Imagine going through major surgery and then starting a treatment regimen of as many as a half-dozen prescription medications per day, in addition to whatever pills, vitamins and supplements you are already taking. The average patient receiving chemotherapy in neuro-oncology takes several different medications per day, so it’s little wonder they sometimes feel overwhelmed, confused, and stressed about this aspect of their treatment. Recognizing this, researchers undertook a feasibility study a few years ago at Calgary’s Tom Baker Cancer Centre to determine if the addition of a pharmacist to the neuro-oncology team could be of benefit to patients attending the clinic. The study demonstrated a definite need and this past fall, funding was obtained to staff two part-time pharmacy positions in the neuro-oncology department. Presently, these positions are filled by Nadine Lam and Frances Cusano.
FAB PHARM: Led by pharmacists such as Frances Cusano, the initiative is bringing results to patients.
Photo Brian Buchsdruecker
Team members have already noticed a difference. “Having a pharmacist on the team has greatly improved patient care,” says Catriona Leckie, nurse practitioner in the Department of Neuro-Oncology. “Patients have a lot questions about medications and it’s good to have someone with expertise in the area. The pharmacists provide answers to questions during patient training sessions, help organize individualized medication schedules, provide advice on alternative treatments and follow up with patients to help them manage side effects.”
One of the most important roles the pharmacists have taken on is detecting drug interactions before a patient begins their medication regimen. “One of the largest areas of my practice is responding to questions about natural health products,” Frances Cusano says. “We don’t discourage people from using complementary medicines, but we do want them to understand the risks and benefits. Some natural products aren’t a concern, but some have side effects such as an increased risk of bleeding or seizures that could be dangerous when combined with chemotherapy agents. Other herbs, such as those with anti-oxidant properties, can decrease the effectiveness of radiation therapy.”
The addition of a pharmacist to the team has also facilitated a proposal for a new research study the neuro-oncology group hopes to undertake. The team would like to see if an herb, Boswellia serrata, could benefit the typical treatment regime for clinic patients. Cusano has been documenting current scientific research on the herb and will play a key role in the group’s research proposal. “There has been some research done elsewhere that shows this herb may decrease swelling in the brain,” explains Cusano. “We hope that adding this complementary medicine to the regular regimen will allow us to decrease the steroids patients have to take after brain surgery and eliminate a lot of side effects.”
When it comes to the complicated medications in neuro-oncology, the group has discovered that it’s great to have an expert around. “There’s no doubt that the addition of pharmacists to the neuro-oncology team has improved patient care, but the pharmacist’s role goes deeper than just the technical aspects of the job,” says Vickie Baceda, primary nurse in the Department of Neuro-Oncology. “It’s been beneficial for our patients to have a relationship with a neuro-oncology pharmacist.” Pharmacists may become regulars in neuro-oncology teams throughout Alberta.
Photo Brian Buchsdruecker
THE NEURO-ONCOLOGY TEAM:
Being told that you have a brain tumour is frightening news that brings questions and concerns, beyond the treatment of the disease. That’s why neuro-oncology clinics are increasingly taking a multidisciplinary approach.
“We’re treating the whole patient, not just the cancer,” explains Vickie Baceda. “Each member of the team has an expertise, but we’re all working together for one thing – our patients.”
A team of approximately 15 people works in neuro-oncology (not always at the same time) and Baceda co-ordinates the clinics, which take place twice each week. Members of the neuro-oncology team include medical oncologists, radiation oncologists, nurses, nurse practitioners, clinical associates, visiting fellows, clerical staff, pharmacists, psychologists, and spiritual advisors. The team can also call on social workers, financial advisors, and home-care providers to assist if necessary. “Some people are surprised at the wide variety of disciplines represented on the team, but there are many things that our patients have to deal with,” Baceda explains. “For example, most people can’t work when they’re being treated for a brain tumour and if they are self-employed and without disability insurance, they often have concerns about how they’ll support their families. Those concerns might be eased by talking with a social worker or our team psychologist. ”
While pharmacists are the newest addition to the neuro-oncology team, the team’s expertise is broad. Beceda has overseen and co-ordinated its growth, and she looks after business at the clinic like a conductor at an orchestra. She has so much on the go that, when she retires later this year, there are plans to replace her with two people.
There was a time when hospitals only considered the medications and procedures that would be used to treat the tumour, but modern medicine is about much more than just treating the disease. “Every person on the neuro-oncology team has an important role,” says Baceda. “We all work together to enhance the care.”