title: Optimizing pain relief in a specialized outpatient palliative radiotherapy clinic: contributions of a clinical pharmacist.
abstract: OBJECTIVE
  Bone metastases are the most common cause of cancer pain, with palliative radiotherapy (RT) the mainstay of treatment. However, relief from RT may be delayed, incomplete, or short-lived and therefore optimized pharmacologic therapy is essential. Our objective was to describe the contribution of the clinical pharmacist (CP) to an outpatient palliative RT clinic.
  
  
  METHODS
  The Edmonton Symptom Assessment System, an 11-point scale for measuring nine symptoms, and other validated screening tools were administered, and a medication history performed by the CP. Baseline CP assessment also included opioid toxicity, need for supportive medications, and drug interactions. Anonymized clinical information was collected prospectively and descriptive statistics were compiled including themes of counselling performed by the CP.
  
  
  RESULTS
  The CP reviewed 114 patients over 140 clinic visits (01/2007-12/2008). Median age was 68.3 years, 68.4% were male and 36.8% had prostate cancer. All symptoms improved or stabilized in ≥ 80% by 4 weeks. Median pain score was 6/10 (SD 2.6) at baseline, and 2.1/10 (SD 2.4) by week 4. Average morphine equivalent daily dose was 76.8 mg at baseline and 44.5 mg at week 4. CP assessment included screening for opioid toxicity (87.9%), recommending a change in analgesic (28.9%), and liaison with the community pharmacy (17.1%). Medication counselling took place in 84.3% of visits, on bowel routine (85.6% of the time), opioids (82.2%), and hydration (40.7%).
  
  
  CONCLUSIONS
  The CP plays a key role in holistic patient assessment and optimization of pharmacologic therapy, contributing to improved symptom control of patients receiving palliative RT.
authors.affiliation: Rapid Access Palliative Radiotherapy Program, Cross Cancer Institute, Alberta Health Services - Cancer Care, Edmonton, Alberta, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Gagnon
authors.forename: A
authors.initials: A
authors.lastname: Fairchild
authors.forename: E
authors.initials: E
authors.lastname: Pituskin
authors.forename: J
authors.initials: J
authors.lastname: Dutka
authors.forename: C
authors.initials: C
authors.lastname: Chambers
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000458:organization & administration; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006694:Holistic Health; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000473:pathology; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy*; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods*; D010353:Patient Education as Topic; D010595:Pharmacists / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D024382:Professional Role; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid