Shared care guidelines for patient medicines management in breast and colon cancer

Abstract

The introduction of oral chemotherapy has lead to cancer patients receiving these medications through community pharmacies rather than having to visit a hospital to have their oncology medication administered. This change represents a shift from therapy being given in hospital, to therapy being given in the patient’s own home. In this context, community pharmacists can provide a significant intervention by supporting patients to manage and prevent oral chemotherapy side effects, thus avoiding unwarranted trips to hospital, which saves money and time, resulting in an improvement in the patient’s quality of life. The aim of this research was to compile shared care guidelines for oral chemotherapy used in the management of breast, colon and prostate cancer.

Five shared care guidelines were created for: capecitabine, everolimus, abiraterone, enzalutamide and ruxolitinib. The developed documents were validated by a panel of experts consisting of four oncologists, a principal and a senior pharmacist within the compounding section at Mater Dei Hospital, and a senior pharmacist at Sir Anthony Mamo Oncology Hospital. A patient focus group was developed during which five patients receiving oral chemotherapy from a community pharmacy were invited to participate in the focus group and given a questionnaire to capture the patient’s experience about the service received from the community pharmacist. The developed shared care guidelines were presented to community pharmacists during an educational program about managing chemotherapy side effects. Scored questionnaires were handed out to the pharmacists before and after the program to determine if there was an improvement in responses.

The validation panel reported on the content and validity of the shared care guidelines developed. The educational program was carried out for 11 community pharmacists who are currently practicing in community pharmacies where dispensing of oncology oral therapy is undertaken. The mean response rate before the educational program was 5.45% whilst the mean response rate after the program was 80%. From the patient focus group issues related to information presented to the patient about what side effects to be expected, how these side effects should be handled and how these medications should be stored were identified. These points were used to develop the framework for the shared care guidelines and each guideline now consists of indications, administration, side effects and storage information.

The shared care guidelines were developed within a collaborative framework and are intended to further substantiate effective communication between healthcare professionals at different settings, namely: the hospital multidisciplinary team and the community pharmacist dispensing the oral chemotherapy drugs.