But do I add value? (Sue Marsh)

I often wonder if I add value to the oncology clinic. Is there an added benefit to patients from seeing me, as a pharmacist, rather than the consultant oncologist? Certainly my reviews take longer than the doctors’ — and I used to worry about this. Perhaps my “conversation-halting skills” are not up to scratch! I realise now that the patients tell me about problems they don’t bother the doctor with.

The other day I saw one of my regular patients in clinic ahead of her fourth chemotherapy cycle. Having first presented in 2005 with ovarian cancer, she was then treated with debulking surgery and adjuvant chemotherapy (carboplatin and paclitaxel). She had a good response until four months ago when she presented with possible signs of relapse, which was confirmed with various investigations. The 60-year-old has since been receiving treatment with carboplatin and paclitaxel, as per national guidelines.

I saw this woman for the first time following cycle 2. Although coping reasonably well with chemotherapy she had seemed down and complained of pins and needles in her lips, tongue and fingers.

In addition, she described a “real low” on completing her antiemetics at around days 5 to 7 of the cycle, resulting in her spending a lot of time in bed and also experiencing nausea, indigestion and heartburn (which was putting her off eating).

She had also experienced these symptoms with the first chemotherapy cycle but hadn’t mentioned it to the doctor since she thought it was all to be expected as part of the treatment. It was only because I asked about side effects specifically that she even mentioned them.

Pins and needles are a common side effect of paclitaxel and the “low” and heartburn are often seen in patients sensitive to steroids. Following a long chat about these symptoms, their cause and possible treatments, I reduced her paclitaxel dose slightly, added a short three-day reducing dose of steroids (for the end of her standard antiemetic therapy) and prescribed a proton pump inhibitor for her heartburn.

When I saw her the other day she was beaming and couldn’t wait to tell me how much improved her symptoms were. In her words, she had “sailed through” the last cycle. (It was almost like she couldn’t wait for the next one.) She thanked me and left, ready for her next cycle with all the symptoms she described previously having reduced in severity or gone completely.

It amazes me how such small interventions can make such a huge difference to a patient’s journey. It makes me realise that my patient reviews take as long as they need to and I feel under no pressure to hurry patients along. For me this is the added benefit of my time in the oncology clinic.

 

Sue Marsh is lead pharmacist for cancer services at University Hospitals Coventry and Warwickshire NHS Trust