Cancer is scary, not just to those suffering from the disease and the people supporting them, but also to healthcare workers outside treatment centres. Pharmacy staff are no exception, tending to think that anyone who comes in with the condition will be getting everything they need from a specialist team. But life isn’t that compartmentalised and care shouldn’t end at the hospital door.
Dr Jackie Lewis, pharmacist director of Lewis Pharmacy in Exmouth, has a keen interest in this area, which stemmed from realising how many of her customers were affected by cancer.
She says: “Quite often the first thing we know is when someone comes in and has already started treatment. It can be a long journey – they may need surgery and then start a course of chemotherapy cycles, each of which is a few weeks apart, and then go on to have radiotherapy – and the slowness of it all can be very frustrating for patients, so it is important to show empathy and be reassuring.”
Dr Lewis continues: “It may seem that there isn’t much chance to talk about chemo itself – and secondary care is very good at keeping its patients close in this regard – but simply asking how someone is doing may prompt them to mention any problems that they are experiencing.” Some of the most common include issues with oral hygiene, diarrhoea, rashes and other skin ailments, all of which the pharmacist may be able to help with. Dr Lewis adds that is vital that support staff know to urgently refer anyone with cancer who has signs of an infection (see ‘red flag symptom’ panel below), as certain treatments suppress the body’s ability to produce white blood cells, which in turn means that minor infections can turn into life-threatening issues within a matter of hours.
Ann-Marie Lloyd from the Welsh charity Tenovus Cancer Care says pharmacy staff are in a unique position to see people in their normal everyday lives: “People often gear themselves up for their hospital appointments but are more themselves when they pop into their local pharmacy so it may be more obvious that they are struggling. This may well be due to something outside their treatment, for example, they may be struggling to maintain their usual routine with their children because of the strain they are under.”
Ann-Marie carries on: “A lot is made of the ‘fight against cancer’ and patients can feel like they need to keep on going, but telling them that it is OK to not be OK gives them the chance to step outside their cancer diagnosis – which they may feel has come to define them – and gives them guilt-free permission to express themselves. The same is true of carers, who tend to focus on their loved ones with cancer to their own detriment. But you can’t pour from an empty jug, so encourage them to take time for themselves, which might be as simple as stopping and sitting down with a cup of coffee when doing the shopping.”
Pancreatic Cancer Action chief executive and founder Ali Stunt agrees: “The people around the patient – their supporting team – are often overlooked, but are often under a lot of pressure because they are trying to juggle their job with taking someone to appointments and helping them afterwards in very practical ways, while the person with cancer may have taken time off work while they are going through their treatment. Pharmacy staff can provide that much-needed personal human touch by asking how they are doing and simply chatting so they know they are not alone.”
The internet is a wonderful resource, but not everything can be depended upon. Ali says: “There is an important role for pharmacy staff in signposting patients and carers to reliable and non-scary information on conditions and treatments: patient organisations for individual conditions have a wealth of information – and some are peer-reviewed and accredited by the NHS Information Standard, which indicates a certain level of quality and accessibility – and often forums and helplines for specific cancers, whereas Macmillan Cancer Care may be better for someone who has financial or employment worries.”
Some symptoms are so vague that it is difficult to know what is behind them, but the following are considered “red flags”; that is they should trigger a referral to the GP for investigation:
All of the above can be caused by a range of conditions, many of which are not serious, but it is sensible for patients to get them checked out. If a GP has already seen the patient but the symptom still hasn’t resolved, the patient should go back and ask for another check-up.
Another area in which community pharmacy can contribute is cancer prevention. Cancer Research UK says: “Many people believe that getting cancer is purely down to genes, fate or bad luck. But through scientific research, we know that our risk actually depends on a combination of our genes, our environment and things to do with our lifestyle, which we’re more able to control… experts estimate that more than four in 10 cancer cases could be prevented.”
Many of these lifestyle tweaks are things that pharmacy staff already promote – not smoking, maintaining a healthy body weight, eating a healthy balanced diet, keeping alcohol intake below Government guidelines, staying active and enjoying the sun safely – so are relatively easy to tie into cancer awareness campaigns. Dr Lewis suggests tying in with national campaigns where possible, as this is a good way of reinforcing the messages they convey.
Ann-Marie highlights how many campaigns are now run through social media channels. While this is a good way of raising awareness among certain populations, she points out: “There is a real danger that a whole generation might miss out, as they simply don’t use things like Twitter and Facebook. Having a display in the pharmacy that uses campaign materials and gives the same information is a good way of reaching these people.”
Dr Lewis states: “Don’t forget about rarer cancers. Breast, skin and prostate are obviously important and are the focus of many charities and campaigns, but people also need to know about cancers such as lymphomas. Some of these less common cancers are not well known at all, and so often patients don’t get a diagnosis until the cancer is quite advanced, at which point the outlook isn’t very good. They may seem a bit scary to tackle, but are actually a great training opportunity for the whole staff.”
Ali is in full agreement: “Pharmacy staff play a crucial role, particularly for cancers with non-specific symptoms for which people are likely to self-medicate. For example, they might notice that someone has been buying antacids for months and is asking for something stronger, plus perhaps some painkillers: this can be a sign of pancreatic cancer. The same is true of dispensed medicines, so someone who mentions that their prescribed proton pump inhibitor doesn’t seem to be working as well as it used to should be cause for concern.
“In such situations, ask if the customer has any other symptoms such as unintended weight loss or wants to speak to the pharmacist about a medicines review. You might suggest they go back to the GP or even phone to make an appointment for them there and then,” Ali says. “Pharmacy support staff are hugely under-recognised for what they can do, but have a closer relationship with their customers so can spot that something isn’t quite right, and have the time and familiarity to do something about it.
A patient who is receiving chemotherapy or systemic radiotherapy and who complains of any of the following should seek immediate medical help as they may need urgent antibiotic treatment to prevent it turning into something much more serious:
Patients should be in possession of details of whom to contact in such situations, but if there is any uncertainty, they should telephone their cancer centre without delay.
“Pharmacy staff can provide that much-needed personal human touch”