A harm with nothing to find
Educational use only. Not clinically reviewed66-year-old woman for medicines reconciliation, interaction recording, escalation to the treating team, evidence-boundary review, and handoff practice. About 8 simulated minutes.
What you will practise
- Reconcile what she is actually taking, not what was prescribed.
- Record the interaction and the direction its harm runs.
- Tell the treating team rather than the record.
- Refuse both dismissal and overstatement of the evidence.
- Record bounded qualified-team treatment intent.
- Review the boundaries and what retrospective data can support.
- Hand off a finding that has no abnormality in it.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Lee CH, Shen MC, Tsai MJ, Chang JS, Huang YB, Yang YH, Hsieh KP. Proton pump inhibitors reduce the survival of advanced lung cancer patients with therapy of gefitinib or erlotinib. Sci Rep. 2022;12:7002. A retrospective cohort study using the Taiwan Cancer Registry, National Health Insurance and Death Registry databases from 1 January 2010 to 30 December 2018, covering 4,340 gefitinib and 1,635 erlotinib users. Concurrent proton pump inhibitor use was associated with worse overall survival: median 14.35 against 21.87 months with gefitinib, adjusted hazard ratio 1.58 (95% CI 1.42-1.76), and 16.97 against 23.92 months with erlotinib, adjusted hazard ratio 1.54 (95% CI 1.30-1.82). Time to next treatment was used as a surrogate for progression because progression data were unavailable. The authors state association rather than causation.
- Raoul JL, Hansten PD. Proton pump inhibitors and cancer treatments: emerging evidence against coadministration. Cancer Treat Rev. 2024;129:102794. Most tyrosine kinase inhibitors depend on gastric acidity for absorption, and retrospective studies indicate that concurrent proton pump inhibitor use reduces the survival benefit of drugs including erlotinib, gefitinib and pazopanib. The authors recommend informing patients and clinicians of these interactions and suggest antacids or H2 blockers as alternatives for those requiring acid suppression.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.