Healthcare professionals involved in direct patient care, such as nurses, pharmacists, advanced practice providers, and physicians, learn methods of symptom assessment during education and training, but each profession uses a slightly different lens. The ability to consider polypharmacy and drug-drug interactions in patient assessment is one of the most important skills a clinical pharmacist uses in daily practice. Clinical pharmacists caring for patients with cancer must identify drug-related side effects, monitor and manage patients during chronic drug therapy, and educate patients and members of the interprofessional team, all in the context of the intricacies of antineoplastic therapy and adherence assessment.
A clinical oncology pharmacist’s assessment inquires about the onset, quality, severity, duration, timing, aggravating and remitting factors, and location of a patient’s symptoms and adverse events. In my role as a clinical oncology pharmacist at Fred Hutchinson Cancer Center, I conduct routine evaluations and assessments for patients experiencing symptoms and adverse events from oral antineoplastics.
Typically, a patient who is prescribed a new oral cancer treatment at our institution will receive education and assessments for symptom and medication adherence from a clinical pharmacist. This includes discussions on symptom management and prevention strategies tailored to the patient and their chosen treatment.
When I educate my patients about self-management and self-monitoring of symptoms, I address:
- What are we doing as the patient’s care team to monitor symptoms and support them?
- What can the patient do to monitor, prevent, and manage symptoms at home?
- When and who should the patient call to report a new or worsening symptom?
- What should the patient do if their symptom severity affects their ability to adhere to the treatment schedule?
During a follow-up visit, I begin with open-ended symptom assessment questions such as, “How has your treatment been going?” or “What symptoms have you experienced?” Then I discuss my evaluation and recommendations with the patient and document and share them with the interprofessional team. When I conduct a follow-up visit, I often have an idea of certain adverse events that I want to highlight, either because of a likelihood of onset at a point in a patient’s treatment or because of a potential for harm.
Close contact with my nurse colleagues while I conduct symptom assessments is critical because patients most often report symptoms to their nurses first. Depending on the scenario, as well as the extent and etiology of a patient’s symptom distress, nurses and I plan for who would best address the management plan with the patient.
A common question is, “Could the treatment be causing this symptom, or is it something else?” As a clinical pharmacist, I collaborate with patients and colleagues to help distinguish between medication- and disease-related symptoms and plan specific interventions for their management. Resources and consensus guidelines, like those published by ONS, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network, can aid in the evaluation and management of many symptoms, and specific interventions for treatment-related symptoms can often be found in the agent’s full prescribing information.
Specific and thorough communication is key to symptom assessments. Ask clarifying questions and be ready to offer more than one suggested management strategy. In my professional practice, I believe the best patient care and outcomes result from collaboration with my interprofessional colleagues who each bring a different perspective. I know my practice is bettered by clinical nurses, and I hope to be able to positively influence theirs as well.