Cancer Pain and Pharmacists: A Synergistic Approach in Multidisciplinary Team

 

“Mastering Pain: How Pharmacists Enhance Cancer Care in Multidisciplinary Teams”

Sunil Shrestha is currently leading the Department of Research and Academics at Kathmandu Cancer Center, Tathali, Bhaktapur, Nepal. He is also PhD candidate at Monash University’s School of Pharmacy and is a registered pharmacist and clinical researcher from Nepal. He has extensive experience as a Clinical Pharmacist and Research Associate at the cancer hospital in Nepal. Sunil played a crucial role in establishing regional pharmacovigilance and drug information centers. Sunil serves as an editorial board member for BMC Health Services Research and an academic editor for Plos One. With over 100 research articles, 10 book chapters, an H-index of 25, and 3000+ citations, his expertise spans pain management, oncology pharmacy, pharmacovigilance, and health outcomes.

Pull Quotes 

“Pharmacists bring unique skills and knowledge to cancer pain management, significantly improving patient outcomes through medication review, patient education, and adverse drug reaction management.”

“Effective cancer pain management requires a holistic approach, with pharmacists playing a crucial role in optimizing pharmacotherapy and ensuring safe use of opioids.”

“Pharmacists’ involvement in multidisciplinary teams has been shown to reduce pain intensity and adverse drug reactions, enhancing the quality of life for cancer patients.”

“The growing emphasis on personalized medicine positions pharmacists to tailor pain management plans based on individual patient profiles, improving treatment efficacy and safety.”

“By closely monitoring patients and providing comprehensive medication reviews, pharmacists help mitigate adverse effects and enhance pain control in cancer care.”

 

Cancer pain is a distressing reality for many patients, significantly affecting their quality of life. Effective management of cancer pain is complex and multifaceted, necessitating a comprehensive approach that integrates both pharmacological and non-pharmacological strategies. Based on a comprehensive systematic review of pharmacist involvement in cancer pain management, this article explores pharmacists’ critical role in the multidisciplinary teams (MDTs) dedicated to managing cancer pain.

Understanding Cancer Pain

Cancer pain can arise at any stage of the disease and is influenced by various factors, including tumour growth, treatment side effects, and psychological components. The World Health Organization (WHO) introduced the analgesic ladder as a framework for managing cancer pain, which primarily involves the stepwise use of non-opioids and opioids. Despite this model’s effectiveness, managing cancer pain requires more than just medication; it demands a holistic approach involving different healthcare professionals.

Pharmacists’ Role in Cancer Pain Management 

A systematic review and meta-analysis published in The Journal of Pain provides compelling evidence of pharmacists’ positive impact on cancer pain management. The review analyzed 64 studies, revealing that pharmacist interventions significantly improve pain intensity, reduce ADRs, and enhance the quality of life for cancer patients. Pharmacists bring unique skills and knowledge to the table, considerably enhancing cancer pain management outcomes. Their involvement ranges from medication review and patient education to detecting and managing adverse drug reactions (ADRs), making pharmacological recommendations, and assessing pain.

Key Contributions of Pharmacists

1. Medication Review and Optimization: Pharmacists evaluate patients’ medication regimens, ensuring appropriate dosing and addressing potential drug-drug interactions. This careful review helps in optimizing pharmacotherapy, particularly in the use of opioids, which are central to cancer pain management but come with risks of side effects and dependency. Patients are known to communicate comfortably with pharmacists about their medication history. As healthcare professionals with unique knowledge from medication identification to medication formulation and their use and adverse effects, pharmacists are valuable members of medication review and optimization. 

Case Study: In a clinical setting, pharmacists identified a patient on multiple opioid medications experiencing severe side effects. Through a thorough medication review, the pharmacist recommended a simplified regimen with an alternative opioid, reducing side effects and improving pain control.

1. Patient and Healthcare Professional Education: Pharmacists educate patients and collaborate with other healthcare professionals about pain management strategies, medication adherence, and the safe use of opioids. This education is crucial in empowering patients and enhancing the effectiveness of the treatment regimen.

