Oncology clinical pharmacy from practice to research

1. Noha El Baghdady, M.Sc.
Oncology Clinical Pharmacy from
Practice to Research

2. Cancer was first described
by the ancient Egyptians
The earliest description of
cancer was found in the
Edwin Smith Papyrus dating
back to 1600 B.C.
The document describes
breast tumours removed by a
tool called the fire drill.
However, it states that "there
is no treatment".

3. • Fact 1
There are more than 100 types of cancers; any part of the body
can be affected.
• Fact 2
In 2008, 7.6 million people died of cancer - 13% of all deaths
worldwide.
• Fact 3
About 70% of all cancer deaths occur in low- and middle-income
countries

4. • Fact 4
Worldwide, the 5 most common types of cancer that kill men are
(in order of frequency): lung, stomach, liver, colorectal and
oesophagus.
• Fact 5
Worldwide, the 5 most common types of cancer that kill women
are (in the order of frequency): breast, lung, stomach, colorectal
and cervical. In many developing countries, cervical cancer is the
most common cancer.

5. • Fact 6
Tobacco use is the single largest preventable cause of cancer in the
world causing 22% of cancer deaths
• Fact 7
One fifth of all cancers worldwide are caused by a chronic infection, for
example human papillomavirus (HPV) causes cervical cancer and
hepatitis B virus (HBV) causes liver cancer.
• Fact 8
Cancers of major public health relevance such as breast, cervical and
colorectal cancer can be cured if detected early and treated
adequately.
• Fact 9
All patients in need of pain relief could be helped if current knowledge
about pain control and palliative care were applied.

6. • Fact 10
More than 30% of cancer could be prevented,
mainly by not using tobacco, having a healthy
diet, being physically active and moderating the
use of alcohol.
In developing countries up to 20% of cancer
deaths could be prevented by immunization
against the infection of HBV and HPV.

7. • The Lowest income countries have a survival
rate for oncology patients of 25% compared
with 56% in wealthiest.

8. Role of The Clinical Pharmacist

9. Symposium on Clinical Pharmacy and
Clinical Pharmacology,1981
• The purpose of the Symposium is
to describe the present and future
functional roles of clinical
pharmacists and clinical
pharmacologists in drug
research, professional
education, and patient care.
RUSSELL R. MILLER Pharm.D., Ph.D, 1981

10. Clinical Pharmacists’ role
Drug research
Patient care
Professional
education

11. Level of Action of Clinical
Pharmacists(ESCP)
Before The Prescription
During The Prescription
After The Prescription

12. 1- Before the prescription
• Clinical trials
• Formularies
• Drug information
• Clinical pharmacists have the
potential to implement and
influence drug-related policies’
national and local formularies’,
which prescribing policies and
treatment guidelines should be
implemented.
• Clinical pharmacists are also
actively involved in clinical trials at
different levels.

13. 2- During the prescription
• Counseling activity
• Clinical pharmacists can influence the attitudes and
priorities of prescribers in their choice of correct
treatments.
• The clinical pharmacist monitors, detects and prevents
harmful drug interaction, adverse reactions ad medication
errors through evaluation of prescriptions' profiles.
• The clinical pharmacist pays special attention to the dosage
of drugs which need therapeutic monitoring.
• Community pharmacists can also make prescription
decisions directly, when over the counter drugs are
counseled.

14. 3- After the prescription
• Counseling
• Preparation of personalized
formulation
• Drug use evaluation
• Outcome research
• Pharmacoeconomic studies

15. 1- patient Care

16. Oncology Pharmaceutical Care Plan
• Cancer therapy
• Side effects or consequences of the cancer
therapy
• Complications of the problems associated with
the cancer (e.g. pain)
• Comorbidities

17. Pharmaceutical Care Plan Issues
PCP
Disease
MedicationsPatient

18. B - Side effects or consequences of the
cancer therapy
1-Recognition
2-Prevention strategies
3- Management strategies (CTC grading
system)
4- Patient counseling

19. B- Side effects or consequences of the
cancer therapy
• Hematological.
• Gastrointestinal.
• Mucocutaneous.
• Hypersensitivity
• Renal Toxicity
• Bladder Toxicity
• Hepatotoxicity
• Nervous System Toxicity
• Gonad Dysfunction
• Extravasation
• Infusion related reactions

20. Principles for the Prevention and Management
of CINV
1. Evaluate each patient individually
2- Evaluate the emetogenic potential and pattern of the
chemotherapeutic regimen to be given
3- Antiemetics are most effective when given prophylactically
4. Flexibility is the key
a. There are many “right” answers for anti‐emetic regimens.
b. Remember that every patient has
a different “threshold” for nausea/vomiting;
cost‐effective therapy does not mean being
stingy with antiemetics.
c. Institution‐specific guidelines standardize therapy,
facilitate tracking of outcomes, and reduce costs.

