Jackie Lewis: Putting cancer on the community pharmacy map
Oncology may not be a traditional domain but it's incredibly rewarding, says contractor Jackie Lewis
It is always assumed that cancer is the domain of secondary care. Generally, community pharmacy believes it has little to offer this group of patients, who are regularly visiting hospitals for chemotherapy and specialist advice. My pharmacy has always stocked palliative care medication and provided information for nurses from the local charity Hospiscare, and I thought this was the extent of what we could offer. But when I started talking to our cancer patients, I realised just how much more we could do.
My interest in this area was sparked by previous work at the Royal Free Hospital and a subsequent PhD, so it was logical to continue when we took over the pharmacy 15 years ago. I soon realised cancer patients didn’t like the winding Devon roads to hospital when they were feeling ill and started to think how my pharmacy could help.
Via a friend from university days, I went to a British Oncology Pharmacy Association (BOPA) committee meeting and a symposium and became aware of the lack of community pharmacy presence in this field. It was really interesting but, with no financial help available – and my business unable to release my time without this – work could not progress beyond a collaborative paper exploring the feasibility of providing anticancer medication from a community pharmacy that was published in the European Journal of Oncology Pharmacy (2008/1 Vol.2).
Six years later I realised, through casual conversation and an MUR, that I was supplying regular medication to patients who had cancer and were on various treatments. I would not have known about their cancer or treatment if I had not asked; this has implications with regards to supplying the rest of their medication, dealing with minor ailments/OTC requests and general lifestyle advice.
I talked to a few regular customers with cancer and asked if they thought that my team, as their community pharmacy, would be able to support them in any way. Initially, they all said that the oncology unit dealt with everything but they then came back and accepted my offer.
A point of support
After much deliberation about how to reach such customers, I put a sign up asking patients on chemotherapy to come forward. I asked Hospiscare nurses to give out leaflets and visited the local FORCE charity centre (non-palliative care) on the hospital site to gain information for signposting.
For those patients we recruited, I carried out an MUR by exploring potential interactions and side effects of treatment, using standard pharmacy resources and information from the Macmillan website. I made myself available to answer any questions the patients may have in the future and asked their consent for me to phone them occasionally.
As a result, I have: helped improve understanding of the side effects of chemotherapy, such as tiredness versus a thyroid condition, candidiasis and pain following treatment; signposted patients to GPs and local charities; and helped with general questions on the disease itself, such as nutrition, prognosis and general understanding. I know customers have appreciated my support and knowing that I am there for them. The pharamacy team has also found the resultant professional contact and patient care very rewarding.
Spreading the word
Last year, I was asked to present my work at the Royal Pharmaceutical Society’s annual conference, where my enthusiasm and passion were well received. I am now the first community pharmacist committee member of BOPA (and was helped by the local practice forum to attend last year’s symposium) and am enjoying the opportunity to bring together interested parties, such as the Macmillan-Boots partnership and Lloydspharmacy, to work towards a gold standard of care for cancer in community pharmacy. My committee colleagues are very supportive and there is a community pharmacy slot at the next BOPA symposium. This work featured heavily in our recent C+D Award for Independent Pharmacy of the Year 2015 and I am delighted this area is being put onto the community pharmacy map.
My goal is to define and spread the work I have done and give other community pharmacists the confidence to care for their patients with cancer. I also want to break down communication barriers with secondary care. Why not use the information your pharmacy already has, have a look at the excellent learning available through BOPA and the Centre for Pharmacy Postgraduate Education (CPPE), and have a go yourself?
Jackie Lewis is owner of Lewis Pharmacy in Exmouth, which won the C+D Award for Independent Pharmacy of the Year 2015