ABSTRACT
Cancer is a disease that requires long term treatment and intensive monitoring. There are several methods to manage cancer but most cases are treated with chemotherapy. Patients who receive chemotherapy should receive advice on side effect management and proper self-care to properly cope with drug related problems and ultimately obtain the maximum benefits from the treatment. The prospective descriptive study was designed to evaluate the outcome of chemotherapy counseling utilizing standard questionnaires by a pharmacist who participated in an oncology care team during December 2004 to March 2005. The study setting was a medical oncology patient care unit (5E ward), Srinagarind Hospital, Khon Kaen University, Thailand. Ninety-one cancer patients were assessed for eligibility and 82 (90.1%) were recruited in this study. The counseling by pharmacist took place three times before and after patient received chemotherapy at each visit. The patients were evaluated in terms of knowledge, satisfaction and frequency of side effects. The results demonstrated that patients had an improved knowledge score based on disease and chemotherapy, possible side effect of chemotherapy and self care behavior after receiving chemotherapy counseling by a pharmacist following three evaluation periods (p \< 0.01). Satisfaction score also significant improved (4.8 of 5) after receiving intervention by a pharmacist (p \< 0.01). As for the adverse event evaluation, gastrointestinal (GI) side effects such as anorexia were the most common adverse event (91.5%) found in the first evaluation period however GI side effects were reported to be less in degree and frequency at the second and third follow up period post counseling. In conclusion, the pharmacist intervention based on chemotherapy counseling improved knowledge and satisfaction in oncology inpatients and reduced adverse events following chemotherapy treatment. The results of the present study should be used to encourage the establishment of oncology pharmacy practice model. By utilizing this pharmaceutical care activity, pharmacists will be able to serve as valuable health care staffs who can ultimately improve the quality of oncology care in the future.
ABSTRACT
Background: Pain is among the most common symptoms encountered in cancer patients and remains the first priority of care.Methods: This cross sectional study aimed to explore a result of pain management at Srinagarind Hospital, Khon Kaen University following the implementation of World Health Organization (WHO) Pain Guideline. Cancer pain patients were categorized based on prior analgesic exposure into two groups; Naïve group, and Routine group. Treatments were defined according to WHO as 1) drug treatment relevant to pain severity, 2) analgesics being prescribed as around-the-clock and 3) analgesics used for break-through pain for patients receiving strong opioids.Results: From Dec 2005 to Jul 2006, 261 patients were enrolled, 93.1% (n=243) were in advanced stages and 88.5% (n=231) were in moderate to severe pain.In Naïve group (n=159), 32.7% (n=52) of patients were given analgesics following the WHO on both day 1 and day 3 of admissions; 3.8% (n=6) of patients followed WHO only on day 1; 23.3% (n=37) of patients followed WHO only on day 3 whereas 40.2% (n=64) of patients did not follow WHO on both days. A decreased pain score was greater (2.61, SD±1.5) in a group following the WHO both days on day 1 and a decreased pain score was much improved (3.9, SD±1.8) as continuing to follow WHO on day 3 (p \< 0.0001) compared to those not following WHO on both days.In Routine group (n=102), 31.4% (n=32) of patients were given analgesics following WHO guideline on both day 1 and day 3 of admission. 5.9% (n=6) of patients followed WHO only on day 1; 27.5% (n=28) of patients followed WHO only day 3 while 35.3% (n=36) of patients did not follow WHO on both days. A decreased pain score was statistically significant greater (2.6, SD±1.8) in a routine group following the WHO both days on day 1 (p \< 0.0001). Furthermore, a decreased pain score was even greater (3.9, SD±2.3) in the routine group continuing to follow WHO on day 3 compared to those not following WHO on both day 1 and day 3 of admission. The most common of adverse effects related to analgesics was constipation.Conclusions: The results demonstrated that patients who received pain management following the WHO guideline reported significantly lower pain intensity than those not following the WHO regardless the history of analgesics exposure.