan Cancer Hospital and in collaboration with national academic organizations, a multidisciplinary expert panel conducted a systematic literature review, nationwide surveys, and consensus meetings. The recommendations were formalized through a two-round Delphi process.

Three levels of pharmaceutical care are defined in this consensus, along with their corresponding implementation principles, including prioritization of high-risk patients, assignment of the highest applicable level when multiple criteria are met, and dynamic reassessment in response to changes in clinical status. The stratification system is established based on a comprehensive assessment across three core dimensions: 1) Pathophysiological conditions, including fertility preservation, age, body mass index, performance status, comorbid chronic diseases, concurrent infections, nutritional status and support, pain management, and hepatic or renal impairment; 2) Medication-related factors, encompassing antineoplastic agent toxicity risk and management, therapeutic drug monitoring, pharmacogenomics, clinically significant drug-drug interactions, polypharmacy, special administration routes or delivery devices, medication adherence, and complex medication issues; 3) Non-medication therapeutic interventions, such as radiotherapy, interventional therapy, surgery, and novel therapies (e.g., CAR-T therapy, tumor-infiltrating lymphocyte therapy). Specific recommendations for stratified pharmaceutical care were formulated based on these factors.

This expert consensus establishes a standardized and practical framework for stratified pharmaceutical care in cancer patients, aiming to improve care quality, optimize resource allocation, and enhance patient outcomes in China. It may also serve as a reference model for international initiatives seeking to establish or refine standards for oncology pharmaceutical care.