Pharmacist interventions in ambulatory cancer care

Abstract

Background: Cancer treatment has drastically evolved over the years, leading to the transition of cancer care from an inpatient to an outpatient setting. Intravenous chemotherapy can now be safely administered at home with the use of ambulatory chemotherapy pumps, whilst many anticancer medications are available orally and dispensed from community pharmacies. The aims were to identify pharmacist interventions that support cancer patients in the community, analyse challenges associated with pharmacist interventions in cancer care and propose solutions to address the associated challenges. Method: A questionnaire was developed to investigate the interventions carried out by community pharmacists to support cancer patients and to determine their perceptions regarding future roles in cancer care. The questionnaire was validated through a pilot study and disseminated to community pharmacists in Malta and Gozo. Collected responses were analysed and the challenges associated with pharmacist interventions in cancer care were identified. A focus group was then conducted with a doctor, a nurse and a clinical pharmacist working at Sir Anthony Mamo Oncology Centre (SAMOC). During the first part of the discussion, the panel reviewed the questionnaire findings. In the second part, the discussion focused on the use of ambulatory chemotherapy pumps in Malta, particularly the current and potential roles of pharmacists in this service. Results: A total of 81 community pharmacists responded to the questionnaire. Patients seek advice from community pharmacists regarding medications (n=63), side effects management (n=62) and guidance on nutrition and lifestyle (n=34). A small percentage of pharmacists feel highly confident in providing cancer-related advice (n=6) and in dispensing anticancer medications (n=7). Lack of training and knowledge (n=65) and limited collaboration with other healthcare professionals (n=59) were the most prevalent barriers to carrying out cancer care interventions. During the focus group, the panel proposed initiatives to target the associated challenges. Educational initiatives could include targeted lectures and the inclusion of community pharmacists in oncology conferences. Collaboration could be strengthened through regular meetings between primary and secondary care representatives, as well as providing community pharmacies with access to relevant patient information from the oncology specialists. The panel further proposed the establishment of an online database with monographs for each oral anticancer agent. Three clinical pharmacists are currently working at the oncology hospital Their role primarily involves validating prescriptions and verifying treatment protocols. The panel agreed that pharmacists should have a greater clinical role, including patient counselling, medication management and reconciliation, monitoring of adverse effects and drug interactions and enhanced clinical presence on the wards. Conclusion: The findings of this study highlight that lack of training and knowledge is the most significant challenge community pharmacists face in cancer care interventions. Despite their lack of confidence, community pharmacists are willing to intervene, emphasising the need for targeted training programmes and enhanced collaboration with healthcare teams. Clinical pharmacists’ roles in ambulatory care also have the potential to expand to include direct patient care activities. Addressing these gaps would allow pharmacists’ expertise to be fully utilised, which not only strengthens multidisciplinary care but ultimately enhances patients’ quality of life.