Download Community Oncology Rotation

Community Oncology Rotation
Primary Preceptor Contact Info:
Preceptor(s):
Rob Watt
(250) 565-2425
[email protected]
Pager: (250) 561-6470
Rob Watt, BScPharm
Tammy Bluemink, BScPharm
Rotation:
Community Oncology – 4 weeks
Dates of Rotation:
The Regional Cancer Care Unit (RCCU) provides care to ambulatory cancer patients in the NHA. The RCCU assesses patients for
diagnosis of cancer and provides chemotherapy treatments for many malignancies. Drug therapy plays an important role in inducing
and maintaining remissions, as well as in symptom control and palliation for patients with metastatic disease. This unit is staffed by
an Oncologist, general practice oncologists, registered nurses as well as involvement from social workers, dietitians, pharmacists
and clinical technicians. There are potential opportunities to liase with the Palliative Care team and Hospice House as appropriate.
Goal:
The resident shall develop the skills, knowledge and values necessary to provide pharmaceutical care to patients living with cancer.
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Objectives Summary
Provide evidence-based direct patient care as a member of an interprofessional team
Demonstrate a working knowledge of medication use system(s), as well as pharmacy and other care
provider roles within the system, in order to manage and improve medication use for individual
patients and groups of patients
Apply leadership skills
Apply skill in the management of his/her own practice of pharmacy, to advance his/her own learning,
to advance patient care, and to contribute to the goals of the program, department, organization and
profession
Effectively respond to medication and practice-related questions, and educate others
Apply therapeutic and pharmacotherapeutic knowledge to the management of common disease
states and complications in the oncology patient population
Objectives:
1. The objectives and activities for direct patient care rotations must be met.
2. The resident will demonstrate knowledge of the common disease states seen in this patient population.
Expected Outcome:
The resident will be able to:
 Describe the pathophysiology and general management of the following diseases, and apply this knowledge to the
pharmaceutical care of your patients:
 Lung cancer
 Breast cancer
 Hodgkin’s and non-Hodgkin’s lymphoma
 Multiple myeloma
 GI cancer
 Prostate cancer
3. The resident will demonstrate knowledge of the treatment protocols used in this patient population.
Expected Outcome:
The resident will be able to:
 For each of the cancers encountered on rotation, describe and compare traditional and emerging treatment protocols,
including the role of surgery, radiotherapy, immunotherapy, and/or chemotherapy, and apply this knowledge to the
pharmaceutical care of the patients encountered.
4.
The resident will demonstrate knowledge of the chemotherapy used in this patient population.
Expected Outcome:
The resident will be able to:
 For each of the chemotherapy agents encountered during this rotation, discuss the pharmacology, dose, schedule,
administration, side effects and their management, drug interactions, monitoring for efficacy and toxicity and economic
considerations and apply this knowledge to the pharmaceutical care of your patients. Some of the medications you may
encounter include:
 Anthracyclines (doxorubicin, epirubicin)
 Cyclophosphamide
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Vinca alkaloids (vincristine, vinorelbine)
Taxanes (docetaxel, paclitaxel)
Methotrexate
Fluorouracil
Capecitabine
Platinums (cisplatin, carboplatin, oxaliplatin)
Fludarabine
Gemcitabine
Irinotecan
Rituximab
Trastuzumab
Bevacizumab
Bisphosphonates
Tamoxifen
Aromatase inhibitors
Erlotinib
Sunitinib
6. The resident will demonstrate a knowledge of the complications seen in this patient population.
Expected Outcome:
The resident will be able to:
 Discuss the pathophysiology, prevention, management and monitoring of the following complications of cancer and/or its
therapy, and apply this knowledge to the pharmaceutical care of your patients:
 Nausea and vomiting
 Mucositis
 Neutropenia and Febrile Neutropenia
 Anemia
 DVT
 Hypercalcemia
 Thrombocytopenia
 Pain
 Extravasation
 Diarrhea
 Bone metastases
Additional Activities:
Activities
Observe and discuss with nursing staff the administration of various types of
chemotherapy, and personal protection requirements.
Provide an Inservice to Nurses (optional)
Attend oncology conference/seminars/CE events
Personal learning objectives
CPR Re-Certification
Shadow GPO’s, nurses, dietician
Breast cancer clinic Tuesday mornings
Group teaching Tuesday afternoons (5th floor)
PSAP Oncology every 2nd Friday afternoon
Attend a palliative care round on a Tuesday
Completed
Expectations:
1. The resident is expected to work ~8 am – 4 pm Monday – Friday. There is no on-call component to this rotation.
2. The resident will dress professionally when in the clinic. Lab coat is optional if clothing is professional. (No bare midriffs, no
open toed shoes.)
