Oncology is undoubtedly currently the fastest developing area of healthcare. More or less every month new drugs come to the market; many of them are formulations for oral administration. This means that the complex treatment of often co-morbid oncology patients is moving from a supervised hospital setting to the patient’s home and dispensing of potent oral anticancer drugs to general community pharmacies. Pharmacists in such pharmacies are not specialized in care for oncology patients, since the curriculum of pharmacy studies includes few oncology-related topics.
Our purpose is to empower pharmacists to improve therapy-related outcomes and patient safety by lending support for the pharmaceutical counselling related to the dispensing of oral anticancer drugs. By doing so in selected member countries, we will create a best-practice model for the EU.
To this end, we will first survey the current situation and problems at dispensing of oral anticancer drugs in the EU. Based on the results we will design optimal post-graduate education for pharmacists about oncology topics and develop IT-tools that assist the pharmaceutical counselling process. This will allow the pharmacist quick access to essential information on oral oncology drugs including important advice for patients as well as useful service options like the preparation of treatment plans for the patient. By evaluating user satisfaction with the IT-tools and educational programme and subsequent implementation of improvements, we establish a ‘learning system’. This system will be put to effect in the participating partner countries and later made available for implementation in other EU-countries.
These measures will improve patients’ self-efficacy regarding his or her disease and therapy and, consequently, will enhance adherence.
The number of orally available anticancer agents has been growing continuously. Patients appreciate the easier handling, increased independence from medical facilities and being reminded less of their disease. However the Achilles‘ heel in oral anticancer therapy is the patients’ adherence, thus both the will and the capability to take the medication exactly as prescribed by the oncologist. Parenteral and oral therapy require very different amounts of will and capability: the tablets and capsules must be swallowed regularly and precisely in the right dose in spite of nausea and emesis or severe skin reactions mentioned as side effects in the package leaflets or experienced as real adverse drug reactions. Also, most therapy regimens are complex, with specific time intervals between administration and meals and alternating days of therapy and days of pause. Therefore, counselling and comprehensive explanations concerning benefit, risks and the singular traits of oral anticancer therapy are pivotal for the empowerment of patients in oral anticancer therapy.
Patients will only be adherent, if they are fully convinced of the benefit of their oral anticancer therapy. Besides prolonged survival, this may also be an improved quality of life. Some patients have incorrect notions about their anticancer tablets, for example that they are less effective and / or less toxic than an infusion or just the “last try” before palliative treatment. Such misconceptions ought to be identified by questions like “How do you feel with your therapy?” and corrected as quickly as possible because they are a threat to adherence. With fewer visits at the oncologists, patient self-administration and storage at the patient’s home, community and hospital pharmacists have an increasingly important role in counselling the patient about his or her anticancer therapy.
EPIC project targeted pharmacists involved in the dispensing of oral chemotherapy with emphasis on education and adherence. Cancer patients receiving oral chemotherapy were targeted indirectly. The project goal was to improve current practice in different countries with the aim of improving adherence to oral chemotherapy.
Direct contact between patient and pharmacist at the moment of dispensing the prescribed drugs holds the opportunity to offer pharmaceutical advice that complements and affirms the physician’s counsel. Within the project we have improved existing way of oral anticancer drugs dispensing through two mechanisms – education of pharmacists and implementation of e-tool supporting pharmacists at dispensing of these drugs. By including different European countries, this project improved uniformity of health care across participating countries in the specific field of oral anticancer therapy. Based on the feedback, results and experience gained at the level of three EU-countries, we will continue to work on the presentation, improvement, harmonization and implementation of good practices at the level of all the countries of the European Union.
During the second reporting period, we launched online educational programme and online database with information on oral anticancer drugs. Both services are available to all Slovenian and Estonian pharmacists who dispense oral anticancer drugs.
For the purpose of evaluation of the training programme and oral anticancer drugs database we conducted an online survey. We invited all pharmacists, who attended the training and the database users to participate in the survey.
