Gagnon L, Fairchild A, Pituskin E, Dutka J, Chambers C
Rapid Access Palliative Radiotherapy Program, Cross Cancer Institute, Alberta Health Services - Cancer Care, Edmonton, Alberta, Canada.
J Oncol Pharm Pract. 2012 Mar;18(1):76-83. doi: 10.1177/1078155211402104. Epub 2011 Apr 13.
Bone metastases are the most common cause of cancer pain, with palliative radiotherapy (RT) the mainstay of treatment. However, relief from RT may be delayed, incomplete, or short-lived and therefore optimized pharmacologic therapy is essential. Our objective was to describe the contribution of the clinical pharmacist (CP) to an outpatient palliative RT clinic.
The Edmonton Symptom Assessment System, an 11-point scale for measuring nine symptoms, and other validated screening tools were administered, and a medication history performed by the CP. Baseline CP assessment also included opioid toxicity, need for supportive medications, and drug interactions. Anonymized clinical information was collected prospectively and descriptive statistics were compiled including themes of counselling performed by the CP.
The CP reviewed 114 patients over 140 clinic visits (01/2007-12/2008). Median age was 68.3 years, 68.4% were male and 36.8% had prostate cancer. All symptoms improved or stabilized in ≥ 80% by 4 weeks. Median pain score was 6/10 (SD 2.6) at baseline, and 2.1/10 (SD 2.4) by week 4. Average morphine equivalent daily dose was 76.8 mg at baseline and 44.5 mg at week 4. CP assessment included screening for opioid toxicity (87.9%), recommending a change in analgesic (28.9%), and liaison with the community pharmacy (17.1%). Medication counselling took place in 84.3% of visits, on bowel routine (85.6% of the time), opioids (82.2%), and hydration (40.7%).
The CP plays a key role in holistic patient assessment and optimization of pharmacologic therapy, contributing to improved symptom control of patients receiving palliative RT.
骨转移是癌症疼痛最常见的原因，姑息性放疗（RT）是主要的治疗方法。然而，放疗带来的缓解可能会延迟、不完全或短暂，因此优化药物治疗至关重要。我们的目的是描述临床药师（CP）在门诊姑息性放疗诊所中的作用。
使用埃德蒙顿症状评估系统（一种用于测量九种症状的11分制量表）和其他经过验证的筛查工具，并由临床药师进行用药史调查。临床药师的基线评估还包括阿片类药物毒性、对支持性药物的需求以及药物相互作用。前瞻性收集匿名临床信息，并编制描述性统计数据，包括临床药师进行咨询的主题。
临床药师在140次门诊就诊中评估了114例患者（2007年1月至2008年12月）。中位年龄为68.3岁，68.4%为男性，36.8%患有前列腺癌。到4周时，所有症状在≥80%的患者中得到改善或稳定。基线时中位疼痛评分为6/10（标准差2.6），到第4周时为2.1/10（标准差2.4）。基线时平均每日吗啡当量剂量为76.8毫克，第4周时为44.5毫克。临床药师的评估包括筛查阿片类药物毒性（87.9%）、建议改变镇痛药（28.9%）以及与社区药房联络（17.1%）。84.3%的就诊进行了用药咨询，涉及肠道常规（85.6%的时间）、阿片类药物（82.2%）和补液（40.7%）。
临床药师在全面的患者评估和药物治疗优化中发挥关键作用，有助于改善接受姑息性放疗患者的症状控制。