3. Patients will be assigned to the resident on a daily or weekly basis based on the experience of the resident and progress
through the rotation. Residents are expected to look after 2-4 new patients daily, depending on the stage of the rotation in the
year, experience of the resident and complexity of the patients. It is important for the resident to advise the preceptor of
workload issues (if they are feeling overwhelmed or underutilized). In general, this rotation involves quite a bit of
independence. It is important that the resident advise the preceptor if they feel they are being asked questions beyond their
skill level.
4. The resident will meet with the preceptor daily to review patients and discuss topics as agreed upon in advance with the
preceptor. The resident should prepare for topic discussions using readings supplied by the preceptor and by researching the
topic on their own. The resident should be prepared to discuss what they know about the topic, rather than receive a lecture
from the preceptor.
5. The resident will not provide any recommendation to patients, nurses or physicians without first discussing that
recommendation with the preceptor first, until directed otherwise by the preceptor.
6. All encounters with patients will be documented in the progress notes of the patient’s chart following a SOAP note format.
Initially, all notes must be reviewed with the preceptor prior to being written in the chart. After the preceptor is satisfied with
the quality of the notes, residents may write notes without first reviewing them with the preceptor but must alert the preceptor
to the patient’s chart note so that it may be reviewed.
7. The resident will attend weekly patient care rounds on Thursdays at 8 am.
Readings:
Refer to preceptor or S:drive for most update readings. There is a regional oncology i-portal link with many resources as well as the BCCA
website.
Mandatory:
1. Interprofessional Core Curriculum Pilot project information from CCNS. Author: Dana Cole. (This document is not in final form and refers
to some policies that are specific to Nova Scotia, however it provides a good basic level of information on a variety of chemo related
symptoms.)
2. Rizzo JD, Lichtin AE, Woolf SH, et al. Use of epoetin in patients with cancer: evidence-based clinical practice guidelines of the American
society of clinical oncology and the American society of hematology. J Clin Oncol 2002;20:4083-107.
3. Smith TJ, et al. 2006 update of recommendations for the use of white blood cell growth factors: an evidence-based, clinical practice
guideline. J Clin Oncol 2006;19:1-18.
4. Kris MG, et al. American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol 2006; 24:2932-47.
5. The Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer (MASCC). Prevention of chemotherapy- and
radiotherapy-induced emesis: results of the 2004 Perugia International Antiemetic Consensus Conference. Ann Oncol 2006;17:20-28.
6. Sonis ST, et al. Perspectives on cancer therapy-induced musosal injury. Cancer 2004;100:1995-2025.
7. Rubenstein EB, et al. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal
mucositis. Cancer 2004;100:2026-46.
8. Summary of Evidence-based clinical practice guidelines for Cancer Patients with Oral and Gastrointestinal Mucositis (2005 Update).
9. Kyle RA, et al. American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple
myeloma. J Clin Oncol 2007;25:1-9.
10. Lesperance ML, Olivotto IA, Forde N, et al. Mega-dose vitamins and minerals in the treatment of non-metastatic breast cancer: an
historical cohort study. Br Cancer Res Treat 2002;76:137-43.
11. Hughes WT, Armstrong D, Bodey GP, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin
Infect Dis 2002;34:730-51.
12. Natural Health Products and Breast Cancer. BCCA 2002.
13. Cox LS, et al. Tobacco use outcomes among patients with lung cancer treated for nicotine dependence. J Clin Oncol 2002;20:3461-9.
14. Garces YI, Hays JT. Tobacco dependence: why should an oncologist care? J Clin Oncol 2003;21:1884-6.
Suggested:
15. Balmer CM, Valley AW. Cancer Treatment and Chemotherapy. Chapter 124 in Dipiro.
16. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the national surgical adjuvant breast
and bowel project p-1 study. J Natl Cancer Inst 1998;90:1371-88.
17. Winer EP, et al. American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for
postmenopausal women with hormone receptor-positive breast cancer: status report 2004.
18. Loblaw DA, et al. Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2006 update
of an American Society of Clinical Oncology Practice Guidelines. J Clin Oncol 2007;25:1-10.
Optional:
19. Viscoli C, Castagnola E. Treatment of febrile neutropenia: what is new? Curr Opin Infect Dis 2002;15:377-82.
20. Garcia-Carbonera R, Paz-Ares L. Antibiotics and growth factors in the management of fever and neutropenia in cancer patients. Curr
Opin Hematol 2002;9:215-21.