Background Recently there has been a significant increase in the number of oral anti-cancer medicines (OAM) available with patient preference the primary driver behind this increase. There are associated safety concerns surrounding OAM. The key safety concern is linked to the fact that OAM are not managed to the same strict standards as parenteral chemotherapy. The involvement of pharmacists in oncology multi-disciplinary teams (MDTs) is recognised as a means of implementing risk reduction strategies for the management of OAM.
Purpose To ascertain the most appropriate use of a pharmacist’s skills and knowledge to help improve the safe use of oral anti-cancer treatment for patients attending an oncology out-patient clinic.
Materials and methods Data collection in this project focused on three aspects:
Pharmacist involvement in a MDT oral chemotherapy review clinic
Questionnaire for medical and nursing staff
Results A total of 71 patient reviews were conducted and 152 interventions were recorded. These interventions had a direct effect on the care of 46 patients. The greatest number of interventions occurred during the patient consultation phase of the pharmacist review highlighting the significant role pharmacists can play in the provision of education, advice and pharmaceutical care to patients on oral chemotherapy. Although the number of interventions performed during the prescription and medication review was low, the consequence of such interventions is significant.
41% of patients felt better about taking oral chemotherapy following attendance at the oral chemotherapy review clinic. When asked to identify the most and least important actions completed by the pharmacist during the patient-pharmacist consultation, the top five most important actions were:
Discussion of side effects of treatment
Advice on managing side effects
Clinical check of their prescription
Explanation of how to take their OAM (i.e. with/after food, etc.)
Discussion of other medicines the patient may have been taking.
This advocates a greater role for pharmacists in the management of patients on OAM than simply supply of drug – patients view quality of services and information provided as more significant than assurances on safety alone.
The results of the staff questionnaire highlighted the safety concerns of staff relating to the management of oral anti-cancer medicines, with 80% of staff reporting a need to alter the current system for supply of oral chemotherapy. Staff were asked to identify the role they believed the pharmacist should play within the oral chemotherapy review clinic. The top five roles identified by staff were:
Liaison with community pharmacy (13%)
Verification of drug dispensed (12%)
Verification of other medicines and checking for interactions (11%)
Patient counselling on how to take OAM (11%)
Clinical verification of prescription (10%)
Conclusions Pharmacists have a significant role to play in a MDT oral chemotherapy review clinic.
No conflict of interest.
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