The Role of the Pharmacist in Survivorship Care

Supportive care in cancer is a collective term used to indicate services that may be needed by cancer patients and their close networks. It consists of self-help and support in the realms of psychology and spirituality, information provision, symptom management, rehabilitation, palliative care and bereavement care. In summary, supportive care in cancer refers to the following five areas of need:

• Psychological;
• Spiritual;
• Social needs;
• Physical; and
• Informational.

Supportive care offered by all members of the multidisciplinary team, as well as help from family, friends, support groups, volunteers and other community-based organisations, make a vital difference to the quality of supportive care. Healthcare systems with a strong primary care component have been demonstrated to be more cost-effective than those which are predominantly led by hospital specialists.

Pharmacists, as primary care professionals, can make a contribution to supportive and survivorship care in the following areas:

• Symptom management;
• Health promotion and wellness;
• Assist patients to make informed decisions about health improvement;
  • Focus areas can include diet, exercise, alcohol use, smoking cessation, etc.
• Act as an interface between the patient/survivor, primary healthcare professional, oncology team, and any other providers involved;
• Facilitate guidance as to what services should be offered as components of care and indicate who is responsible for managing these; and
• Support patient self-management.

Communication skills are central to providing supportive and survivorship care. This broadly involves the pharmacist effectively:

• Pinpointing the needs of the person;
• Establishing a therapeutic relationship with the patient;
• Meeting the informational needs identified in relation to diagnosis and treatment plans;
• Reducing distress and anxiety; and
• Developing the patient’s self-management skill set.

Successfully working within interdisciplinary teams – establishing rapport with others and participating in positive partnership and synchronisation, while having an understanding and level of respect for the purpose and role of all stakeholders and assimilating facets of care by engaging those in other sectors, as well as employing good communication skills and timely initiation of services is key. The skills required by the pharmacist in order to achieve these attributes include the following:

• Strong communication skills;
• Health promotion knowledge and an awareness of resources, services and supports available and accessibility to these;
• Psychosocial support and assessment skills;
• Cultural sensitivity;
• Ability to assess various health risk factors;
• Utilisation of peer support;
• Assess the self-management ability of the patient; and
• Care planning in cooperation with other stakeholders.

Pharmacists can use the following checklist for ensuring effective patient interaction⁷:

• Active listening;
• Open questioning;
• Good eye contact;
• Open body language;
• Appropriate environment;
• Use of timing;
• Alertness to verbal and non-verbal cues;
• Allow the patient time to speak;
• Use of silence appropriately;
• Sensitivity in handling uncomfortable situations;
• Recognise one’s own distress;
• Clarify patient concerns; and
• Inquire about the patient’s home circumstances and feelings.

The role of primary care generally in cancer control is increasingly recognised as a vital part of cancer services in Australia. This arm of healthcare plays an important role across the cancer continuum: in primary cancer prevention, discussing and delivering cancer screening tests, accurately diagnosing people with cancer when they present in the community, providing supportive care during and after treatment, and at the end-of-life. Cancer prevalence is rising due to improvements in survival and the ageing population. Therefore, primary care will, in turn, need to play a growing role in managing survivorship to ensure cancer care is sustainable.