Colorectal Cancer Risks and the Community Pharmacist's Role

Lives can be saved by encouraging screening for colorectal cancer in eligible patients.

Affecting both males and females, colorectal cancer is one of the most common types of cancer in the United States. The importance of early detection cannot be overemphasized. Proper screening and education play an important role in helping prevent or reduce the impact of colorectal cancer. Pharmacists are often thought of as the most trusted and accessible health care professionals within the community. Because of this perception, pharmacists have the opportunity to help patients by suggesting colorectal cancer screenings and follow-up care for those patients found to be at elevated risk.

There are many reasons why eligible patients may not be screened for colorectal cancer. The primary reason is that it simply has never been suggested. Pharmacists should communicate the universal message that colorectal cancer screenings save lives. Other reasons why eligible patients are not screened for colorectal cancer can vary. Certain groups of patients do not have health insurance or regular health care, are not aware of the importance of screenings, and/or may not realize they are at risk. Patients may also fear colorectal cancer screenings because of bowel preparation procedures and possible embarrassment during the screening. These issues can easily be discussed during patient-pharmacist counseling sessions.

The pharmacist can help provide educational and financial resources and relieve any anxiety related to the screening process. Pharmacists have the ability to recommend colorectal cancer screening tips and tools to reduce risk. Pharmacists can also refer patients to qualified health care providers for follow-up care and act as a prescriber-patient liaison. Pharmacists can also play an essential role by reviewing the proper instructions for any colorectal screening preparation medications.

Reducing Colorectal Cancer Risk in Your Patient Population

Community pharmacists have the responsibility to help patients differentiate between modifiable and nonmodifiable risk factors during counseling sessions. There are many modifiable risk factors that reduce the risk of colorectal cancer. For example, diets high in processed meats, such as deli meat and hot dogs, lead to an increased risk for colorectal cancer. It also is important for the pharmacist to encourage and consistently reinforce healthy lifestyles. Pharmacists should discourage inactivity, heavy alcohol consumption, tobacco use, and diets high in red meat. Consumption of vegetables and fruits should be encouraged. Pharmacists should also be able to identify eligible patients for colorectal screenings through nonmodifiable risk factors. Common nonmodifiable risk factors include advanced age, certain race/ethnicity, and family and personal medical histories.

Brown Bag Consult:

EM is a 64-year-old male who has been coming to your pharmacy for the past 10 years. Over this time, you have observed him making poor lifestyle choices and noticed he has become less adherent with various drug regimens. EM suffers from multiple disease states and lacks interest in managing them. You noticed in your last counseling session that EM lacks positive energy and seems negative about his therapy. EM is worried about the financial impact of his disease states and mentions his stress over his father’s passing from colon cancer. You ask EM if he would be interested in participating in a brown bag session. You explain what happens during a brown bag consult and tell EM you are interested in reviewing his medications and lifestyle. This will allow him to maximize his medications, which may also have a positive financial impact. EM nods and appreciates the opportunity to talk with you in depth, one-on-one. He schedules a time with you tomorrow to bring in all of his medications.

Upon reviewing EM’s medication profile at your pharmacy, you find the following:

• Metformin 1000 mg twice daily
• Pioglitazone 45 mg daily
• Furosemide 80-mg tablet daily
• Enalapril 10-mg tablet daily
• Fluoxetine 20 mg daily
• Polyethylene glycol/electrolytes solution—on hold
• Atorvastatin 40 mg daily

When EM comes in for his scheduled appointment, you notice the following additional medications in his brown bag:

• OTC multivitamin daily
• Used insulin (insulin + insulin glargine) vials, expired 12/2012, unlabeled
• Various rosiglitazone 4-mg sample packets, expired 1/2011, unlabeled
• Adalimumab 40 mg subcutaneously every other week, filled by mail order specialty pharmacy

After reviewing EM’s medications, you realize EM would benefit from an MTM session and you schedule a follow-up appointment. An MTM session will allow you to further communicate with EM’s health care providers, obtain lab values, and further evaluate EM’s medical goals, particularly those related to his colon cancer risks. An MTM session will also give you the opportunity to offer detailed diabetes education, as requested by EM.

Dr. Drury works as a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her doctor of pharmacy from Midwestern University College of Pharmacy. Her blog, Compounding in the Kitchen, appears on www.PharmacyTimes.com.