Planning, Verification and Clinical Responsibility Flashcards
1
Q
What is the challenge with current National Cancer Planning?
A
- Growing numbers; over 250,000 diagnosed in England annually, with 130,000 dying as a direct result.
- Growing costs; annual costs to NHS for cancer services £5 billion (£1.2 on cancer drugs)
- Total cost to society incl. loss of productivity is £18.3 billion, globally £895 billion.
- UK survival rates worse than those for other countries with similar welath
2
Q
What are the issues regarding Variation of cancer care?
A
- Variation in quality, safety, equity, outcomes, money spent, types of services used
- Significant variation in treatment of cancers; NHS Atlas identifies two-fold variation between best and worst areas
- 30% of patients in worst-performing areas diagnosed when disease is at early stage; compared w/56% in the best.
3
Q
What are the issues regarding postcode prescribing and variation associated with it?
A
- Term describing variation in the access to medicines
- NICE guidelines have done much to reduce this by placing statutory duty on NHS to offer treatment based on clinical need, not affordability
- BUT, commissioners can but prescribers under pressure to save money, patients can be put on pressure
- Patients can also put doctors under pressure to prescribe; despite lack of data to support safety or efficacy
4
Q
What are the financial challenges to National Planning?
A
- NHS is broke; £20-35 billion efficiency saving (25% on operating budget of £105 billion) over
coming years - Whilst costs and demands continue to increase
> Patent extension; pharmaceutical industry extends patents for its medicines no matter what (to pay off R&D costs).
> E.g. w/Trastuzumab; evolutions of it till Kadycla reached a QUALY of £166,000. - Global cost variation; average monthly costs of patented drugs vary six-fold across different countries (as well as generics showing variation)
- Growing cost of cancer treatment
- Limited value; interventions/treatments of limited value.
- Cancer Drug Fund (CDF); gives access to licensed unaffordable medicines (but costs out of control; 37% overspend in ‘15-2016)
5
Q
How is improving value achieved WRT National Planning?
A
- National Policy (2010-15); to match average survival rates in Europe (save an extra 5,000 lives a year) by:
> Reduce lifestyle risks (smoking, obesity, alcohol, xs. exposure to sun)
> ‘Be clear on cancer’ campaigns
> Earlier and extended screening
> Improving access and treatment
> Increased investment - Improving value; via national commissioning, reducing variation, controlling costs and improving outcomes
> Clinical reference groups set up to develop national treatment algorithms. - Clinical reference groups
> Advise NHS England on best ways that specialised services should be provided
> Clinicians, commissioners, public health experts, patients, carers.
> Putting the N back in NHS (+National approach) - SACT (Systemic Anti-Cancer Therapy Data Set)
> Collects clinical management information on patients undergoing chemotherapy from the NHS
> Goal to improve patient care by identifying patterns of systemic anticancer therapy to support teams to choose appropriate treatments and care
6
Q
What is a typical patient journey with a Cancer MDT (local planning)?
A
- Early diagnosis/referral w/GP, or community pharmacist
- Or patient admitted to hospital w/non-specific signs and symptoms
- Referred to surgeon/oncologist; then after a preliminary diagnosis, referred to a cancer site specific MDT e.g. lung, breast, bowel, often in a subspecialty of
7
Q
Why were Cancer MDTs developed?
A
- Improve access to specialist care, collaboration across specialties, information and audit, communication with patients and carers
- Consider patients holistically (i.e. not just their cancer); their views, making shared recommendations, not isolated decisions.
8
Q
What members are in a cancer MDT?
A
- Cancer information staff
- Clinical psychologists
- Counsellors
- Chaplains
- Dieticians
- Occupational therapists
- Physiotherapist
- Radiographers
- Social workers
- Speech & language therapists
9
Q
Who are the members of a Cancer Pharmacy Team?
A
- Directorate Pharmacist
> Advanced Pharmacists
> Specialist Pharmacists
> Rotational Pharmacists - Chief Technician
> Aseptic Technicians
> Ward based MMT
> Pharmacy Assistants - Other
> Clinical trials team
> Consultant pharmacist
10
Q
What are the roles of the Cancer Pharmacy Team? (Strategic, Clinical, Technical etc?)
A
- Strategic
> New drugs/funding
> Clinical guidelines - Clinical
> Verification
> Counselling
> Prescribing - Technical
> Aseptic manufacture
> Dispensing medication - Clinical Trials
- Training and education
11
Q
What is a typical chemotherapy journey?
A
- Decision to treat with chemo by consultant/MDT
- Consent obtained (formal, written)/patient assessed and chemo prescribed electronically
- Appointment made for nurse-led counselling and assessment
- Prescription screened by pharmacist once blood results availible. Supply of supportive drugs arranged
- Chemotherapy manufactured in aseptic unit, checked and released by production pharmacist
- Chemotherapy administered in chemotherapy suite by nurses
- Patients seen prior to next cycle of treatment, toxicities assessed, cycle repeated
12
Q
What needs to be considered WRT Pharmacy Capacity Planning with Demand, Resourcing and the Product?
A
Demand
- Increase in patients requiring chemotherapy by 10-15% each year (some offset by shift to PO anticancers e.g. TKIs)
- Flow can be difficult to predict (whilst patients receive treatment cyclically) due to treatment delays, dose reductions, urgent chemotherapy (e.g. acute myeloid leukemia (AML).
- Specialist clinics; allows treatment of patients w/similar conditions = ‘campaigns working’ in clinic and aseptic preparation
Resourcing
- Staffing and space = a premium (need for appropriate skill-mix, forward planning; capacity planning software)
- Preparation is rate-limiting step
- Increased homecare is being offered by outreach teams, private companies and clinics.
Product:
- Campaign working; preparing treatments for multiple patients with same treatment at same time (efficiencies in planning and drug use)
- Dose banding; standardised doses grouped by weight, BSA; saving time, money, reducing dosing errors, allows out-sourcing.
- Vial sharing; during a single aseptic session, vials shared to maximise efficiency and product more patient doses w/fewer vials (e.g. saved £74,000 in East Mids one year w/bortezomib campaign dispensing)
13
Q
What is the role of the pharmacist in secondary care WRT clinical roles, strategic and production?
A
Clinical roles:
- Inpatient and outpatient
- Screening Rx
- Patient counselling
- Supportive medication
- Prescribing advice
Strategic:
- Funding and guidelines
- Access and procurement
Production:
- Oversee manufacture of chemotherapy
- Ensure quality and GMP
14
Q
What are the extended roles of a secondary care pharmacist?
A
Prescribing
- Chemotherapy
- Supportive care
- Oral chemotherapy
Patient assessment
- Suitable for next cycle?
- Treat toxicities/adjust chemotherapy
Clinical trials & audit
Education & training
15
Q
What does the secondary care pharmacist need to educate the patient about?
A
- Specific regimen
- Adjuvant medicines
- Symptom management
- Side effect management (sickness, mouth problems, pain or blood passing urine), signs of neutropenic septicaemia (sore throat, fever).
