Expanding the Prescribing Pharmacist role in uro-oncology

ABSTRACT

Background: Patient satisfaction with non-medical prescriber (NMP) clinics at the Churchill Cancer Centre (Oxford University Hospitals NHS Foundation Trust) has been reported previously.1 Patient consultations, (face to face or telephone) by prescribing pharmacists in uro-oncology clinics (mostly prostate cancer) have increased significantly and the scope of the role is expanding from cycle 2+clinical reviews to treatment initiation, consent and cycle 1 prescribing. Objectives • To quantify the increase in patient numbers seen or telephoned in prescribing pharmacist clinics, both as whole numbers and as a proportion of the Uro-oncology service (medical oncology). • To identify how the role of the prescribing pharmacist role is expanding to patient care at earlier stages in the treatment pathway. Method: Contribution to the uro-oncology service has been measured using the following parameters (see Table 1). • Number of patient consultations in prescribing pharmacist clinics over the past 12 months, using data from the Trust's Electronic Prescribing and Medicines Administration system. • Proportion of these patient contacts as a percentage of the overall uro-oncology service. • And compared to prior year. Results: In the 12 months to June 2021- • Uro-oncology prescribing pharmacists have seen or telephoned 61% more patients than the previous 12 months. • 78% of the 889 patient contacts were telemedicine consultations, compared to 20% in the prior 12 months. This is due to the covid pandemic. • The contribution of prescribing pharmacist consultations to the overall uro-oncology service has increased by 7%. Discussion: At the Churchill Cancer Centre two prescribing pharmacists see or telephone an average of 21-24 patients per week. Current scope of the prescribing pharmacist role comprises clinical review of metastatic prostate cancer patients being treated with luteinizing hormone-releasing hormone (LHRH) agonists, with or without bicalutamide, enzalutamide, abiraterone, docetaxel, cabazitaxel. Clinical consultations typically include assessment of treatment efficacy and tolerability, prescribing continued treatment, or referral to Consultant, addition of bicalutamide (PSA relapse) or stopping bicalutamide (for PSA withdrawal response), ordering CT or MRI scan if appropriate, managing symptoms e.g. medroxyprogesterone / cyproterone for hot flushes, requesting GP to initiate bone protection (bisphosphonate). The expanding scope of the role includes liaison with MDT / Consultant for diagnosis and treatment, consenting patient for treatment, cycle 1 prescribing, oral education session prior to starting treatment (patient counselling including safety netting, clinical checks, drug interactions, drug supply). Adherence to treatment pathway (e.g. enzalutamide) to ensure correct blood tests ordered and timing of next clinic review. Conclusion: Prescribing pharmacist clinics enable follow up and treatment of large numbers of uro-oncology patients. The covid pandemic has driven trends for oral systemic anticancer treatment (e.g. enzalutamide) and telemedicine consultations. Expanding the role of the prescribing pharmacist to treatment initiation, patient consent, and cycle 1 prescribing can improve the efficiency of the clinical service and bring opportunities for enhanced skills and development.