Keynote abstract
Scientific discoveries have transformed the outcome of cancer from a usually fatal disease to a curable illness for some people and a chronic condition for many more. With this shift has come not only a growing optimism about the future but also an increasing appreciation for the human costs of cancer care. As patients live longer with cancer, concern is growing about both the health-related quality of life of those diagnosed with cancer and the quality of care they receive.
Cytotoxic drug treatment is one of the modalities for treatment of cancer, beside surgery, radiotherapy and immunomodulating drugs. Cancer itself and treatment cause many secondary effects to the patient which is possible to alleviate in a supportive care plan. The pharmacist as an important member of the cancer care team has role in the formulation of a care plan and particular for supportive care. Effects such as pain, fatigue, nausea and vomiting, diarrhoea, constipation, mucocitis, neutropenia, alopecia, fewer are well cared for by an experienced and empathetic oncology pharmacist. The anxiety, social and psychological aspects of the disease must be cared for as well.
Cancer-related fatigue (CRF) is a significant and distressing problem affecting physical and psychosocial functioning and reducing the patient’s quality of life.The condition is associated with a feeling of tiredness and lack of physical energy. It is difficult to define but “a persistent, subjective sense of tiredness related to cancer or treatments that interferes with usual functioning” may explain. The prevalence of CRF for patients undergoing cytotoxic drug therapy is reported to be 80-100%. Limited knowledge of the mechanism of CRF has led to inefficient or inappropriate treatment. Pharmacological therapies to combat fatigue have not been rigorously evaluated in controlled trials. In recent years, scientific knowledge has dramatically changed the ideas about the relationship between physical activity, rest and CRF and convincing evidence supports management of fatigue with physical exercise.
An effective emesis therapy is fundamental. Emesis is the most feared side-effect by the patients and perceived to be especially unpleasant. If not adequately managed, cytotoxic drug therapy might be discontinued prematurely. Only few years ago patients experienced a most severe and long lasting nausea and vomiting following cytotoxic drug therapy. Today the situation is much better. The improved anti-emetic effect was due to other receptor interactions and further elaboration has revealed the mechanisms causing cytotoxic drug induced emesis that will be highlighted.
Patient also needs information. Many patients do want to participate in decisions about care, clinicians underestimate their need for information and they are also unaware of the patient´s preferences. In reality no one talks about anxiety and concern and there are insufficient information on treatment, recovery and investigation both to the patient and the relatives. Most patients want to have information from pharmacist but the majority has got none.
All aspects in a care plan for a cancer patient must be considered by the oncology pharmacist. He is the expert in supportive care but also in the chemistry, pharmacology and safe handling and administration of cytotoxic drugs. Professional development of precautions and methods for preparation of cytotoxic drugs has reduced health effects to handling personnel to a minimum. New therapy is required for distressing side effects such as fatigue, mucositis, pain and diarrhoea. It is further evident that pharmacists do not support enough to alleviate the psychological and social distress in the patient with cancer. Better mental strength will also mobilise resources to combat the disease itself.
