6.1 Wk 2 - Role of Cancer Pharmacist

Question 1

What is the estimated of new patients diagnosed with cancer in the UK, each day

Answer 1

1000

Question 2

How is cancer care delivered in the UK?

Answer 2

Cancer alliance

Hospitals, units, etc

Question 3

What is a cancer alliance group

Answer 3

Each cancer alliance has a cancer alliance group, who are a MDT, who have a special interest in one or more cancer types.

They typically get involved in best practice.

Question 4

What does MHRA stand for

Answer 4

Medicines and Healthcare Regulatory Agency

Question 5

Once a drug has MHRA approval what happens next?

Answer 5

A decision on how this will funded has to be made…

Question 6

What are the different ways which a new drug might be funded?

Answer 6

• NICE conduct a therapeutic assesmsent and approve the drug for use
• NICE recommend that the drug is funded by the cancer drugs fund, until it has sufficient data for a full theraputic assessment.
• Nice accept the drug for an Early Access to Medicines Scheme (EAMS) - The drug is usually provided free by pharma companies.
• The drug is approved for compassionate use at a local level

Question 7

Once a cancer drug receives a grant of marketing authorisation from the MHRA, what is the next step which is required before it is available to patients?

Answer 7

Pricing and Reimbursement decision from the National Institute for clinical excellence (NICE) or the Scottish Medicines Consortium.

Question 8

How do nice review a drug approved by the MHRA for pricing and reimbursement?

Answer 8

Pharma companies submit a scientific dossier so that NICE can review the:

• Quality data
• Efficacy
• Safety

Pharma companies also submit a health economic model so that they can review the cost effectiveness of the proposed treatment.

Question 9

If NICE review an asset and agree to the pricing and reimbursement, does this mean that the NHS have to make the drug available.

Answer 9

IN theory Yes, If NICE approve a drug for USE the NHS are supposed to make the drug available within 90 days of this dcision.

However in practice this does not always happen leading to post code prescribing.

Question 10

What is the purpose of dose banding?

Answer 10

Reduce waiste

Question 11

What is the concept of dose banding?

Answer 11

• If a patient is 60kg
• The dose is 5mg/kg
• Giving an optimal dose of 300mg
• But the vial is 320mg
• The dose is increase to 320mg to ensure the whol vial is used as it is only slightly higher than the prescribed dose.

? 4 padlet - Is there is a set % you can go above or below the Rx dose

Question 12

What is the abbreviation SACT

Answer 12

Systemic Anti Cancer Treatment

Question 13

What is the role of a SACT pharmacist

Answer 13

Support MDT to make informed decisions about a patient cancer care

Question 14

Pre treatment decision/Script/Recommedations/Med optimisation..

What does this SACT pharmacist role look like?

Answer 14

** Pre treatment decision**
* Attend Out/Pts to get full MH and DH if possible
* Check performance score to ensure fit for SACT
* Support MDT to make treatment decision

Script
* Verify prescriber - Correct grade
* Verify Therapeutic regimen
* Verify dose
* Verify drug interactions
* Verify toxicity profile of each drug and ensure not duplicated.
* Verify number of cycles and confirm in line with best practice
* Verify funding for the treatment regimen
* Recommend appropriate supportive medication

Recommendations which might be considered
* Rx an alternative
* Dose adjustment
* Temporarily stop drugs during cycle
* Rschedule administration
* Monitoring e.g. renal function for AKI

Medicines optimisation
* Medicines reconciliation
* Medicines validation
* In patient vs outpatient administration
* Supply or discharge medication
* Counselling and education