Life sciences · Journal article

Pharmacist-led educational intervention for rational prescribing and deprescribing of proton pump inhibitors in cancer patients: A quasi-experimental study from Pakistan

Journal of Oncology Pharmacy Practice · August 17, 2026

Promising Why this matters to you Expert discussion

Encouraging direction, but not yet definitive.

AI Summary

This quasi-experimental study demonstrates that pharmacist-led education incorporating CME and AGA guideline pamphlets substantially reduced inappropriate PPI prescribing and costs in cancer patients at a single tertiary centre in Pakistan. The intervention lowered inappropriate use without indication from 34.3% to 14% and reduced average treatment cost from PKR 530 ± 428.6 to 336.4 ± 250.8 (p < 0.001), with improved documentation of indications (39.3% to 60.7%, p < 0.001). The findings support pharmacist integration into oncology teams but require multi-centre confirmation and comparison against usual care or alternative interventions.

What was studied

Quasi-experimental study (pre–post intervention without concurrent control). Cancer patients receiving PPI prescriptions at a tertiary care cancer hospital in Peshawar, Pakistan. Specific eligibility criteria, cancer types, and baseline patient demographics not reported.. Intervention: Pharmacist-led education programme: physician CME sessions and weekly distribution of AGA (American Gastroenterological Association) guidelines pamphlets. Compared with: Pre-intervention usual care (retrospective comparison only; no concurrent control group). n = 400. Single centre: tertiary care cancer hospital in Peshawar, Pakistan.

Key findings

Inappropriate PPI use without proper indication decreased from 34.3% to 14.0% Long-term PPI use without valid reason declined from 7.3% to 1.8% Average treatment cost dropped from PKR 530 ± 428.6 to PKR 336.4 ± 250.8 (p < 0.001)

Safety

Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.

Who this may help

Pharmacist-led educational interventions addressing guideline-adherent PPI prescribing and deprescribing appear effective in reducing inappropriate use and costs in cancer care. However, a single-centre quasi-experimental design without a concurrent control group limits confidence that these improvements are causally attributable to the intervention rather than secular trends; multi-centre RCT evidence is needed before recommending widespread implementation.

Plain-language summary

A well-designed quasi-experimental study from a single tertiary centre showing clinically meaningful improvements in PPI prescribing appropriateness and cost reduction, but limited by lack of randomization and single-site geography.

Study design

As stated by the source record.

MethodsPrescriptions were collected prospectively in two periods: 200 pre-intervention and 200 post-intervention (November 2024 to January 2025). The intervention consisted of physician education via CME sessions and distribution of weekly AGA guidelines pamphlets. Data on patient age, cancer type, PPI prescriptions, indications, documentation, co-prescribed medicines, and costs were collected. Outcomes assessed were adherence to AGA guidelines, changes in PPI prescribing patterns, inappropriate PPI use, and total therapy costs.

DesignQuasi-experimental study (pre–post intervention without concurrent control)

PopulationCancer patients receiving PPI prescriptions at a tertiary care cancer hospital in Peshawar, Pakistan. Specific eligibility criteria, cancer types, and baseline patient demographics not reported.

Sample size400

InterventionPharmacist-led education programme: physician CME sessions and weekly distribution of AGA (American Gastroenterological Association) guidelines pamphlets

ComparatorPre-intervention usual care (retrospective comparison only; no concurrent control group)

SettingSingle centre: tertiary care cancer hospital in Peshawar, Pakistan

Reported figures

Quoted from the source exactly as published.

Inappropriate PPI use without indication – pre-intervention34.3%

Inappropriate PPI use without indication – post-intervention14.0%

Long-term PPI use without valid reason – pre-intervention7.3%

Long-term PPI use without valid reason – post-intervention1.8%

Average cost of treatment – pre-interventionPKR 530 ± 428.6

Average cost of treatment – post-interventionPKR 336.4 ± 250.8

p-value for cost reduction< 0.001

Documentation of indications – pre-intervention39.3%

Clinical bottom line

Caveats

No concurrent control or comparison group; pre–post design vulnerable to secular trends and unmeasured confounding
Single-centre study in Pakistan; generalizability to other settings, healthcare systems, and patient populations unclear
No long-term follow-up reported; sustainability of changes beyond the study period unknown
Specific patient eligibility criteria, cancer types, age distribution, and baseline characteristics not reported

Evidence assessment

Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.

Study design

moderate

Quasi-experimental with pre–post comparison; no randomization or concurrent control arm.

Directness

strong

Directly measures rational prescribing, deprescribing, and documentation adherence to AGA guidelines.

Consistency

insufficient

Single study; no external replication or comparison to other interventions reported.

Risk of bias

moderate

No blinding; potential for secular trend or selection bias without concurrent control group.

Sample adequacy

moderate

400 prescriptions analysed (200 pre, 200 post); adequate for primary outcome, generalizability limited to single centre.

Source abstract

PurposeProton pump inhibitors (PPIs) are often overprescribed in cancer care, leading to unnecessary side effects and increasing healthcare costs. Pharmacists can optimize and improve the rational prescribing of PPIs particularly in low/middle income countries, where such data is limited. We aimed to evaluate how a pharmacist-led education program affects PPIs rational prescribing and deprescribing in cancer patients through adhering to American Gastroenterological Association (AGA) guidelines, documentation of indication, and reducing costs.MethodsThis quasi-experimental study was conducted at a tertiary care cancer hospital in Peshawar, Pakistan from November 2024 to January 2025. Intervention included physician education via CME sessions and weekly AGA guidelines pamphlet. Data related to patient age, type of cancer, PPI prescriptions, indications for use, documentation, other co-prescribed medicines, and costs were collected. Outcomes included guidelines adherence in terms of changes in PPI prescribing, inappropriate PPI use, and the total costs of therapy.ResultsA total of 400 prescriptions (200 pre- and 200 -post intervention) were analyzed. Inappropriate use without proper indication decreased from 34.3% to 14%. Long-term use without a valid reason also declined from 7.3% to 1.8%. The average cost of treatment dropped from PKR 530 ± 428.6 to 336.4 ± 250.8, with p < 0.001. Significant improvements in adherence to multiple AGA Best Practice Advise (BPA) categories were observed, especially in deprescribing PPIs without definitive indications and step-down dosing. The documentation of indications for PPI use improved from 39.3% to 60.7%, with p < 0.001.ConclusionPharmacist-led interventions greatly improved rational PPIs prescribing, enhanced documentation, reduced inappropriate PPI use, and reduced therapy costs in cancer patients. These results support the pharmacist's integration into oncology healthcare team to improve medicine safety, rational use and resource utilization.

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Muhammad AshfaqQasim KhanGhulam MujtabaMuhammad Junaid Hassan SharifOmar Akhlaq BhuttaHaider Hikman