Interactive Sessions: Pharmacists conduct regular workshops and one-on-one sessions to discuss pain management plans, ensuring patients understand their medications and manage their pain more effectively.

1. Adverse Drug Reaction Management: By closely monitoring patients, pharmacists can detect and manage ADRs promptly, ensuring that any negative effects of medications are swiftly addressed, thus preventing further complications.

Real-time Monitoring: Pharmacists use tools like electronic health records to track patient responses to pain medications, allowing them to adjust dosages or switch drugs to mitigate adverse effects quickly.

1. Pain Assessment and Management: Pharmacists actively assess pain levels and the effectiveness of the prescribed treatments. They use their pharmacological expertise to recommend therapy adjustments that can lead to better pain control.
2. Pain Clinics: In specialized pain clinics, pharmacists collaborate with physicians to conduct comprehensive pain assessments, ensuring that treatment plans are tailored to individual patients’ needs.

Impact on Clinical Outcomes

The systematic review highlights that the inclusion of pharmacists in MDTs significantly reduces pain intensity and the occurrence of ADRs while improving the quality of life. For instance, pooled data from randomized controlled trials (RCTs) showed a significant reduction in pain intensity with a standardized mean difference (SMD) of 0.35. Similarly, nonrandomized studies demonstrated a significant decrease in ADRs and improved quality of life.

Despite the clear benefits, integrating pharmacists into MDTs can face challenges such as:

• Resource Limitations: Adequate staffing and training are required to support the expanded role of pharmacists.
• Interprofessional Collaboration: Building strong, collaborative relationships among healthcare providers is essential to maximize the benefits of pharmacists’ contributions.
• Solution-Oriented Approaches: Developing protocols and guidelines that outline the roles and responsibilities of pharmacists within MDTs can facilitate smoother integration and more effective teamwork.

The Unique Contributions of Pharmacists to Cancer Pain Management

Pharmacists contribute uniquely to cancer pain management through several distinct avenues:

Multidimensional Approach to Pain

Cancer pain is multifaceted, involving physical, emotional, and psychological components. Pharmacists are trained to adopt a holistic approach, addressing not only the physical symptoms but also the emotional and psychological aspects of pain. They work closely with other healthcare providers to develop comprehensive pain management plans incorporating pharmacological and nonpharmacological strategies.

Role in Palliative Care

Pharmacists play a critical role in palliative care settings, where the focus is on improving the quality of life for patients with life-limiting illnesses. They help manage symptoms, provide medication counseling, and support patients and their families navigate the complexities of pain management. Their involvement ensures that patients receive compassionate and effective care during the most challenging phases of their illness.

Enhancing Patient Adherence

When it comes to taking medications and talking about medication history, it has been noted that patients are more open to talking about these issues with pharmacists than doctors. So, pharmacists can play a big role in proper communication with the patient to enhance patient adherence to their medications. Patient adherence is a significant challenge in cancer pain management. Pharmacists engage with patients to ensure they understand their treatment regimens and the importance of adhering to them. They provide practical solutions to overcome barriers to adherence, such as simplifying dosing schedules and offering patient-friendly education materials.

Expertise in Pharmacology

Pharmacists possess extensive knowledge of pharmacology, which is crucial in managing complex medication regimens for cancer pain. Their expertise ensures that the pharmacotherapy is both effective and safe, minimizing the risk of drug interactions and adverse effects. They provide their expertise in adjusting doses, switching medications, and suggesting alternative treatments based on individual patient needs.

Tailoring Treatment to Individual Needs

Every cancer patient is unique, and so are their pain management needs. Pharmacists can play a role in tailoring the treatment plans to individual patient profiles, considering factors such as the type and stage of cancer, comorbid conditions, and patient preferences. This personalized approach enhances the effectiveness of pain management and improves patient outcomes.

