Cancer is one of those conditions that community pharmacy has traditionally shied away from. On the face of it, it’s easy to see why. Due to the acute nature of the condition, cancer care predominantly takes place in hospitals. Oncology is also one of the most complex clinical areas. While the likes of breast, prostate, lung and bowel cancer are probably among the best known forms of the disease, and indeed account for half of all new cases each year, there are in fact more than 200 different types of cancer – each with different causes, symptoms and treatment. 

But community pharmacy’s lack of involvement has to change. By 2030, there will be around 4 million people in the UK who are living with a cancer diagnosis, points out Jenny Ritchie-Campbell, director of services, strategy and innovation at charity Macmillan Cancer Support. This means pharmacists will regularly come into contact with these patients. “Many of them will be living at home [and] many of them will be older, probably have other chronic health conditions and may be living with the consequences of cancer treatment, such as fatigue or incontinence,” says Ms Ritchie-Campbell. This trend will give healthcare professionals who don’t specialise in cancer – GPs, pharmacists and practice nurses – an “important role” to play in supporting these patients, she stresses. 

When faced with such a complex and serious condition, it can be difficult to know where to start. But community pharmacies are already starting to make inroads into cancer care – whether it’s providing simple information or having conversations about medicines adherence.

 

Information point
 

Through its partnership with Macmillan, Boots is one of the most high-profile pharmacy organisations embracing the challenge. The partnership came about after Boots recognised the need for a service in the community, says Boots director of healthcare HR Marc Donovan. “We knew we had a huge role to play in signposting the thousands of people who come into our stores each day and who are affected by cancer, either personally or through someone they know, and we knew we could have a huge impact,” he tells C+D.

Primarily, the Macmillan partnership is all about providing information to these customers. Two Boots branches are home to Macmillan information centres, which hold leaflets detailing the cancer services that are available in the local area, DVDs and support packs. In other branches, the pharmacy team is the main source of information. 

All 11,000 Boots healthcare advisors have received training to understand how to have helpful conversations with cancer patients. And nearly all Boots pharmacists have taken on an additional role as Macmillan information pharmacists, which means they are trained to offer practical and emotional support.

Angela Chalmers, who works as a relief pharmacist for Boots, was one of the first to do the Macmillan training. She describes the experience as “life-changing and eye-opening”. “It demystified cancer and made me not scared to talk about it,” she says. 

A large part of the role is about identifying individuals who have been affected by cancer – something that can be difficult to do (see case study, below) – and signposting to local services and appropriate sources of information, she says. Ms Chalmers stresses the importance of this considering “a lot of information is thrown at patients” when they receive a cancer diagnosis. The training has enabled her to provide more in-depth support such as conducting MURs with cancer patients, because “simply knowing what patients are going through means you can give that little bit of extra support”.

The partnership also encourages innovation. Mr Donovan says all Boots pre-registration students are required to undertake a research-based community investment project that focuses on the condition and “some of these have really had quite a big impact”.
 

Helping hand
 

Of course, Boots has the resources and profile to command a nationwide partnership with a leading cancer charity. So how can independent pharmacies get involved? Nicola Stoner, cancer consultant pharmacist at Oxford University Hospitals NHS Trust, says it is not as difficult as you may think to provide a helping hand. In fact, cancer care covers a number of familiar clinical areas. 

“Community pharmacies are already involved in cancer prevention – for example, stop smoking services, bowel cancer screening, sun safety campaigns,” she campaigns.

 Another important area of cancer care is medication adherence – a topic that clearly lies within the expertise of community pharmacists. Although cancer patients are usually very motivated to take their medication, Professor Stoner says both over- and under-adherence can be a problem. Patients may take a drug for more days than intended or take a “drug holiday” from ongoing treatment. “Simply being a healthcare professional who is available to speak to without an appointment is an advantage for community pharmacists in supporting cancer patients,” Ms Stoner says.

If pharmacy teams want to provide a more in-depth service, there is certainly a need for extra training in this clinical area. But it is also important to avoid labelling cancer patients with their diagnosis and assuming all their healthcare needs will be met by their specialist oncology team. People with diabetes or hypertension, for example, will continue to have these conditions managed in primary care, and having cancer can lower your immunity to everyday conditions such as colds and flu.

So, instead of concentrating on the unknown, perhaps it is more sensible to start with the familiar. The ever-growing cancer population needs a healthcare professional on the high street – whether they are signposting to information, providing support with everyday conditions or talking to them about their medication. 

Simply being willing to listen, community pharmacy teams could make a huge difference to patients’ lives. Because, as Macmillan says: “No-one should face cancer alone.”

*Source: Macmillan Cancer Support

 

Case study

 

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“‘I have made a difference by

simply talking to patients”

Jackie Lewis, Lewis Pharmacy, Exmouth, Devon

 

 

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Jackie Lewis is doing all she can to help her customers affected by cancer. The decision to provide this support was a no-brainer, given that pharmacists are adopting a more patient-facing role, she says. “The NHS environment has changed, not just in terms of a brave new world of commissioning but also the way we are working sees us sitting down with patients more,” Dr Lewis explains.

Providing this support isn’t always easy. One of main problems Dr Lewis has encountered is the difficulty identifying people who are on treatment for cancer. “It is remarkable in this day and age that there seems to be no way of a hospital notifying a community pharmacy that one of its patients has been diagnosed with cancer,” she says. Instead, she relies on spotting something new or unusual when dispensing or a patient divulging the information – whether during an MUR or in a conversation over the counter. 

Once Dr Lewis has identified patients, she finds MURs a useful way of providing support. She looks at their medication and potential interactions with any other medicines, and finds out what services and support they are accessing. “I also make sure they know they can contact me, as well as any other contacts they have been given, if they have any questions, and I will help or refer them as appropriate,” Dr Lewis adds.

Although community pharmacy has not traditionally been involved in the supply of cancer medicines, she would like to see this change in future. “Because hospitals have to pay VAT on all medicines they supply, [this function] is outsourced to various homecare companies. This can mean that the patient is told what to do at the hospital but doesn’t have any support when their parcel arrives at their home and they need to start their medication,” she explains. If community pharmacies worked with homecare companies, Dr Lewis points out that patients would have more opportunities to ask questions, which could boost compliance and potentially improve patient outcomes.

There is also a need for more education on chemotherapy agents and side effects, as well as how to manage them, Dr Lewis argues. Community pharmacy has tended to not keep up with advances in this important clinical area, probably because it is usually delivered in secondary care, she says. 

“Some people have asked why I am doing this when there is no funding available, but if we all thought that, we’d never do anything. I can make a difference to my patients and that’s what matters,” she stresses. “Given the right training – and there is plenty available, for example, from the British Oncology Pharmacy Association – anyone can have a go.”

 

 Useful resources on cancer care

 

• The British Oncology Pharmacy Association www.bopawebsite.org holds study days and has an e-learning site, some of which is accessible to non-members

• Cancer Research UK www.cancerresearchuk.org and Macmillan Cancer Support www.macmillan.org.uk provide information on cancer for both healthcare professionals and patients

• The Centre for Pharmacy Postgraduate Education www.cppe.ac.uk has an open learning programme on the contribution pharmacy teams can make to the identification, management and support of people at risk of or living with cancer

• The NHS has a directory of its cancer services across England www.nhs.uk/Service-Search/Cancer%20information%20and%20support/LocationSearch/320 that is searchable by postcode, hospital or cancer type

• NHS England publishes statistics on waiting times in local areas www.england.nhs.uk/statistics/statistical-work-areas/cancer-waiting-times