Cancer care is a highly complex task. Starting from screening, it is made of an intense diagnosis and treatment process, with the implication of multiple healthcare providers. In an interprofessional approach, it is standard for community pharmacists to manage cancer treatment in collaboration with physicians and nurses. Further, in a growing number of jurisdictions, pharmacists are offering cancer screening services. Should they also be involved in the diagnosis of cancer? (1) In many settings, the system might not be ready for such a move and more evidence is needed.
Pharmacists have a major role in the provision of multiple healthcare and preventive services (2,3). Redesigning the primary healthcare system in a patient-centered and interprofessional perspective does not mean however that healthcare providers are interchangeable. While several services can be delivered by different healthcare providers, such as screening, health education, and counseling, others require a team-based approach with each healthcare professional having specific tasks. Hence, physicians have the skills and training for cancer diagnosis and prescription. Pharmacists are trained and equipped for cancer treatment management and, in collaboration with physicians and nurses, for the follow-up of cancer patients (4). While screening is increasingly provided by community pharmacists, it is not the same as making a diagnosis (5). Early detection in the population, through screening, should not be confused with early diagnosis in patients who present with suspicious symptoms or signs.
For pharmacists to be involved in the early diagnosis of cancer, clinical trials should be conducted to test if it improves health outcomes. We have high-level evidence from multiple trials of the benefits of pharmacist care in cardiovascular disease management (2). Trials have also shown the value of pharmacists for health promotion and primary prevention activities (3). In an evidence-based health services approach, how to best involve pharmacists in all steps of cancer care needs more research.
Arnaud Chiolero, professor of public health (1), Viktoria Gastens, health services researcher (1), and Valérie Santschi, professor of health services research (2)
From (1) Population Health Laboratory (#PopHealthLab), University of Fribourg, Switzerland & (2) La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
References
1) Bradley SH, Jones D, Wood S, Rafiq M, Bradley C, Hamilton WT. Diagnosing cancer in English community pharmacies. BMJ. 2024; 385:e077087.
2) Gastens V, Kiszio B, Del Giovane C, Tsuyuki R, Paradis G, Chiolero A, Santschi V. Pharmacist interventions to improve hypertension management: protocol for a systematic review of randomised controlled trials. BMJ Open 2022; 12(5):e059399.
3) Thomson K, Hillier-Brown F, Walton N, Bilaj M, Bambra C, Todd A. The effects of community pharmacy-delivered public health interventions on population health and health inequalities: A review of reviews. Prev Med. 2019; 124:98-109.
4) Lindsey L, Husband A, Nazar H, Todd A. Promoting the early detection of cancer: a systematic review of community pharmacy-based education and screening interventions. Cancer Epidemiol. 2015; 39(5):673-81.
5) Bretthauer M, Kalager M. Principles, effectiveness and caveats in screening for cancer. Br J Surg 2013; 100(1):55-65.
Competing interests:
No competing interests
08 July 2024
Arnaud Chiolero
Professor of public health
Viktoria Gastens, health services researcher (1), & Valérie Santschi, professor of health services research (2)
1) Population Health Laboratory (#PopHealthLab), University of Fribourg, Switzerland & 2) La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
Rapid Response:
Cancer Evidence-Based Interprofessional Care
Dear Editor
Cancer care is a highly complex task. Starting from screening, it is made of an intense diagnosis and treatment process, with the implication of multiple healthcare providers. In an interprofessional approach, it is standard for community pharmacists to manage cancer treatment in collaboration with physicians and nurses. Further, in a growing number of jurisdictions, pharmacists are offering cancer screening services. Should they also be involved in the diagnosis of cancer? (1) In many settings, the system might not be ready for such a move and more evidence is needed.
Pharmacists have a major role in the provision of multiple healthcare and preventive services (2,3). Redesigning the primary healthcare system in a patient-centered and interprofessional perspective does not mean however that healthcare providers are interchangeable. While several services can be delivered by different healthcare providers, such as screening, health education, and counseling, others require a team-based approach with each healthcare professional having specific tasks. Hence, physicians have the skills and training for cancer diagnosis and prescription. Pharmacists are trained and equipped for cancer treatment management and, in collaboration with physicians and nurses, for the follow-up of cancer patients (4). While screening is increasingly provided by community pharmacists, it is not the same as making a diagnosis (5). Early detection in the population, through screening, should not be confused with early diagnosis in patients who present with suspicious symptoms or signs.
For pharmacists to be involved in the early diagnosis of cancer, clinical trials should be conducted to test if it improves health outcomes. We have high-level evidence from multiple trials of the benefits of pharmacist care in cardiovascular disease management (2). Trials have also shown the value of pharmacists for health promotion and primary prevention activities (3). In an evidence-based health services approach, how to best involve pharmacists in all steps of cancer care needs more research.
Arnaud Chiolero, professor of public health (1), Viktoria Gastens, health services researcher (1), and Valérie Santschi, professor of health services research (2)
From (1) Population Health Laboratory (#PopHealthLab), University of Fribourg, Switzerland & (2) La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
References
1) Bradley SH, Jones D, Wood S, Rafiq M, Bradley C, Hamilton WT. Diagnosing cancer in English community pharmacies. BMJ. 2024; 385:e077087.
2) Gastens V, Kiszio B, Del Giovane C, Tsuyuki R, Paradis G, Chiolero A, Santschi V. Pharmacist interventions to improve hypertension management: protocol for a systematic review of randomised controlled trials. BMJ Open 2022; 12(5):e059399.
3) Thomson K, Hillier-Brown F, Walton N, Bilaj M, Bambra C, Todd A. The effects of community pharmacy-delivered public health interventions on population health and health inequalities: A review of reviews. Prev Med. 2019; 124:98-109.
4) Lindsey L, Husband A, Nazar H, Todd A. Promoting the early detection of cancer: a systematic review of community pharmacy-based education and screening interventions. Cancer Epidemiol. 2015; 39(5):673-81.
5) Bretthauer M, Kalager M. Principles, effectiveness and caveats in screening for cancer. Br J Surg 2013; 100(1):55-65.
Competing interests: No competing interests