Background: OADs are increasingly used for cancer treatment. However, fatal outcomes have been associated with patients misinterpreting dosage instructions. Guidelines recommend that prescriptions for OADs be checked by an oncology pharmacist and patients receive counselling before commencing therapy. Prior to the start of this pilot, neither was standard practice in our department.
Methods: A pharmacy- and nurse-led oral anticancer agent counselling clinic was developed for patients starting oral cytotoxic chemotherapy, targeted agents and second-generation antiandrogens. After oncologist review, a pharmacist checked the prescription, counselled the patient on drug dosing, provided written information on the OADs and checked their medicines for interactions. Patients with complex needs were seen by the Oncology Clinical Nurse Consultant. Telephone follow up was performed one week after commencing treatment to ensure they were taking the correct dose and to assess any side effects. Here we present the results from the pharmacist input into the clinic for the first 26 weeks of the pilot.
Results: Thirty-five patients were seen during the pilot, comprising 37 separate clinic appointments. Two patients were seen in the service twice on separate occasions. Fifty-five consultations were undertaken of which 37 were clinic attendances and 18 were telephone follow ups. Forty-six percent of patients received a telephone follow up by a pharmacist. A number of clinically important interventions were made during the initial clinic appointment or telephone follow up. One intervention was for an incorrect dose and one patient experiencing side effects that necessitated treatment cessation was identified.
Conclusion: While the number of patients seen was modest, the interventions made during the pilot illustrate the need for specialist pharmacist supervision of patients commencing OADs. All patients commencing OADs should be provided with specialist counselling prior to commencing an OAD.