Addressing Challenges in Integrating Pharmacists into MDTs

While the benefits of including pharmacists in MDTs are clear, several challenges need to be addressed to leverage their potential fully:

Ensuring Adequate Resources

Adequate staffing and resources are essential to support the expanded role of pharmacists in cancer pain management. Healthcare institutions must invest in training and development programs to equip pharmacists with the skills required for their enhanced role. Additionally, sufficient staffing levels are necessary to ensure pharmacists can dedicate time and attention to each patient.

Promoting Interprofessional Collaboration

Effective cancer pain management requires seamless collaboration among healthcare professionals. Building strong, collaborative relationships among team members is crucial for maximizing the benefits of pharmacists’ contributions. Regular interdisciplinary meetings, joint training sessions, and clear communication channels can foster a culture of teamwork and mutual respect.

Developing Clear Protocols and Guidelines

Clear protocols and guidelines are essential for defining the roles and responsibilities of pharmacists within MDTs. These documents should outline the specific tasks pharmacists are expected to perform, the decision-making processes, and the mechanisms for communication and collaboration with other team members. Well-defined protocols can facilitate smoother integration and more effective teamwork.

Future Directions for Pharmacists in Cancer Pain Management

As the healthcare landscape continues to evolve, the role of pharmacists in cancer pain management will likely expand further. Several trends and developments are expected to shape the future of this field:

Integration of Advanced Technologies

Advanced technologies, such as electronic health records (EHRs), telemedicine, and mobile health applications, are transforming healthcare delivery. Pharmacists can leverage these technologies to enhance their contributions to cancer pain management. For example, EHRs enable real-time monitoring of patient responses to pain medications, while telemedicine allows pharmacists to provide remote consultations and support to patients.

Emphasis on Personalized Medicine

The growing emphasis on personalized medicine will likely enhance pharmacists’ role in cancer pain management. Pharmacists are well-positioned to contribute to developing and implementing personalized pain management plans based on genetic, biochemical, and lifestyle factors. They can provide the pharmacogenomics perspective to help tailor treatments to individual patient profiles, improving the effectiveness and safety of pain management strategies.

Expansion of Pharmacists’ Scope of Practice

The scope of practice for pharmacists is expanding in many regions, allowing them to perform tasks traditionally reserved for other healthcare providers. This expansion includes prescribing authority, administering medications, and conducting comprehensive medication reviews. While doctors and nurses are conducting prescribing medications and administering them, comprehensive medication review is something that is usually missing in our setting and that is exactly where pharmacists can start to provide better patient care. Such developments are likely to enhance the role of pharmacists in cancer pain management and enable them to contribute more significantly to patient care.

Conclusion

The involvement of pharmacists in cancer pain management as part of a multidisciplinary team is beneficial and essential. Their expertise in pharmacology, ability to manage complex medication regimens, and dedication to patient education and safety make them invaluable in the fight against cancer pain. As the healthcare landscape continues to evolve, the role of pharmacists in MDTs should be recognized and utilized to their fullest potential to improve patient outcomes and quality of life. By addressing the challenges and accepting future opportunities, pharmacists can continue to make significant contributions to the field of cancer pain management and help patients live better, more comfortable lives.

 

References

1. Shrestha S, Kc B, Blebil AQ, Teoh SL. Pharmacist Involvement in Cancer Pain Management: A Systematic Review and Meta-Analysis. J Pain. 2022 Jul;23(7):1123-1142. doi: 10.1016/j.jpain.2022.02.002. Epub 2022 Feb 10. PMID: 35151871.
2. Shrestha S, Blebil AQ, Teoh SL, Sapkota S, Kc B, Paudyal V, Gan SH. Clinical pharmacists’ intervention on pain management in cancer patients (PharmaCAP trial): study protocol for a randomized controlled trial. J Pharm Policy Pract. 2023 Jan 24;16(1):14. doi: 10.1186/s40545-022-00505-0. PMID: 36694232; PMCID: PMC9875431. 
3. Shrestha S, Gan SH, Paudyal V, KC B, Sapkota S. Current practices, gaps, and opportunities on the role of clinical pharmacists in cancer pain management: Perspectives from Nepal. Journal of Oncology Pharmacy Practice. 2023;29(8):2049-2056. doi:10.1177/10781552231205025