Authors (including presenting author) :
Tsang JSC (1), Choi YF (1), Yiu TT(1), Yip YT (1), Chan CW (2), Ng V (1), Cheng ACK (2)
Affiliation :
(1) Department of Pharmacy, Princess Margaret Hospital, (2) Department of Oncology, Princess Margaret Hospital
Introduction :
The role of oncology clinical pharmacists is invaluable in the management of cancer treatments. Not only can drug education be provided, but oncology clinical pharmacists are also competent in identifying urgent oncologic conditions, treatment-emergent toxicities, and implementing effective supportive drug regimens to mitigate the adverse effects of treatment. With the growing demand in complex cancer treatment management, oncology clinical pharmacists are capable of advancing practice by performing patient assessment for proceeding systemic anti-cancer therapy (SACT).
Objectives :
To advance oncology pharmacy practice through piloting an Integrated Systemic Anti-Cancer Therapy Clinic (ISACTC) in collaboration with oncologists. In the ISACTC, oncology clinical pharmacists provide independent pre-SACT assessment under protocol, striving to optimize drug therapy and simultaneously taking up a certain number of Specialist Out-Patient Clinic (SOPC) consultations in order to relieve oncologists to attend to other patients with more complicated disease states.
Methodology :
In June 2020, the ISACTC was piloted at the Oncology Department of Princess Margaret Hospital. Subsequent to the initiation of SACT, oncology clinical pharmacists and oncologists perform patient assessment at alternate visits. Under specific protocols, oncology clinical pharmacists perform laboratory and adverse effects screening, determine patients’ fitness to proceed with the next cycle of SACT and actively implement supportive medications. Oncology clinical pharmacists would also make immediate physician referrals if the patient’s conditions were deemed to require physical examination or when red flag symptoms arise. Physician and patient surveys were obtained to evaluate the acceptance of the new program.
Result & Outcome :
A total of 426 patients entered into ISACTC. From 22 June to 30 Nov 2020, 776 patient-episodes were recorded. The proportion of malignancies are as follows: colorectal 47%, lung 25%, breast 8%, ovarian 8%, others 12%. Treatment settings included neo-adjuvant, adjuvant and palliative. Of the 29 patients who completed the patient-satisfaction survey after seeing the pharmacist at least twice in their SACT journey, all agreed that the pharmacist made useful recommendations to alleviate the adverse effects of SACT. All 29 patients expressed confidence in the pharmacist in following up with their SACT and as a whole were satisfied with the service. A survey of 9 oncologists who worked in collaboration with oncology clinical pharmacist in ISACTC all agreed that oncology clinical pharmacists are competent in identifying treatment-related toxicities or red-flag symptoms and this service model improved continuity of care. Eight of them were comfortable with adding new SACT regimens into the program. Seven of them agreed that the implementation of ISACTC spared them more time to attend to other more complex patient cases. Overall, all would like to continue having the clinical pharmacist manage SACT for patients at alternate visits.
