CAPhO ENews - September 2011 Update

Report from Mark Pasetka

As our plane made its final descent, I must admit to being at a profound loss for words when my eyes first beheld the magnificence of Greece. Of course, I was there to attend the MASCC annual meeting.

The introductory sessions on the first day encompassed a broad range of supportive care topics including social exclusion of cancer patients, the ethics of research in patients with advanced cancer, and patient dignity. Many of these aspects are not often discussed or perhaps taken into consideration when caring for patients. One aspect of social exclusion that was presented was that of patients who are incarcerated or homeless and the challenges that these situations present to clinicians - e.g., the presence of guards at a clinic appointment and patients who do not attended their treatment.

The keynote presentation for the evening was focused on cancer- and chemotherapy-induced anaemia, which is an area of great personal interest. Although there was little new information on this subject, a new preparation to Canada (apparently in the near future), but not to Europe, is ferric carboxymaltose. This preparation would definitely seem to be a more convenient approach for both the patient and the clinician as it is administered in much less time. There is currently no data in the oncology population (cardiac patients); however, this presents fertile ground for study.

The evening ended with the first of two poster sessions at the conference, of which I was able to present findings from one study and describe an internet-based clinical support and research tool developed at the Odette Cancer Centre by our clinical coordinator. The range of topics for posters was immense with several hundred posters present for viewing over the two viewing sessions. Topics ranged from clinical issues, drug development, research, quality of life, survivorship, and palliation.

The second day of the conference was overflowing with numerous presentations given in various styles and formats on a countless array of topics. I attended the series which focused on the pharmaceutical aspect in supportive care. The discussion was divided into four sections: implementation of supportive care guidelines; continuity of pharmaceutical care by primary clinicians when patients are not in the treatment centre; medication burden in cancer patients; and common drug related issues in geriatric oncology patients. There was something to be gained from all of these lectures that is relevant to our practice as pharmacists and pharmacy technicians in oncology. Clearly the seamlessness that is thought to be present is unfortunately often lacking. Implementation of practices to improve the continuity of care for these patients seems to be an avenue that is well suited to pharmacy and will be of great benefit to patients as well as an area available for rigorously studied.

The keynote presentation was on chemo- and radiotherapy-induced nausea and vomiting (CINV/RINV) which was of particular interest to me as I am currently involved in a study examining the use of aprepitant in the RINV setting. Although there was not a significant amount of new information on the topic of CINV, it is encouraging to see that there seems to be an increasing awareness of the prevalence of RINV than previously and potential strategies to treat it...

The final day included sessions for oral presentation of abstracts and concluded with several discussions on the future of supportive care in cancer and our role in it as health care providers. The future of supportive care in oncology is expanding and incorporating many different areas of care which include pharmaceutical, radiological, psychological, sociological, and medical aspects. These topics were the focus of the final day at the symposium and how we as clinicians would be able to contribute to their improvement.

I feel very fortunate to have been able to attend this international conference with world leaders in this field. The learning opportunities were both plentiful and of excellent quality. It was a tremendous experience and I would like to thank CAPhO for the generous grant which made this endeavour possible.

Mark Pasetka
Odette Cancer Centre - Sunnybrook Health Sciences Centre

Report from George Dranitsaris

MASCC 2011 was held from June 23 to 25 in Athens, Greece. I was very fortunate to be able to attend this meeting in part because of the generous support from CAPhO in the form of a travel grant. The Meeting covered various aspects of cancer supportive care such as the prevention and management of febrile neutropenia, chemotherapy induced emesis and the treatment of toxicities caused by the newer targeted therapies.

One of the more interesting sessions that I attended was presented by Dr. Mario Locouture of the Sloan Memorial Kettering Cancer Center in New York City. Dr. Locouture, a dermatologist, presented a review of current interventions to prevent and manage skin toxicities from agents such as cetuximab and pantuzumab. He highlighted the importance of early intervention in order to help the patient remain on active therapy.

In addition to the presentations relating to traditional cancer supportive care, there were also some very interesting sessions on patient survivorship and the enhancement of quality of life. One abstract (# 727) of particular interest to me was presented by Dr. Mustian from the University of Rochester Cancer Center. This was a comparative trial where cancer survivors (total n = 410) were randomized to receive standard care and twice weekly sessions of yoga or to a standard of care control group. The primary outcomes of the study were sleep quality, mood, patient reported anxiety and the use of anxiolytic medication. After the 4 week intervention period, patients in the experimental group reported statistically significant improvements in sleep quality, mood, reduced anxiety and a reduction in the need for pharmacotherapy. The investigators concluded that a structured yoga program can have an overall benefical effect on patient care and quality of life. This study illustrates that both the classical medical model and alternative medicine can be used in a complimentary way to enhance the care of our patients.

In summary, the 2011 MASCC meeting was well worth going to and illustrated the active role that can be played by the oncology pharmacist in cancer supportive care. Given our place as part of the health care team, oncology pharmacists are well positioned to offer modern supportive care in order to enhance patient quality of life.

George Dranitsaris, M.Pharm., FCSHP
Consultant in Health Economics and Biostatistics