Thursday, December 22, 2011

Multidisciplinary Oncology

Posted by Eric Zhao at Thursday, December 22, 2011

St. Joseph Mercy Hospital has been my home for the past month, where I rotated with Dr. Carol Yarrington in Ambulatory Care Oncology.

New Oncology Infusion Centers in Canton, MI and Brighton, MI
Patient bays increase privacy and comfort

After brushing up my knowledge on the oncology drugs, therapeutic areas, and side-effect management strategies, I was charged with setting the groundwork for a pilot pharmacy intervention at the Multidisciplinary Oncology Clinic.

The Multidisciplinary Clinic (MDC)
The clinics are held on Monday (head/neck cancer), Tuesday (lung cancer and gastrointestinal cancer), and Friday (breast cancer). In one sitting, a patient can see a nurse navigator (explained below), nurse practitioner, palliative care nurse, physician assistant, medical oncologist, radiation oncologist, and surgeon. What's nice about this initiative is that the patients receive the full spectrum of care in a single trip. Each of the healthcare professionals will individually visit with the patients, rotating between patient rooms. Afterwards, they all convene to discuss their plan for each patient.

The Multidisciplinary Team in the Cancer Care Specialty Center
[Link to Brochure]

Nurse Navigator
The nurse navigator, a rising new concept, serves as the main contact and face of the multidisciplinary clinic. They make sure the patient is acquainted to the clinic by setting up appointments with the healthcare professionals and providing follow-up when needed. Because days can get hectic, these navigators help orient the patient during their treatment visits.

Pharmacy Intervention
Between visits from the healthcare providers, patients may have 30-120 minutes of downtime before the next visit. What a convenient time for pharmacy to step in, interview the patient, and review their medication list! The clinic is mainly focused on the oncology aspect, so there is a lot of room to manage their chronic health concerns. Oftentimes, patients with cancer will try complementary or alternative medications to improve their situation. However, these medications may interact with chemotherapy to reduce their efficacy; for example, some chemotherapy agents rely on creating free radicals to destroy tumor cells, so ingesting a large amount of antioxidants may cause more harm than good.

Green tea, an antioxidant, may negate chemotherapy agents that depend on producing free radicals to destroy the tumor

Future Direction
The multidisciplinary clinic shows a lot of promise, and I hope the clinic continues to pilot the program with the next student. It's a great way for pharmacists to get involved in the multidisciplinary care of oncology patients through a review of not only their chemotherapy regimen, but their maintenance medications too.

Eric Zhao

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