Investigating the preliminary actions of lung and colorectal cancer patients to manage symptoms
Frances Notman, University of Aberdeen
Research into the potential for community pharmacists to promote earlier detection of cancer is lacking. Audits conducted by the Royal Pharmaceutical Society demonstrate that some people with symptoms suggestive of lung or colorectal cancer present to community pharmacies, and are subsequently referred to a GP. However, this research did not follow-up on subsequent GP consultations, nor explore whether these referrals resulted in a cancer diagnosis. The proportion of cancer patients attending a pharmacy during the pre-diagnosis period is not known. This limits our understanding of the potential of community pharmacy to support earlier cancer diagnosis.
This study aimed to investigate what action patients with lung or colorectal cancer took to manage their early cancer symptoms and to inform a potential role for community pharmacists in promoting earlier diagnosis.
Research Design and Methodology
A self-completed, postal questionnaire, using both structured and open questions was developed, based on the existing literature. Questionnaires were mailed to eligible patients, identified by clinical colleagues from relevant oncology clinics, in three health board areas: Grampian, Tayside and Greater Glasgow and Clyde, between November 2013 and February 2014. Inclusion criteria included: aged ≥18 years; confirmed diagnosis of lung or colorectal cancer within the previous year, and well enough to participate as assessed by the attending oncology consultant. One reminder was sent after 1 month.
Two hundred and twenty questionnaires were returned completed (38% response rate): 145 colorectal cancer/ 75 lung cancer participants: 53% respondents were male, more males had colorectal cancer (59%), and more females lung cancer (57%). The majority of respondents were between 50 -79 years (88%), with the highest frequency for each cancer in the 70-79 age group. The main findings were: self-treating with medicines was the most popular action taken by both cancer groups to manage their symptoms (n=61/96, 63.5%); a small minority bought the medicine in a pharmacy (n=12/96, 12.5%,); only 4 of these received symptom-management advice from the pharmacist or their staff before the purchase, (3 of whom were referred to their GP) and 6 were counselled regarding action to take if their symptoms persisted. did not always seek.
The proportion of cancer patients who, pre-diagnosis, bought a medicine from or consulted in a pharmacy, was low. Given this rare engagement with pharmacy staff, more thought is required to elucidate the best role for community pharmacy in early cancer diagnosis.
Pharmacists and their staff could adopt a more pro-active approach when discussing patients’ symptoms with them, particularly when patients present with potential cancer warning symptoms. This could facilitate earlier appropriate referral and earlier detection rather than delaying the diagnosis by selling medicines, which may mask their symptoms.