21. C- Complications of the problems
associated with the cancer
• Pain Management.

22. 2- Patients Issues
1- Performance status (ECOG)
2- Health status
a)Organ function
b)Nutritional status
3- Comorbidities

23. Comorbidities
Cancer

24. 3- Concurrent medications

25. Oncology PCP
Disease
Cancer issue
Disease
Therapy
Response
Side effects
1-Recognition
2-Prevention
strategies
3- Management
strategies
4- Patient
counseling
Complications
Patient
Performance
Health status
Comorbidities
Concurrent
Medications

26. Communicate to apply your
recommendations

27. Follow up

28. Talk to your patient about his medications
and if he has any concerns or queries

29. Talk to the nurse about drug administration
(especially new drugs and high alert medications)

30. Study updated guidelines

31. Guidelines
1- NCCN (National Comprehensive
Cancer Network)
2- ASCO (American Society of Clinical
Oncology)
3- ESMO(European Society of Medical
Oncology)
4- MASCC guidelines

32. Start your organization guidelines
and polices

33. Continue updating your self

34. 2- Research

35. 1960 “ University of Michigan, US “

36. 1996

37. Evidenced based practice guidelines often
recommend enrollment in a clinical trial when
other standard therapies fail and a treatment or
cure is not possible.

38. -

40. Pharmacists as PI
• 1983, U.S. Food and Drug Administration
(FDA) Associate Commissioner for Health
Affairs, who stated, “It has long been FDA
policy to accept Doctors of Pharmacy as
principal investigators of studies of
investigational drugs within their expertise.”
ACCP, Update: The Clinical Pharmacist as Principal
Investigator American. Pharmacotherapy, 2010

41. www.ClinicalTrials.gov
• Use of www.ClinicalTrials.gov provided a stronger
picture of clinical pharmacist research, with 523
studies performed by those with a Pharm.D.
degree when searched in 2009.
ACCP, Update: The Clinical Pharmacist as Principal Investigator American.
Pharmacotherapy, 2010

42. Egyptian Clinical Pharmacist Research

43. Eur J Clin Pharmacol (2013)

44. ACCP, Evidence of the Economic
Benefit of Clinical Pharmacy Services
1979, the first cost- benefit
analysis of a clinical pharmacy
service was published.
ACCP, Evidence of the Economic Benefit of
Clinical Pharmacy Services: 1996–2000.
(Pharmacotherapy 2003;23(1):113–132)

45. Evaluation of Clinical Pharmacy Services in
a Hematology/ Oncology Outpatient
Setting
• A clinical pharmacist in outpatient hematology
- oncology clinics can potentially result in
overall decreased health care costs and in an
improvement in the quality of patient care
(Wong and Gray 1999).

46. Breast cancer risk assessment
The first study assessed the impact of breast
cancer risk assessment and education provided
by a community pharmacist.
• The pharmacist provided direct patient care
to 140 women.
• There was a positive correlation to
adherence of breast self-examination by the
patients after patient education was
performed by the clinical pharmacist (Giles
et al. 2001).

47. Interventions documentation
• In another study, Where Washington DC
Medical Center.
• Over an 8 month period, the pharmacy staff
reported 503 interventions, the 2 most
common being clinical consultation (33%) and
correction of prescribing errors (17%).
• There were 129 supportive care services
provided by pharmacists, including
nausea/vomiting, hematologic toxicity, pain
control, mucositis, allergy, and other general
issues. Overall interventions by oncology
pharmacists resulted in a medication cost
avoidance of $23,091 (Waddell et al. 1998).

48. 1996

49. Documentation

50. Make it Loud!

51. Journal Publications
1- Original Research
(Clinical trials –
pharmacy practice)
2- Review
3- Short Report

52. Original Research
• Original research articles
are primary sources of
scientific literature and
present an original study.
• Authors have to conduct
research on a particular
topic through experiments,
surveys, observation, etc.
and report the findings of
their study through original
research articles.

53. Literature Review
• In writing the
literature review, your
purpose is to convey
to your reader what
knowledge and ideas
have been established
on a topic, and what
their strengths and
weaknesses are.

55. Case Study (Short Report)

56. Where ???
• ACCP virtual poster symposium.
• International Oncology
Pharmacy Conferences.
• Pharmaceutical conferences.
• Cochrane collaboration

57. Increase the acceptance !!

58. Be Part of our Egyptian guidelines 

60. THANK YOU !