Brown Bag Consult: Offering Preventative Cancer Care in the Community Pharmacy

Community pharmacists play a substantial role in helping patients maintain the health of their skin. From reducing the risk of sun exposure by recommending appropriate sunscreens to counseling patients on the use of OTC acne medications, pharmacists are often the first consulted health care professional when it relates to our body’s largest organ. Pharmacists also are on the front line of defense against skin cancer, as they are frequently consulted about potentially concerning skin conditions or lesions. It is important for community pharmacists to be aware of skin disorders and cancer risks so that they are able to help their patients by providing preventative and early-stage care.

Brown bag sessions are a nice opportunity to not only review patient medications, but also the risks for developing preventable conditions. The pharmacy serves as both a chronic and preventative hub of care within the community. Pharmacists are ideally positioned to counsel patients about the importance of appropriate skin care. In addition, many medications can compromise the health of our body’s outer layer. Counseling patients on possible adverse effects that impact skin health can help patients prepare for serious or cosmetic impacts, such as rash, itching, redness, or discoloration.

CASE

LP is a 57-year-old woman who is a relatively new customer to your pharmacy. Her life has been turned upside down by the pandemic. The pharmacy she used to go to changed their hours, making it harder for LP to consistently go there for care. LP also lost her job this past spring and does not have the same level of health insurance as she did in early 2020. She has become more conservative when it comes to preventative screenings and making appointments, as she does not have a lot of extra money to spend.

When she was recently in your pharmacy to pick up a refill prescription, LP told you she had spent the summer trying to make the best of times by enjoying the outdoors and gardening. She told you that hiking and gardening are new for her and have caused her many scrapes, bumps, rashes, and itches. LP joked that she may be allergic to the outdoors.

She also told you that as her summer tan started to fade, she noticed some dark spots that she never really saw before on her lower left leg and neck. You asked her about her sunscreen use, and LP admitted she never uses sunscreen. She thought getting a tan means having an attractive healthy glow.

You counseled LP on her refill prescription and explained the concept of pharmacy brown bag and medication therapy management sessions. LP would be a great candidate to participate, as over the past few months you have noticed adherence issues and an increase in OTC medication usage. LP appreciated your attention and set up an appointment to meet with you tomorrow, when you have extra coverage, and liked the idea of hopefully saving money.

To prepare for tomorrow’s session, you pull up LP’s pharmacy profile to compare it to what is in her brown bag:

• Ibuprofen 600 mg, twice daily as needed
• Levothyroxine 25 mcg, once daily every morning
• Sertraline 100 mg, once daily as needed
• Atenolol 50 mg, daily
• Lisinopril/hydrochlorothiazide 20/25 mg, daily
• Rosuvastatin 20 mg, daily
• Vitamin D3 1000 IU, twice daily as directed

LP arrives the next day for your appointment. She empties her brown bag, and you notice these additional medications:

• OTC aspirin 81 mg enteric coated, once daily
• Calcium carbonate 1000 mg, once daily
• Adult multivitamin, once daily
• OTC omeprazole 20 mg, once daily
• OTC topical retinoid
• Retin-A samples, not labeled
• OTC benzoyl peroxide solution
• OTC hydrocortisone 1% cream
• OTC diphenhydramine 50 mg capsules
• OTC loratadine 10 mg tablets

As you review the medications for accuracy, LP tells you that she has been feeling down, and she thinks her stress is impacting her health and mood. You ask her to explain further, and LP tells you that being out of work, the coronavirus disease 2019 pandemic, and not being able to embrace extended family has been making her feel depressed. She does not think her antidepressant is working, and she decided to only take it a few times a week.

You calm LP down and explain to her that she still has people like you within the community to help.

You explain that antidepressants do not just work every now and then, and stress the importance of taking her medication daily as prescribed. LP also admits to not taking her blood pressure medications as prescribed. She volunteers to start watching her blood pressure with a home cuff she has and to get in touch with her cardiologist after she tells you that she has 3 stents.

Because LP has been spending a lot of time outdoors, you counsel her to take proper prevention from the sun’s rays and review some sunscreens you recommend. You also look at some of the dark moles that LP is worried about. You review the skin ABCDEs (asymmetry, border irregularity, color not uniform, diameter greater than 6 mm, and evolving size) and suggest LP follow up with her dermatologist because the moles do appear quite irregular.

LP also tells you how she is going through a lot of OTC antihistamine treatments to treat various rashes and itchy skin. You suggest that she ask her dermatologist for a higher-strength hydrocortisone cream and to possibly conduct an allergy test.

What other counseling tips and advice could you give LP as it relates to her medication list and cancer prevention?

Jill Drury, PharmD, BCOP, is a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin.