Supporting Patients with Cancer in the Community Pharmacy

Pharmacists working in outpatient clinics have counseling opportunities that are similar to the often abundant counseling opportunities in community retail settings. For example, medication reconciliation is a form of brown bagging and medication-therapy management. Both can be used to advance communication and prevent errors.

As with any counseling session, medication reconciliation helps ensure that a patient’s medications are accurate and safe. By relying on medication reconciliation, a clinic pharmacist can prevent errors that may occur when a patient’s medications include prescription drugs, OTC drugs, herbals, and dietary supplements. The process allows for the checking of omissions, duplications, dosing errors, adherence, and drug interactions. In all, the services provided by a clinic pharmacist can enhance communication between providers and patients to ensure care is coordinated.

Patients battling cancer should not be overlooked in the community pharmacy. Many of these patients are in need of support, encouragement, and care coordination. They will endure a grueling process of coping with diagnosis, treatment, and, in cases of recovery, the fear of recurrence. All of these stages will have emotional and physical repercussions. As the most accessible member of the health care team, the community pharmacist can give patients with cancer the information and support they need to get through what might be the most challenging time of their lives. Willingness to help at this crucial time demonstrates care and concern that patients will likely never forget.

The Case

CB is a 65-year-old loyal customer who recently became a new patient at the local oncology clinic because she was diagnosed with metastatic breast cancer and is facing many “ups and downs” regarding her various treatment options. CB presents to you a brand new list of medications and her current laboratory data. As the pharmacist, you page through the papers and notice a medication reconciliation performed by the clinic pharmacist. You review it against CB’s profile at your pharmacy and notice changes.

As you conduct your review, you see the concern and confusion on CB’s face. You explain the concept of pharmacy brown bag and medication-therapy management sessions and ask if she would be interested. CB is relieved and informs you that she will bring in all of her oral medications the next day. She is looking forward to the opportunity to review her entire history and current medication list. She has been feeling confused and mildly depressed due to her current diagnosis. She is also anxious about the possible adverse effects oncology medications are known to cause. You suggest CB visit around 3 pm, which is a slower time in your pharmacy. This will allow you to provide her with the best service and care.

The next day, CB is waiting in your consultation area. Having done your homework, you have filled CB’s new medications, reviewed discontinued medications, opened her medication profile, and have access to her laboratory data and medication reconciliation. You compare what is in CB’s brown bag to your information:

• Aspirin 81 mg enteric coating daily
• Atorvastatin 40 mg daily
• Niacin supplement
• OTC omeprazole 20 mg daily
• Ondansetron 4 mg as needed
• Lorazepam 0.5 mg as needed
• OTC acetaminophen 500 mg as needed
• OTC loperamide as needed
• Letrozole 2.5 mg daily
• Tamoxifen 20 mg daily

Your pharmacy profile includes the following:

• Atorvastatin 20 mg daily
• Niaspan 500 mg daily at bedtime
• Aspirin 81 mg enteric coating daily
• Atenolol 25 mg daily
• Ibuprofen 600 mg twice daily as needed
• Letrozole 2.5 mg daily
• Palbociclib 125 mg daily for 21 days (from a specialty pharmacy)

The goal of a brown bag session is to discover discrepancies. Awareness can allow you to make a number of short- and long-term suggestions that may improve communication between CB and her multiple providers. This may help improve CB’s quality of life and reduce her risk for admission to a hospital.

CB is willing to have you act as a community liaison between her and her providers. The first step is to follow up with CB’s providers to make them aware of your brown bag session discoveries and the suggestions you have regarding CB’s plan of care. Making time for this will be the most challenging aspect, so you will need to find a way to incorporate complex clinical opportunities into your workflow. Loyalty and patient satisfaction are priceless and worth the energy to help CB.

What are your general suggestions after reviewing CB’s brown bag medications? What laboratory data might have helped you when you reviewed CB’s medications? What questions do you have for the oncology clinic pharmacist?

Considering your time restrictions, how can you help ensure that CB does not fall off the track you have helped put her on toward a better quality of life?

Dr. Drury works as a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her Doctor of Pharmacy degree from Midwestern University College of Pharmacy. Her blog, Compounding in the Kitchen, an innovative amalgam of pharmacy and cooking, appears on www.PharmacyTimes.com/blogs/compounding- in-the-kitchen. Read, and enjoy!