title: Impact of a clinical pharmacist-led guidance team on cancer pain therapy in China: a prospective multicenter cohort study.
abstract: BACKGROUND
  Cancer treatment capacity in China is severely limited relative to the enormous size of the population; and many aspects of treatment, such as opioid protocols for pain control, are not standardized. To improve the quality of drug treatment, clinical pharmacists are taking a more active role in patient care.
  
  
  OBJECTIVE
  This study compared the effectiveness of opioid treatment between cancer patients receiving interventions from Clinical Pharmacist-Led Guidance Teams (CPGTs) and a comparable control group.
  
  
  METHODS
  This was a prospective, multicenter, double-arm, controlled study conducted in China. Multidisciplinary guidance teams were established and led by clinical pharmacists with expertise in cancer pain therapy. The CPGTs provided pre-therapy consultation and drug education to physicians, monitored prescriptions during treatment, and conducted patient follow-up. The process and outcome parameters of therapy were collected and analyzed with overall statistics and logistic regression.
  
  
  RESULTS
  A total of 542 patients were enrolled, 269 in the CPGT intervention group (CPGT group) and 273 controls. Standardization of opioid administration was improved significantly in the CPGT group, including more frequent pain evaluation (P<0.001), more standardized dosing titration (P<0.001), and less frequent meperidine prescriptions (P<0.001). The pain scores in the CPGT group were significantly improved compared with the control group (P<0.05). The incidences of gastrointestinal adverse events were significantly lower in the CPGT group (constipation: P=0.041; nausea: P=0.028; vomiting: P=0.035), and overall quality of life was improved (P=0.032). No opioid addiction was encountered in the CPGT group. Risk analysis revealed that patient follow-up by pharmacists and the controlled dosing of opioids were the major factors in improving treatment efficacy.
  
  
  CONCLUSIONS
  The CPGTs significantly improved standardization, efficiency, and efficacy of cancer pain therapy in China. In a country where clinical pharmacy is still developing, this is a valuable service model that may enhance cancer treatment capacity and efficacy while promoting recognition of the clinical pharmacy profession.
authors.affiliation: Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, People's Republic of China. Electronic address: luxiaoyangzju@126.com.
authors.forename: Xiao-yang
authors.initials: XY
authors.lastname: Lu
authors.affiliation: Department of Pharmacy, Hangzhou Cancer Hospital, Hangzhou, People's Republic of China.
authors.forename: Wei-jia
authors.initials: WJ
authors.lastname: Wang
authors.affiliation: Department of Pharmacy, The First Hospital of Jiaxing, Jiaxing, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Shen
authors.affiliation: Department of Pharmacy, Beilun People's Hospital, Ningbo, People's Republic of China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Ye
authors.affiliation: Department of Pharmacy, Shangyu People's Hospital, People's Republic of China.
authors.forename: Hong
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Pharmacy, People's Hospital of Xinchang County, Shaoxing, People's Republic of China.
authors.forename: Qi-sheng
authors.initials: QS
authors.lastname: Wang
authors.affiliation: Department of Pharmacy, Zhengjiang Cancer Hospital, Hangzhou, Zhejiang, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Cheng
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015984:Causality; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000451:nursing; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D010147:Pain Measurement / Q000706:statistics & numerical data; D010166:Palliative Care / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration / Q000706:statistics & numerical data*; D010595:Pharmacists / Q000458:organization & administration / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid
keywords: Cancer pain; China; clinical pharmacist; intervention