The fourth issue of Conquering the Cancer Care Continuum series addresses Treatment Planning Through the Cancer Care Continuum. Following are 2 key articles to provide insight into the role of the clinical pharmacologist as a member of the multidisciplinary team working collaboratively to render recommendations about treatment planning options. Gone are the days, or they should be, when oncology specialists merely passed on – either on paper or electronically – prescription instructions to be filled by the pharmacologist or pharmacist. These individuals, experts in drug management, interaction, and optimization, are integral to the oncology care team. You will soon read and learn why.
And speaking of the team, it is critically important that the patient, and certain family members in some cases, be considered members of the treatment planning team. We should not be doing things to a patient; we must be doing things with a patient. Though the patients, of course, are not experts on oncology care, many have desperately tried to become experts of a sort by turning to the Internet and trying to determine for themselves what treatment would be best for their situation. The goal of the team is optimal medical therapy outcomes.
There are some considerations that have historically been absent but can no longer remain so. Patients want to know about the pros and cons of treatment, risks and benefits, what their quality of life will be while on treatment as well as after treatment is completed. And there is a new wrinkle in the treatment planning process – what will this treatment cost? Will patients have to pay out of pocket for their treatment? Is the cost of treatment worth the clinical outcomes to be achieved? No patients want to leave their family in deep debt, and although we have entered an exciting era of personalized medicine, the cost of these new drugs is incredibly high compared with treatments we have been accustomed to in the past. Even prior treatment regimens have been daunting from a cost perspective.
Everyone wants to make sure that the patient gets the right treatment at the right time and in the right way. Now clinicians must realize that treatment for treatment’s sake is never wise and not the mission. Thoughtful decisions about treatment are a must, and patients, oncologists, pharmacologists, palliative care providers, everyone, must come together for the common good of what will now be, going forward, the right treatment. More is not necessarily better. A primary challenge too will be family members who out of desire to have their loved one alive will state they want “everything humanly possible to be done.” We must respect the treatment goals and hopes of the patient, however, and steer the family members to do the same.
So when you think about it, we are looking at treatment from the perspective of its “value.” Yes, a new era. Perhaps even overdue…
