During C+D’s visit to her Exmouth pharmacy in early August, she explains that the programme – “Not Normal For You?” – arose from her lifelong passion for helping to treat cancer.

Having received training at the Royal Free Hospital in London, Ms Lewis has a PhD in targeting anti-cancer drugs using liposomes.

Patients coming into her pharmacy for medicine reviews tell her they are on medication for treating cancer – but a lack of joined up care means she often doesn’t know the details of their treatment. “We still don’t know what drugs people are on from hospital,” she tells C+D. “It just seemed that hospitals were doing a good job, but we were still seeing cases in the community.”

 

 

How it started

 

Ms Lewis partnered with one of the local GPs when they became a Macmillan GP to see how pharmacists could help spot the early signs of cancer. They involved the local pharmaceutical committee and clinical commissioning group for the area, which identified red flag symptoms as the priority.

After being turned down for funding, Ms Lewis received grants from the National Pharmacy Association and the Health Education Foundation to start a pilot, which ran from January to October 2019, training staff in 10 pharmacies across the area, including her own. Thus, the "Not Normal For You" programme was born.

Staff were trained to spot signs of cancer in walk-in patients, write down those symptoms on a branded card, and persuade the patient to book an appointment to see a GP about it.

“It’s empowering the patient to go and see their GP,” says Ms Lewis. “Obviously, you don’t mention the fact that you think it might be a cancer symptom, but part of the training is to empower the staff to as well to break down the barriers to seeing the GP.”

Even though the pilot only lasted a short period, it has already had a tangible impact. Ms Lewis notes that, following her training, a pharmacist in nearby Newton Abbot referred a man who had been suffering from a cough for six weeks to the GP. At a GP surgery meeting, the pharmacist was told that the patient was being treated for lung cancer, and six months later, his wife went into the pharmacy to tell them that he had been cured.

 

A personal passion

 

“I had breast cancer myself, so I’ve been on that pathway as well,” Ms Lewis explains. However, she adds, “my passion for it came before my own diagnosis.

“It just gave me a better perspective on the pathway, and that has really gone into my project work and my e-learning, because I can tell other people about it, what it’s like.”

Since the pilot ended, Ms Lewis was given funding by Pfizer to develop an online learning course for pharmacists to learn about the basics of cancer, hosted by the British Oncology Pharmacy Association, which launched in March this year.

The “Not Normal For You?” programme, however, remains unpatented and free for others to use. Ms Lewis said she would like to see the programme rolled out nationwide. “I think it will happen, but it’s going to be such a long period of time [before that happens], and it’s such a shame,” she says.

Ms Lewis also hopes to see the scope of the New Medicine Service expanded to include certain cancer medicines – especially the hormonal therapies tamoxifen, anastrazole and letrazole – as “there are cases of people dying when their cancer returns because of non-compliance”.

In the meantime, a friend and fellow pharmacist, Ade Williams of Bedminster Pharmacy in Bristol, is in the process of applying to the National Institute for Health Research to have pharmacists included in the two-week emergency referrals system for suspected cancer patients.

While Ms Lewis’s pilot was short-lived, she has demonstrated that community pharmacy can and perhaps will have a crucial place in helping to diagnose cancer early on.

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