gms | German Medical Science

Background: Cancer patients are increasingly required to manage their cancer care at home as the drug market holds more and more orally available anticancer agents (OAA). With the narrow therapeutic range of OAA patients are vulnerable to treatment failure and side effects due to medication errors, drug interactions and non-adherence. Thus, these patients need concerted counselling by both the oncologist and the community pharmacist.

Research Question: To what extent and in what way do community pharmacists contribute to the counselling of patients with oral anticancer therapy in selected European countries?

Method: We used an electronic mailing approach and standardized online survey to ask practicing pharmacists in Estonia, Slovenia and Germany about their experiences with the dispensing of OAA. Besides data on basic demographics and the practice settings, we surveyed quantitative and qualitative dimensions of the dispensing and counselling process as well as the pharmacists’ access to resources, perceived confidence and needs for specific continuing education in order to generate a European Best Practice-Model to support pharmacists in the care for patients with oral cancer therapy.

Results: The majority of community pharmacists dispensed between 1 and 5 units of OAA per week. Upon the first fill of an OAA prescription, the frequency of patient counselling varied widely in all countries, between ‘never’ and ‘more than 80%’. The frequency of counselling was generally lower with following refills. Counselling encompassed mostly directions for use, the proper use of anti-emetics and side effects. Many pharmacists stated that they did not feel comfortable counseling patients on oral anti-cancer therapies and even more acknowledged that they were uncomfortable with managing patients’ side effects. Concomitantly, only 20% of the pharmacists believed that had received enough knowledge and skills pertaining to OAA through their undergraduate studies, postgraduate education or the professional practice itself. The two main reasons given were i) that OAA were not sufficiently covered by the undergraduate curriculum and b) the lack of continuing education specific for this field of cancer therapy. Pharmacists’ responses differed little between the countries.

Discussion: The proportion of community pharmacists who regularly counsel patients about oral anticancer therapy is insufficient in view of the importance of the patients’ self-efficacy to manage their therapy. According to the results, pharmacists are aware of their own knowledge deficits and educational needs. Easier access to reliable drug information and increased opportunity to attend trainings on the management of OAA are needed and are currently implemented in Germany, Slovenia and Estonia as a model for other countries.

Practical implications: The availability of educational events conveying thorough knowledge and skills in the area of oral anticancer therapy, both under- and postgraduate, must be increased. Chambers of pharmacists and professional societies are called upon to fill the gap quickly.