Stratification System for Pharmaceutical Care in Cancer Patients: Chinese Expert Consensus

Ya Chen¹Xue Ma¹Mao Lin¹Zhiqiang Hu¹Junxiang Zhou¹Yue Qiu¹Zhixi Liu¹Suya Du¹Lihong Shi¹Li Han¹Yan Chen¹Tingting Qi¹Yu Zhang^2*Guohui Li^3*Hongtao Xiao^1*

• ¹Sichuan Cancer Hospital, Chengdu, China
• ²Tongji Medical College Medical Information Research Institute, Wuhan, China
• ³Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China

China bears the world's highest cancer incidence and mortality rates, underscoring the urgent need for precise pharmaceutical care within its complex, multimodal treatment environment. To address the lack of a standardized framework, a multidisciplinary expert panel led by the Sichuan Cancer Hospital developed an evidence-and practice-informed consensus through systematic reviews, national surveys, and Delphi consultations. This consensus proposes a novel three-level stratification system based on comprehensive assessment of three core dimensions: pathophysiological conditions (including fertility preservation, age, body mass index, performance status, comorbid chronic disease, concurrent infection, nutritional status and support, pain management, and hepatic/renal impairment), medication-related factors (encompassing oncology-specific medication considerations such as antineoplastic agents toxicity risk management, antineoplastic agents toxicity management, therapeutic drug monitoring and pharmacogenomics, clinically significant drug-drug interactions, polypharmacy, special routes of administration or delivery devices, medication adherence, and complex medication issues), and non-medication therapeutic interventions (including radiotherapy, interventional therapy, surgery, and novel therapies such as CAR-T and tumor-infiltrating lymphocyte therapy). Level 1 applies to life-threatening or disabling situations requiring intensive real-time monitoring; Level 2 to serious but non-immediately life-threatening situations requiring systematic management; and Level 3 to stable conditions with mild-to-moderate medication-related risks requiring periodic review. Implementation principles are provided, including prioritizing high-risk patients, assigning the highest applicable level when multiple criteria are met, and conducting dynamic reassessment based on clinical changes. Ultimately, this standardized, practical, and oncology-specific framework aims to enhance the quality, precision, and efficiency of pharmaceutical services, optimize healthcare resource utilization, and improve patient safety and treatment outcomes across China, while also offering a reference model for international efforts to establish or refine oncology pharmaceutical care standards.