Consider Transdisciplinary Approach to Pain in Patients with Cancer

Managing cancer pain is a challenge for patients and providers alike. When 2 clinicians of different professions share information, it's interdisciplinary exchange. The National Comprehensive Cancer Care Network Adult Cancer Pain Guidelines recommend taking a broader, multidisciplinary approach.¹ The Advocating for Clinical Excellence Project takes the multidisciplinary definition a step further, saying that providers in a palliative care team should take a transdisciplinary approach. This means that “members create a shared team mission, benefit from role overlap, and have integrated responsibilities, training, and leadership.”^2,3

San Diego Moores Cancer Center at the University of California initiated a pharmacist-physician collaborative care agreement for their outpatient clinic.⁴ They recently conducted a retrospective data analysis examining problems identified, medication revisions made, and changes in pain scores.

The researchers assessed 135 patient visits in this study, of which pharmacists made 430 interventions. Pharmacists' most common intervention was changing the pain medication dose.

Among patients diagnosed with gastrointestinal ailments, pharmacists were most likely to start new medications for constipation, nausea, and vomiting.

Other common pharmacist interventions included recommending medication changes to address lack of efficacy, starting new medications, and changing frequency.

Patients reported significantly improved pain scores by their third visits. The first visit established the baseline; differences in pain scores at the second and fourth visits were statistically insignificant.

Pharmacists are the health care team's medication experts, and are able improve patient care through collaborative practice agreements. They can advance the palliative care team's main goal of making the best plan for the patient and patient’s families.

The researchers concluded that “sustaining pharmacist success in palliative care is dependent upon reimbursement of services, standardization of pharmacist expertise, and increased recognition of a pharmacist’s role by national palliative care professional organizations.”

This study appears in the December 2016 issue of the Journal of Oncology Pharmacy Practice.

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References

1. Swarm R, Anghelescu D, Benedetti C, et al. NCCN Clinical Practice Guidelines in Oncology. Adult cancer pain. Version 2.2016. Oral cancer foundation website. http://oralcancerfoundation.org/wp-content/uploads/2016/09/pain.pdf. Accessed Dec. 16, 2016.

2. Otis-Green S, Ferrell B, Spolum M, et al. An overview of the ACE Project-advocating for clinical excellence: transdisciplinary

palliative care education. J Cancer Educ. 2009;24:120—126.

3. Simpson D. From interdisciplinary to transdisciplinary: Strengthening the hospice team. Hosp Palliat Care Insights. 2003;4:8—15.

4. Ma J, Tran V, Chan C, et al. Retrospective analysis of pharmacist interventions in an ambulatory palliative care practice. J Onc Pharm Pract. 2015;22;757—765.