By: Colleen Biondi
Throughout a cancer patient’s treatment and recovery, pharmacists are actively involved in their care within the cancer centres and at their community retail pharmacy. Both cancer centre pharmacies and retail pharmacies have many important commonalities and will work together to support their patients.
In the past, the pharmacist’s role was technical — count the pills, dispense them to the customer and ring up the sale. “But that function has evolved,” says Melanie Varughese, pharmacy manager at the Cross Cancer Institute in Edmonton. “Today, pharmacists play a critical role in providing direct care to all patients, including those living with cancer.”
Pharmacists provide three key job responsibilities for the communities they serve when it comes to cancer care:
1. As medication managers, they ensure drugs are safe, well-tolerated and effective.
Cancer centre pharmacies dispense cancer medications — prescribed by oncologists — whether they are infusions or medications to be taken by mouth. Pharmacists ensure the medications are the correct dose, indication and do not interact with any other medications/natural medications a patient is taking. They will collaborate with local pharmacies and family physicians to make sure health-care providers are aware of what cancer medication is being prescribed to patients.
Additionally, they follow up with patients during pharmacy visits or by phone. Community pharmacies, “support cancer patients mainly through the dispensing and counselling of supportive-care medications related to the patient’s cancer treatment. These include anti-nausea medications (like dexamethasone) and painkillers,” says Alex Kwan, clinical pharmacist in the breast cancer group at the Cross Cancer Institute and pharmacist at Save-On-Foods in Edmonton. “We also review and help manage drug interactions between these supportive-care medicines and the patient’s other chronic medications.”
Pharmacists check blood work and ask about allergic reactions and side effects to get the broadest clinical picture.
2. As liaison officers, they refer to other health-care professionals in the community and health-care settings (nutritionists, social workers, physiotherapists, for example) if patients are experiencing eating or mobility issues, or are feeling depressed.
If a patient is having swallowing difficulties, the pharmacist may discuss an alternative plan (a liquid form of the medication or a capsule or a product that can dissolve in water) with the oncologist or family doctor on behalf of the patient. Pharmacists will work closely with all health-care providers to ensure patients are able to receive the medications they require.
3. As excellent listeners, they give support to patients who are in crisis or are struggling with their diagnosis and care.
Suppose a patient is overwhelmed and having trouble remembering how to take their medication properly. In that case, the pharmacist may suggest a blister pack (pre-packaged), or a dosette (plastic Monday-to-Friday containers) or recommend management videos or apps. Local pharmacists are often well-known by patients in the community and are in a position of trust.
In addition to these key responsibilities, pharmacists are taking on new roles consistent with their “scope of practice,” determined by their regulatory body and training. For example, they can now administer injections, such as vaccines and B12 shots, which are extra-beneficial for immune-compromised patients, like those undergoing cancer care. Pharmacists can also prescribe medications as part of their role, whether working closely with the oncologist in the cancer clinics, or with family physicians. They also work with technicians and assistants to provide the breadth of pharmacy care.
Pharmacists give clinical information, wise counsel, education and support to ensure people living with cancer get the best care, the most optimal outcomes and their quality of life remains as intact as possible on their journey.
“The pharmacy is an excellent platform to answer questions and provide medication management tools for patients,” says Varughese. “Pharmacists are great problem-solvers.”
Did You Know:
The pharmacy at the Cross Cancer Institute is responsible for mixing and dispensing all chemotherapy preparations for every cancer patient in northern Alberta, no matter where they live. That’s a lot of activity for a pharmacy that is only 520 m². To double clinical trials capacity, the capacity of the pharmacy will also need to increase to manage that growth.
This is one of the major priorities of the Alberta Cancer Foundation’s $30-million We Cross Cancer capital campaign. In addition to the Cross Cancer Institute pharmacy, there are five other cancer care centre pharmacies in the province, located in Grande Prairie, Red Deer, Calgary, Lethbridge and Medicine Hat, and 11 community cancer centres that ensure patients can receive their cancer treatments closer to home.