Implementation of a telephone callback service for ambulatory oncology patients

Evaluating the patient-perceived impact of clinical pharmacy services and proactive follow-up care in an ambulatory chemotherapy unit

Purpose

To evaluate the patient-perceived impact of delivery of clinical pharmacy services, including a proactive follow-up program, on patient understanding, satisfaction, and toxicity management.

Methods

Patients who had received clinical pharmacy services at their initial chemotherapy treatment were identified and asked to complete a 20-point survey at the second or subsequent treatment. The services that the survey evaluated consist of face-to-face education during the first treatment and proactive telephone follow-up 3 to 7 days later.

Results

A total of 107 of the 112 respondents (95.5%) indicated that the time with the pharmacist at the first treatment was worthwhile and 92.6% of respondents reported that the interaction with the pharmacist increased their understanding of the medication regimen. Of the 113 respondents, the majority was either “Very Satisfied” or “Satisfied” with the time the pharmacist spent with them (94.7%), and the pharmacist’s ability to answer their questions (92.9%). In addition, survey results indicate that the clinical pharmacy input provided in the pharmacist call-back program is valuable, with 92.6% of the 82 respondents indicating that this service is worthwhile, and 91.4% of 93 respondents stating that the pharmacist input helped them to manage side-effects at home.

Conclusions

Survey results indicate that patients value clinical pharmacy services in the ambulatory oncology chemotherapy setting. These services contribute to improve patient understanding of the medication regimen, a high level of patient satisfaction, and self-management of treatment-related toxicities. These results support the provision of clinical pharmacy services and proactive follow-up programs in ambulatory chemotherapy units.

Adherence to adjuvant endocrine therapy in women with breast cancer

PURPOSE

To determine how many breast cancer patients who initiated adjuvant endocrine therapy discontinued early and to evaluate adherence in patients who persisted with therapy. Secondary objectives were to explore possible trends to see if certain factors may correlate to early discontinuation of therapy.

METHODS

A retrospective review of charts and pharmacy dispensing records was conducted, including patients who initiated adjuvant endocrine therapy for breast cancer at the Cross Cancer Institute from 1 January to 31 December, 2006.

RESULTS

Out of 346 patients, 81 (22%) discontinued therapy within 2 years. Adherence rates calculated for the 265 patients who remained on therapy beyond 2 years showed that 247 (93%) of these patients had 80% or better adherence. Patients who did not undergo chemotherapy and patients with Cross Cancer Institute follow-up times of less than 1 year were significantly more likely to discontinue therapy early.

CONCLUSIONS

The majority of patients who were prescribed adjuvant endocrine therapy for breast cancer at the Cross Cancer Institute remained on therapy for at least 2 years and were adherent. Longer follow-up by Cross Cancer Institute practitioners may help decrease discontinuation rates.

Interventions for improving communication with children and adolescents about their cancer

BACKGROUND

Communication with children and adolescents with cancer about their disease and treatment and the implications of these is an important aspect of good quality care. It is often poorly performed in practice. Various interventions have been developed that aim to enhance communication involving children or adolescents with cancer.

OBJECTIVES

To assess the effects of interventions for improving communication with children and/or adolescents about their cancer, its treatment and their implications, updating the 2003 version of this review.

SEARCH STRATEGY

In April 2006 we updated searches of the following sources: CENTRAL (The Cochrane Library, issue 1 2006); MEDLINE (Ovid), (2003 to March week 5 2006); EMBASE (Ovid) (2003 to 2006 week 13); PsycINFO (Ovid) (2003 to March week 5 2006); CINAHL (Ovid) (2003 to March week 5 2006); ERIC (CSA) (earliest to 2006); Sociological Abstracts (CSA) (earliest to 2006); Dissertation Abstracts: (2002 to 6 April 2006).In 2003 we conducted searches of CENTRAL; MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, Sociological Abstracts and Dissertation Abstracts.For the initial (2001) publication of this review we also searched the following databases: PsycLIT; Cancerlit; Sociofile; Health Management Information Consortium; ASSIA; LISA; PAIS; Information Science Abstracts; JICST; Pascal; Linguistics and Language Behavior Abstracts; Mental Health Abstracts; AMED; MANTIS.We also searched the bibliographies of studies assessed for inclusion, and contacted experts in the field.

SELECTION CRITERIA

Randomised and non-randomised controlled trials, and before and after studies, evaluating the effects of interventions for improving communication with children and/or adolescents about their cancer, treatment and related issues.

DATA COLLECTION AND ANALYSIS

Data relating to the interventions, populations and outcomes studied and the design and methodological quality of included studies were extracted by one review author and checked by another review author. We present a narrative summary of the results.

MAIN RESULTS

One new study met the criteria for inclusion; in total we have included ten studies involving 438 participants. Studies were diverse in terms of the interventions evaluated, study designs used, types of people who participated and the outcomes measured.One study of a computer-assisted education programme reported improvements in knowledge and understanding about blood counts and cancer symptoms. One study of a CD-ROM about leukaemia reported an improvement in children's feelings of control over their health. One study of art therapy as support for children during painful procedures reported an increase in positive, collaborative behaviour. Two out of two studies of school reintegration programs reported improvements in some aspects of psychosocial wellbeing (one in anxiety and one in depression), social wellbeing (two in social competence and one in social support) and behavioural problems; and one reported improvements in physical competence. One newly-identified study of a multifaceted interactive intervention reported a reduction in distress (as measured by heart rate) related to radiation therapy.Two studies of group therapy, one of planned play and story telling, and one of a self-care coping intervention, found no significant effects on the psychological or clinical outcomes measured.

AUTHORS' CONCLUSIONS

Interventions to enhance communication involving children and adolescents with cancer have not been widely or rigorously assessed. The weak evidence that exists suggests that some children and adolescents with cancer may derive some benefit from specific information-giving programs, from support before and during particular procedures, and from interventions that aim to facilitate their reintegration into school and social activities. More research is needed to investigate the effects of these and other related interventions.