We also performed a detailed analysis of oral anticancer drug database to identify issues with the data base that needed to be fixed before roll-out to other countries.
In second reporting period we have focused on development and implementation of educational (training) programme and oral anticancer drug database for pharmacists who are dispensing these drugs.
The training program was carefully and precisely planned. First, working groups were established within ESHP and LZS with the aim to develop the training programme for pharmacists. We received the input from the survey, which we conducted among pharmacists in Europe, to cover the potential topics in the training programme. Specific needs for the training programme were discussed with stakeholders and relevant professionals’ organizations. The programme was provided for the pharmacists as e-learning course in both countries and also as face-to-face one day educational event in Slovenia. The programme is divided to three modules and every part has been completed by passing the test. The training program consists of more than 500 minutes of lectures and case reports.
In addition we have established and implemented a database which assists pharmacist at dispensing oral anticancer drugs and counselling cancer patients. The database consists of three modules: a module for adverse drug reactions management, a database of oral anticancer drugs, which are available on national market and patients database which enables among others printing of patients dairies and pharmaceutical care documentation. Pilot implementation of the database took place in Slovenia and Estonia. The database is web-based and it conforms to local practices and legislation.
One of important tasks in the second reporting period was also evaluation of the training programme and oral anticancer drugs database. We conducted a survey among pharmacists in Slovenia and Estonia to evaluate the contribution of and satisfaction with education and helping tool. In addition, we analyzed the advantages and disadvantages of the database, differences and similarities between accessibility and the procedures of dispensing oral anticancer drugs in the participating countries, with the aim to offer a best practice model and a common database for adoption in other EU countries.
The two main outputs of the project were that educational programme and oral anticancer drugs database are actively used by pharmacists in Estonia and Slovenia, where we implemented both services. 504 pharmacists (28% of all pharmacists working in pharmacies) were registered in e-training course in Estonia and 310 pharmacists participated in e-training or face-to-face educational event in Slovenia (24% of all pharmacists working in pharmacies). The database is used in 74 different pharmacies in Slovenia and in 33 pharmacies in Estonia.
We are pleased, that pharmacists reported that their knowledge improved in all areas which were covered by training programme. Registered users of the database are satisfied with the structure, quality of information in the database and the process of registration. They agree that the database helps them at dispensing of anticancer drugs.
Therefore, we could conclude that EPIC training programme and implementation of the database considerably improved pharmacists’ knowledge about oncology and oral anticancer drugs and they can provide better counselling and pharmaceutical care for cancer patients.
The importance of quality advice at dispensing of oral anticancer drugs is better recognized not only in the participating countries, but also in other European countries, because of EPIC project. With pilot implementation of the educational programme and the database for pharmacists in two EU countries we have gained valuable experience which helps us to further expand our solutions to other countries.
In the second half of the project we continued with dissemination activities in accordance with the plan. The members of partners’ organizations received newsletters with information about the development ad achievements of the project. The content and results of the project were presented at multiple international / national conferences and meetings as oral presentation, poster or within the workshop (e.g. ECCO European Cancer Congress, DGOPs “Vierte Oralia-Fachtagung”, “Oncology pharmacy neighbourhood day”, ESCP Symposium on Clinical Pharmacy, ESCP International workshop, ESOP Conference for Quality in Oncology, ESOP delegate meetings). Particularly the presentations of the project at the events of European society of oncology pharmacy enabled us discussion and further development of good practices on international level. In addition we published diverse articles in journals intended for professional public. Several dissemination activities on national and international level are planned also after the completion of the project.
Evaluation activities included among others a survey, which we conducted among pharmacists in Slovenia and Estonia after implementation of the e-tool and the training programme to evaluate the contribution of and satisfaction with education and helping tool. Pharmacists reported that their knowledge improved in all areas which were covered by training programme and that information in database is very useful therefore, we could conclude that both training programme and e-tool considerably improved pharmacists’ knowledge about oncology and oral anticancer drugs and they can provide better counselling and pharmaceutical care for cancer patients.