Home' Australian Pharmacist : Australian Pharmacist December 2013 Contents Australian Pharmacist December 2013 I ©Pharmaceutical Society of Australia Ltd.
with oral cancer
Grant Kardachi MPS
I recently attended the FIP conference in Dublin where Australian delegates
and presenters made a very big impact on the international pharmacy stage.
One session I was very taken with,
and which I think has lessons for all
pharmacists, was Managing patients
with cancer -- The role of the pharmacist.
This session was chaired by Dr Ross
McKinnon of the Flinders Centre for
Cancer Prevention and Control in
Adelaide. He also presented during
This session highlighted to delegates
the fact that cancer patients are living
longer and that this creates challenges
for existing systems and models of care.
And with many patients being able to
take oral medications without assistance,
Dr McKinnon talked about rates of
adherence, with some interesting results.
The FIP session examined the fact that
the emergence of cancer survivorship
as a discipline is focused on optimising
the journey for cancer patients and
necessitates careful attention to
issues including navigation pathways,
psycho-oncology, nutrition, long-term
effects of cancer treatments (including
cognitive effects, neurotoxicity, second
tumours, fertility issues etc).
The overarching theme was that we as
pharmacists must go on the medication
journey with this group of patients.
Dr McKinnon pointed out that there are
two facets to medication adherence:
compliance to the dose and dosing
frequency of a medication regimen,
and persistency, which refers to the
duration of time between the start of
therapy to its discontinuation.
Issues with medication compliance and
persistency are well-known for many
However, the relatively recent
introduction of oral targeted cancer
therapies to the pharmacopoeia
has led to a paradigm shift in cancer
management -- the responsibility for
medication administration falls on the
patient, not the clinic. And by falling
on the patient, there is a flow-on effect
for the pharmacist who dispenses
In addition, improved survival rates in
cancer patients along with uncertainty
around optimal dosing protocols often
means that patients may be taking
targeted therapies for prolonged periods.
Collectively, these developments make
it crucial to explore issues of medication
adherence specifically with oral targeted
The session also highlighted that
compliance may be intended, but
not achieved with some patients on
cancer treatments, particularly those on
Side effects of some of these medications
may include cognitive issues and so some
patients may be quite convinced they
are compliant, when in fact they may
be missing their medications, varying
dosages, or even taking their medications
too often -- all the while convinced they
are following a strict regimen to the letter.
The onus therefore may fall on the
pharmacist to be alert for signs of
non-compliance and even if no such
signs are apparent, to regularly discuss
with the patient how they are taking
their medicines, whether they are having
any problems and generally discuss
their health issues. Such discussion can
alert the pharmacist to warning signs of
possible future problems.
By being aware of possible compliance
issues with cancer patients, and the
cumulative cognitive side effects which
may occur in some cases, we can be
better prepared to help our patients
should we see them heading down a path
This approach applies equally to carers
whose patients may not be mobile but
who may still be in a position to take
their own medications. By advising and
educating the carers we can alert them to
the possible cognitive resultant failure to
adhere to a medication regimen.
Interestingly, Dr McKinnon found the
rate of adherence varied depending on
the type of medication and the type of
cancer, and he is continuing his research
into this area.
But already he has found that studies
utilising self-reported measures of
adherence tend to report higher
levels of adherence than other
studies. For instance, some 37 out of
38 chronic myeloid leukaemia patients
receiving imatinib were classified as
adherent, using the Morisky Medication
In Australia, studied patient adherence
to thalidomide for multiple myeloma
and imatinib for CML reported high
to moderate adherence in this study.
The most common issue reported
affecting adherence was forgetting to
Another study among 150 women taking
capecitabine for early-stage breast
cancer found the average adherence
across all treatment cycles was 78%.
In a study of 43 colorectal or breast
cancer patients on capecitabine therapy
23.3% of participants had self-reported
non-adherence behaviours. None of
these participants claimed that their
non-adherence behaviour occurred
'always' or 'often'; they were only reported
as occurring 'sometimes' or 'rarely'.
The main barrier to adherence was
remembering the time of day due to loss
of cognitive function.
It is a fascinating area and one which
all pharmacists must be aware of and
be alert to and enhance our role in
THE NATIONAL PRESIDENT SAYS
Links Archive Australian Pharmacist Nov 2013 Australian Pharmacist January 2014 Navigation Previous Page Next Page