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Published on 1 January 2007

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Cancer care: SIG projects and collaborations

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Mikael Daouphars
PharmD PhD
Hospital Pharmacist
Department of Pharmacy
CRLCC Henri Becquerel
Rouen
France
E:mikael.daouphars@rouen.fnlcc.fr

Since its creation in 1979, the European Society of Clinical Pharmacy (ESCP) has been promoting the value of clinical pharmacy services among other healthcare professionals and scientific societies that share the same interest and generally within the Health Service.

SIGCC
In order to network with ESCP members who share specific topics of interest and to facilitate education through in-depth workshops, masterclasses and business meetings in a specific area during ESCP conferences, special interest groups (SIGs) have been created. SIG Cancer Care (SIGCC) provides a forum for pharmacists interested in the field of oncology pharmacy practices. Over the past few years, SIGCC has organised a workshop on collaboration and communication skills within a healthcare team and a masterclass on individualisation of cancer treatment from clinical and genetic approaches, and has worked in collaboration with SIG Paediatrics to propose a workshop on paediatric oncology.

SIGCC’s projects are currently focusing on the publication and implementation of practice guidelines. Many guidelines already exist in different European countries, but diffusion is limited on an international level, mainly due to a lack of available translations. Other guidelines elaborated on an international level still remain confidential outside of the authors’ field. SIGCC is willing to facilitate the diffusion of existing guidelines by establishing connections with medical and pharmaceutical societies, national or international and to publish ESCP guidelines. SIGCC has decided to focus first on palliative care and to create a taskforce on cancer supportive care. Indeed, palliative care, and especially terminal care practices, imply expert and complex use of drugs regarding indication, dosage or mixes, for which pharmacists could feel a lack of confidence in their knowledge. SIGCC will therefore organise workshops in the near future to improve pharmacists’ skills in palliative care and to implement existing guidelines, to ensure effective interprofessional communication within multidisciplinary teams. As a first step, training sessions on cancer pain management will be implemented, as relief from pain and other distressing symptoms is paramount for patients with advanced, progressive illness, and results from retrospective and prospective surveys consistently show that pain is still prevalent in these patients.(1) In order to target further courses to pharmacists’ needs, SIGCC will carry out a survey entitled Assessment of European pharmacists’ knowledge and practices in cancer pain management, designed from the European Association for Palliative Care (EAPC) guidelines, which have recently been established.(2) This survey will be sent to all SIGCC members before January 2007, and feedback from members will be analysed to elaborate training programmes. Collaboration with another pharmaceutical oncology society could be considered if SIGCC was to diffuse the survey on cancer pain management outside ESCP members.

Another subject of concern is the care of elderly cancer patients. Recent statistics indicate that in Europe about 25% of the population is over 70 years old. Because age is a major determinant of cancer risk, more than half of all newly diagnosed malignancies will occur in this population.(3) Elderly patients provide considerable challenges in treatment management issues as they present with already existing physiological decline and comorbidities when diagnosed with cancer. Indeed, these comorbidities may enhance the risk of chemotherapy- or radiotherapy-related side-effects. In particular, patients with malignant disease have a high incidence of malnutrition, and pretreatment weight loss has been demonstrated to be a major prognostic indicator of poor survival and response to therapy.(4) This observation stresses the principle of the most immediate assessment and the earliest intervention. Artificial nutrition is effective in preventing or treating cancer malnutrition; it also allows cycles of radiotherapy or chemotherapy to be completed, and it reduces the risk of postoperative complications in severely malnourished patients.(5) Pharmacists are not only responsible for parenteral nutrition (PN) compounding, but are also more and more involved in PN orders writing.(6) Practice guidelines for nutrition management of elderly cancer patients are to be proposed by SIGCC in the coming year, and contacts have been made with the International Society of Geriatric Oncology (SIOG) to consider possible collaborations and elaboration of joint guidelines between SIOG and ESCP.

Among the functional impairments observed in elderly cancer patients, renal insufficiency represents a major matter of concern, and it also affects many patients treated for cancer, as shown recently by a French observational study (IRMA project). Prevalence of renal dysfunction concerns about 60% of cancer patients, and up to 75% of patients aged 75 years or more.(7) Pre-existing renal dysfunction frequently necessitates decreasing the dosage, extending the dose interval or even discontinuing treatment. Moreover, nephrotoxicity is an inherent adverse effect of several anticancer drugs, �requiring hydration optimisation and regular renal function assessment during treatment. The risk of renal toxicity is particularly high with platinum salts, especially cisplatin; effects are cumulative and occur in 28-36% of patients treated with a single dose of 50mg/m(2).(8) The prevention and management of �platinum salts-induced renal dysfunction will be reviewed during a masterclass organised at the ESCP congress in Istanbul in late 2007. Updates on assessment of renal function will also be presented, as calculation of creatinine clearance is still under debate, with various formulae being used in the literature. A focus on new platinum salts in clinical development will complete the programme of this masterclass. Finally, ESCP will hold a joint meeting with the American College of Clinical Pharmacy (ACCP) in 2008. The previous joint congress in Paris in 2004 was a great success, permitting in-depth collaborations between the two societies. SIGCC will obviously take part in the preparation of this event and propose cooperative workshops in cancer care.

Patients affected by cancer in their lifetime represent a constantly growing part of the population, because of ageing and improvement of therapeutics that sometimes lead to cancer becoming a chronic disease. Demands for cancer care have been �expanding accordingly, and a huge number of healthcare professionals are now involved in cancer care and grouped into various societies.

Pharmacists may contribute to improve cancer care in different ways,(9) for example by elaborating therapeutic guidelines in a multidisciplinary team approach such as ESCP SIGCC and by encouraging current and future collaborations.

References

  1. Klepstad P, Kaasa S, Cherny N, et al. Palliat Med 2005;19:477-84.
  2. Hanks GW, Conno F, Cherny N, et al. Br J Cancer 2001 Mar 2;84:587-93.
  3. Yancik R, Ries LA. Semin Oncol 2004;31:128-36.
  4. Mercadante S. Support Care Cancer 1998;6:85-93.
  5. Shang E, Weiss C, Post S, Kaehler G.J Parenter Enteral Nutr 2006;30:222-30.
  6. Seres D, Sacks GS, Pedersen CA, et al.J Parenter Enteral Nutr 2006;30:259-65.
  7. Launay-Vacher V, Oudard S,Janus N, et al. J Clin Oncol 2006;24 (18S):Abstract 8603.
  8. Hartmann JT, Lipp HP. Expert Opin Pharmacother 2003;4:889-901.
  9. Liekweg A, Westfeld M, Jaehde U. Support Care Cancer 2004;12:73-9.

Resources
European Society of Clinical Pharmacy (ESCP)
W:www.escpweb.org
European Association of Palliative Care (EAPC)
W:www.eapcnet.org/International Society of Geriatric Oncology (SIOG)
W:www.cancerworld.org/siog/American College of Clinical Pharmacy (ACCP)
W:www.accp.com

Forthcoming events
7th ESCP Spring Conference on Clinical Pharmacy
16-19 May 2007 Edinburgh, UK
36th European Symposium on Clinical Pharmacy
25-27 October 2007
Istanbul, Turkey



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