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Pharmacy support

Application and decision making in cancer therapy

Following a decision to commission a new anticancer therapy, the pharmacy team within a hospital Trust has a key role, as part of the multidisciplinary chemotherapy team, in assuring its safe introduction

Colin Ward MSc Specialist Oncology Pharmacist, NHS England Specialised Commissioning (Midlands and East Region); Divisional Lead Pharmacist for Cancer, Derby Teaching Hospitals NHS Foundation Trust, UK

Since April 2013, all chemotherapy in England is commissioned by NHS England within its Specialised Prescribed Services portfolio. As a result, there is ongoing work to understand historic regional commissioning decisions and transition to clinically agreed national treatment algorithms as part of a strategy to minimise variations in prescribing practice that are not clinically and financially justifiable. For chemotherapy, commissioning policy is produced by NHS England with input from the Chemotherapy Clinical Reference Group. Agreed policies are then communicated via Area Teams to provider Trusts to inform them of policy. While some regions have historic treatment algorithms to illustrate commissioned treatment options at each stage of disease, these are also currently being developed to produce national treatment algorithms for all tumour types.

A key role 26

Following a decision to commission a new therapy, the pharmacy team within a Trust has a key role, as part of the multi- disciplinary chemotherapy team, in assuring the safe introduction of that therapy. Balancing the demand of clinicians and prospective patients to access the new therapy immediately with managing issues associated with its introduction to assure safe service

provision for all users of the chemotherapy service. Within practice at Derby Hospitals NHS Foundation Trust, a process has been developed to support a consistent and structured approach to introducing a new therapy1

to cover issues including:

● Anticipated demand and capacity to deliver therapy

● Staff training – Dispensing – Administration

– Prescription verification2 – Toxicity management

● Dispensing – Stock control – Shelf life and worksheets (aseptic dispensing)

– Patient access schemes – Minimising waste/medicines optimisation

● Protocol

– Dosing – Critical tests

– Dose modifications – Supportive medicines (anti-emetics, fluids, etc)

● E-prescribing ● Risk management ● Patient information ● Information and audit. Many of these aspects can be addressed in parallel but all must be completed before the treatment is made available for use in clinics.

Capacity and demand

In the setting of cancer chemotherapy, it should be borne in mind that chemotherapy is only one of a number of treatment strategies that may be used alone, in combination or sequentially. For many new drugs, their initial place in

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