The drugs are expensive and come with unusual side effects. Add to that the possibility of drug interactions and often complicated rules of insurance companies, and it’s easy to understand why starting chemotherapy can sometimes confuse and overwhelm cancer patients and their families.
But pharmacists like City of Hope’s Cecilia Lau, R.Ph., B.C.O.P., act as partners with physicians to clear away that confusion — so patients can focus on fighting their disease.
Lau spends every day working one-on-one in the clinic as a partner with physicians, nurses and nurse practitioners and the outpatients they serve.
|Cecilia Lau, right, accompanies medical oncologist Dean Lim during his gastrointestinal cancer clinic. (Photo by Darrin S. Joy)|
It’s called clinical pharmacy, and the model aims to involve pharmacists in the care of patients from its very beginning. “There’s so much that we can offer as pharmacists,” Lau said. “We’re drug information specialists.”
City of Hope began its clinical pharmacy model more than two years ago. Lau works specifically with Gastrointestinal Cancer Program medical oncologists Vincent Chung, M.D., Dean Lim, M.D., and Stephen Shibata, M.D., though she also helps other physicians if they need it. On any given day, she follows one of the three oncologists throughout his clinic appointments.
“It’s really a team,” Lau said. “I talk with the doctor and nurse practitioner, and we discuss the treatment plans and the therapy options.”
Lau prepares chemotherapy orders, gets them signed and works with infusion nurses and other pharmacists so patients can start their treatment. She eases patients’ initial worries about chemotherapy, tells them how medications work and what side effects to expect, and tries to head off paperwork snafus.
“In one day, I’ll get stopped by six or seven patients who have questions,” she said. “It makes it easier on them to know that I’m a resource.”
Sometimes she helps patients maneuver their insurance companies’ lists of covered drugs; at other times, she has to make sure that all medications, such as anti-nausea drugs, are ready for patients when they start chemotherapy.
Patients appreciate it. For example, a patient and her family recently successfully battled nasopharyngeal carcinoma — and the tangle of challenges the disease brings — with Lau’s help.
“We were amateurs dealing with thousands of new medical terms, treatments and routines,” the family wrote in a letter to Sally Htoy, Pharm.D., clinical pharmacy manager. “Cecilia helped us progress from mere beginners to advanced students ... she walked us through several treatments from setting up TPN [intravenous nutrition] nightly to getting us free medicine samples when the insurance would not cover [it.]”
City of Hope pharmacy administrators hope to dedicate another pharmacist to work with breast cancer outpatients if the clinical pharmacy program can expand.