Do pharmacists contribute to patients’ management of symptoms suggestive of cancer: a qualitative study

Abstract

Objectives Limited awareness of cancer symptoms results in patient delay in seeking help and contributes to delay in diagnosis. Few UK studies have investigated the potential for community pharmacists to facilitate earlier detection of cancer. This study aimed to investigate what actions patients take to manage their early cancer symptoms, to identify the extent of current community pharmacy involvement and to consider the potential role for community pharmacists to facilitate appropriate management and appraisal of potential early cancer symptoms. Methods Patients diagnosed with lung, colorectal or gastro‐oesophageal cancer in the preceding 12 months were identified during clinic visits by consultants. Semi‐structured interviews were conducted, audio‐recorded, transcribed and thematically analysed, using the Framework Approach. Key findings Twenty‐five consenting patients were interviewed: two‐thirds were male and more than half had lung cancer. Although all had experienced potential cancer symptoms prior to diagnosis, most underestimated seriousness and misattributed causation. Symptoms were managed by lifestyle changes and self‐selecting medicines from local shops, supermarkets and pharmacies but without engaging with the pharmacist. Conclusions For symptom management, participants self‐selected medicines from community pharmacies, but pharmacy staff were rarely involved. Involving community pharmacists or their staff at the point of sale of these medicines might have facilitated earlier cancer diagnosis. Further research is needed to quantify how many patients with symptoms suggestive of cancer present in community pharmacies to understand if a pharmacist's role in facilitating symptom management and appraisal of potential cancer symptoms would be acceptable and effective, before developing any interventions.

Qualitative interview study exploring the early identification and referral of patients with suspected head and neck cancer by community pharmacists in England

“…A previous qualitative study with patients diagnosed with lung, colorectal or gastro-oesophageal cancer found that half of the patients had initially tried to manage red flag symptoms by purchasing OTC medication prior to diagnosis. 18 This work supports the findings of our study, highlighting potential opportunities to use community pharmacies in earlier identification of suspicious symptoms. This study, however, found that frequent purchases of the same medication were not explored fully, highlighting the potential for patients with ongoing symptoms to be missed.…”

“…This work supports the findings of our study, highlighting potential opportunities to use community pharmacies in earlier identification of suspicious symptoms. This study, however, found that frequent purchases of the same medication were not explored fully, highlighting the potential for patients with ongoing symptoms to be missed 18. Several small-scale pilots have also found that pharmacist integration into lung cancer referral pathways is both feasible and acceptable, resulting in high-quality referrals 19 20.…”

“…This study, however, found that frequent purchases of the same medication were not explored fully, highlighting the potential for patients with ongoing symptoms to be missed. 18 Several small-scale pilots have also found that pharmacist integration into lung cancer referral pathways is both feasible and acceptable, resulting in highquality referrals. 19 20 However, outcome data are currently very limited and barriers to successful implementation were identified to include a lack of patient awareness of such services and pharmacists' roles, and concerns about perceived impacts on workloads.…”

Diagnosing cancer in English community pharmacies

“…A 2015 systematic review examining factors influencing timeliness of help seeking for possible cancer symptoms, found that awareness of possible cancer symptoms is lower among more deprived populations, who also take longer to present to medical services when they have symptoms 12. Such people may instead seek advice or over-the-counter treatments for problems like cough or indigestion,1314 leading policy makers to believe that “pharmacies are well placed to spot people presenting with ‘red flag’ potential cancer symptoms.”15…”

Can early cancer detection be improved in deprived areas by involving community pharmacists?

“…One small qualitative study found that more than half of 25 patients diagnosed with lung, colorectal, or gastro-oesophageal cancer had initially tried to manage their red flag symptoms by purchasing over-the-counter (OTC) medication prior to diagnosis; only three participants sought help from pharmacy staff, from whom they received appropriate advice. 12 The study identified that frequent purchases of the same medication were not explored further by staff in the community pharmacy, and participants had low awareness of the pharmacists’ healthcare advisory role. One other study focused on patients seeking advice or OTC medication for red flag symptoms.…”