Perspectives on Oncology Pharmacy in Developing Countries

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Perspectives on Oncology Pharmacy in Developing
Countries

• John T. Wiernikowski, PharmD
• 1st Conference of the Brazilian Society of
  Oncology Pharmacists
• Rio De Janeiro

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Outline

• History
• Models for care delivery
• Training Programs
• Opportunities for your Society
• Internal
• Guidelines, Standards of Practice
• External
• Chapter Status in ISOPP, FIP

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History

• 1995 UICC sponsors first traveling health care
  team, to examine health care models and service
  needs for children with cancer.
• Team composed of Medical and Radiation
  Oncologist, Nurse, Pharmacist, Pathologist.
• Visited centers in Brazil, Chile, Argentina, and
  Uruguay.

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Health Care Team Models
Patient and Family
Medical Oncologist
Surgeon
Radiation Oncologist
Pathologist
Nurses
Pharmacists
Physiotherapists
Social Worker
Patient and Family
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Health Care Team Models
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Training in Pediatric Oncology Clinical Pharmacy

• A proposal for South America

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Background

• Recommendation of the first UICC (endorsed)
  sponsored traveling team 1995.
• Other related endeavors
• MD training programs established (twinning with
  MISPHO).
• Oncology nursing program developed (UCSF/St.
  Jude).
• Establishment of a tumour bank, and board of
  reference pathologists.

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Needs Justification

• Spectrum of childhood disease changing in
  developing countries, as infectious diseases are
  conquered (cancer assumes increasing importance).
• Care of oncology patients increasing in
  complexity.
• Recognized need for multi-disciplinary input.
• Human resources likely to have greater impact on
  outcome than Technology

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Needs and Justification

• Within adult medicine rates of cancer are
  increasing (even when standardized for age).
• Cancer is likely to overtake heart disease as the
  1 cause of death in adults, sometime this
  decade.

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Access to Drugs

• Major issue in the developing world.
• Only 20 of the worlds drugs consumed in the
  developing world. (WHO, World Bank, UNESCO)
• Most drugs are imported (10-20x local cost)
• Quality of local products sometimes suspect.
• Rationing of drugs sometimes necessary.

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Clinical Pharmacy The Garrahan Experience

• Need for pharmacist participation in patient care
  recognized by pediatric oncologists.
• Training program established to prepare
  chemotherapy, unit dose antibiotics. Savings on
  drug expenditures considerable, re-invested in
  further pharmacy initiatives.
• Anti-emetic protocols.
• Febrile neutropenia protocol.
• Clinical pharmacokinetics research.

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Proposed Clinical Pharmacy Program

• 1 year program based at Juan P Garrahan
  Childrens Hospital, Buenos Aires (Spanish) and
  Centro Infantil de Investigacoes Hematologicas
  Dr. Domingo A Boldrine (Portuguese).
• Core Didactic Components
• Drug Literature Evaluation
• Pathophysiology of Pediatric Malignant Disease
• Applied Pharmacotherapy
• Hands on Patient Care.

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Proposed Clinical Pharmacy Program (2)

• Intake of 3-5 trainees annually for 2 years.
• Trainees buddied with junior physician trainee
  in Pediatric Hematology/Oncology.
• Evaluation/External Review at end of 1st year.
• Trainees returning to home countries, serve as
  mentors/resource for further trainees.
• Alternatives (correspondence, Internet) to
  resident training will be explored for
  subsequent years.

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Is it worth it?

• No data from developing countries.
• Data on pharmacist impact in 1st world countries
• Shorter hospital stay.
• Fewer adverse drug reactions.
• Fewer blood tests ordered to monitor
  pharmacotherapy.
• Positive impact on physician prescribing.
• Lower drug costs.

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Opportunities for SOBRAFO

• Standards of Practice
• Minimum standards (Safe Handling, Labeling, Dose
  Check/adjustment, Documentation)
• Realistic goals for the future with realistic
  timelines
• Formulary Development
• Drugs which every patient with cancer should have
  access to. (Cytotoxics, Antibiotics, Analgesics
  etc.)
• Guidelines
• Antibiotics, Antiemetics, Nutrition Support

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Opportunities for SOBRAFO

• ISOPP
• Training programs for pharmacists in developing
  countries a major goal for ISOPP
• Chapter Status
• International Pharmacy Federation

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