CHAPEL HILL, NC - Cancer care has increasingly moved to the outpatient setting, and UNC has developed an innovative program to better provide supportive care services to patients. The UNC Supportive Care Consult Service and Clinic team includes a physician, a clinical nurse specialist and a clinical pharmacist practitioner. What’s innovative is that the pharmacist, John Valgus, PharmD, is an essential member of the team and serves as the main provider of supportive care services to many of these patients.
Their clinic model is described in the November issue of the Journal of Oncology Practice where they report that their outpatient team approach produced significant improvements in symptoms resulting from cancer or its treatment. Their results were comparable to those seen by the UNC inpatient Palliative Care team, an important comparison demonstrating the consistent benefit that these services provide to alleviate the symptoms of cancer patients.
Valgus, first author of the article, explains, “We travel to patients during their oncology clinic visits. Since many of our patients live an hour or more from the clinic and have multiple visits, our visits to them prevent patients from having to schedule yet another appointment for their care.
“The time we spend is 100 percent dedicated to their symptoms that allows the patient more time to discuss these important issues and allows us to focus to strategies to alleviate their symptoms. Our team is always in contact with the patient’s primary oncologist so that everyone is involved. Because some patients with complex care issues require a longer visit, we have also developed a half-day clinic.”
The article describes the consult service and clinic. Patients from all adult oncology services are visited by the team, including gynecologic, radiation, medical and surgical. The pharmacist first sees patients when an assessment and detailed medication history are taken. Next the nurse and physician see the patient and complete a symptom management assessment. The team then “huddles” to develop a treatment recommendation that is then shared with the patients and family.
Valgus said that 75 percent of the consults were for pain management. Other major symptoms addressed by the team were nausea, vomiting and constipation.
Steve Bernard, MD, professor of medicine and lead physician with the program, said, “We feel that we have made a difference in how patients feel and the control of their symptoms from cancer. Having a pharmacist with advanced training in oncology gives the patient and families someone who is knowledgeable in their medications, how to take them, and what side effects to expect. We are also able to contact outside pharmacists by a health care provider who is familiar with their practice environment. Families feel that we bring a team with three areas of expertise to the visit—medical, nursing, and pharmacy.”
Bernard is a member of UNC Lineberger Comprehensive Cancer Center.
Other UNC authors are Sandra Jarr, RN, MSN, supportive care nurse consultant with the UNC Comprehensive Cancer Support Program; Robert Schwartz, MA, assistant director for data management at the Cecil G Sheps Center for Health Services Research; and Michelle Rice, RN, MSN, CWON, ostomy nurse, Duke University Medical Center. Funding for the study was provided in part by a grant from the University Cancer Research Fund.