Implementing a standardized pharmacist assessment and evaluating the role of a pharmacist in a multidisciplinary supportive oncology clinic.

Abstract

Supportive care, or palliative care, in oncology patients has been a shifting paradigm in the last few years. Patients with advanced cancer experience significant symptom burden and psychosocial distress from the onset of their diagnosis and throughout treatment. The focus on cancer treatment often defers the integration of palliative care to a more "reactive" vs "proactive" approach, which can hinder symptom management. Many cancer centers are integrating palliative care programs in their practice; however, the scope of services and degree of intervention varies widely, especially with regard to the pharmacist's role. The purpose of this article is to describe the operational aspects of a multidisciplinary supportive oncology clinic at St. Luke's Mountain States Tumor Institute (MSTI). The MSTI supportive oncology clinic is a half-day clinic where complex patients are seen by a multidisciplinary team led by a nurse practitioner. The team also includes a nurse, a pharmacist, a dietitian, and a social worker. The pharmacist is responsible for medication reconciliation, which includes assessment for drug interactions, adverse effects, duplications in therapy, lack of efficacy, and untreated conditions. Within the first year of the supportive oncology clinic's operation, we saw a total of 75 patients. Use of a standardized pharmacy assessment helped to elucidate and address medication issues such as duplicate therapies (46.7% of patients), drug interactions (44%), side effects (74.7%), lack of efficacy (94.7%), and untreated conditions (73.3%). Pharmacists are uniquely trained in medication therapy management, and a thorough medication therapy review has been shown to assist other disciplines in their own assessments.