Supportive Care and Consult Team Makes Outpatient Cancer Treatment Easier

CHAPEL HILL, N.C. - The UNC Supportive Care and Consult Service and Clinic’s innovative model of a pharmacist as part of the care team in the outpatient setting continues to attract national attention and interest. The group published an article describing their successful program in the April 1, 2011 issue of the American Journal of Health-System Pharmacy.

The article describes how integration of a clinical pharmacist practitioner (CPP) has made a positive impact on patient care through:

1) A formal chemotherapy counseling process for the adult medical oncology clinic infusion center was established. The session (also available in Spanish) is offered to patients to inform them about the agents involved in their chemotherapy regimen, to discuss anticipated adverse effects and their management, and to answer patient question. Such counseling was previously offered by the infusion nurses. With the CPP offering the counseling, nurses are now able to devote more time to other patient care duties.

2) An infusion clinic efficiency project that targeted patients receiving the biologic agent Rituximab decreased each infusion for these patients by over 1.5 hours per visit and was equally as safe as the previous longer method of infusion.

3) The addition of pharmacy students and residents paired with supportive care CPPs in the cancer clinics where previously there was no exposure of these learners to the outpatient oncology clinics.

The article highlights the team’s future projects such as looking to get patients out of the hospital faster through using the oncology pharmacist to monitor methotrexate levels as an outpatient instead of in the hospital.

Hear a podcast Icon indicating that a link will open an external site. of John Valgus, PharmD, hematology/oncology clinical pharmacist practitioner, as he describes the program’s innovative model and how it improves patient care. Valgus is a clinical assistant professor in the UNC Eshelman School of Pharmacy.

Co-author of the journal article are:  Aimee Faso, PharmD, hematology/oncology clinical pharmacist; Sandi Jarr, RN, MSN, supportive care nurse consultant; and Steve Bernard, MD, professor of medicine, division of hematology/oncology. Co-authors from the UNC Eshelman School of Pharmacy: Kelly M Gregory, hematology/oncology postgraduate year 2 pharmacy resident; Scott Savage, PharmD, MS, clinical manager, department of pharmacy and clinical assistant professor; Stephen Caiola, MS, FRSPH, associate professor and chair, division of pharmacy practice and experiential education; Christine Walko, PharmD, assistant professor division of pharmacotherapy and experimental therapeutics; and Jiyeun Kim, pharmacy student.

The UNC Supportive Care and Consult team includes a physician, a clinical nurse specialist and a clinical pharmacist practitioner. 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. A majority, 75 percent, of the consults are for pain management. Other major symptoms addressed by the team were nausea, vomiting and constipation.