From prevention and early detection through to support for survivors and end-of-life care, there’s plenty community pharmacists can be doing in the fight against cancer.

This month, the World Health Organization (WHO) warned that the world was facing a “cancer tidal wave” with the number of annual cancer cases worldwide expected to rise from 14m to 24m by 2035.

In the UK, 330,000 people are diagnosed with cancer every year. However, due to advancements in treatment and care, survival rates have doubled in the past 40 years. There are currently 1.8m cancer survivors in the UK and the number is set to double in the next 17 years.

Community pharmacists have many roles as part of the wider healthcare team in preventing and detecting cancer, as well as supporting patients through their cancer journey.

Prevention

It is a common misconception that it is impossible to reduce an individual’s risk of cancer when, in fact, a third of cancers are preventable through healthy lifestyle choices.

A YouGov poll commissioned by the World Cancer Research Fund (WCRF) to mark World Cancer Day (February 4) revealed that around half of Britons are unaware of the link between cancer and diet and over half do not know that they can reduce their risk by maintaining a healthy weight (59 per cent), eating less processed meat (62 per cent) or being physically active (66 per cent).

By contrast, a third incorrectly stated that family history is the biggest risk factor for cancer, even though only 5 to 10 per cent of cancers have a genetic basis. “These results show that many people still seem to mistakenly accept their chances of getting cancer as a throw of the dice. But by making lifestyle changes today, we can help prevent cancer tomorrow,” says Amanda McLean, WCRF general manager.

She called for all sectors of society, including Government, healthcare professionals, retailers and charities, to work together to raise cancer prevention awareness.

Community pharmacy has shown that it is well placed to promote lifestyle changes that could prevent cancer. For example, alcohol ‘scratch cards’ available in healthy living pharmacies have shown positive results in campaigns led by Pharmacy London and Devon LPC. To build on this success, the NPA has recently launched a suite of health improvement scratch cards to help pharmacy teams engage with customers about public health issues, many of which can affect cancer risk, including alcohol, smoking and physical activity.

Early detection 

In recent years, pharmacy has demonstrated its role in increasing early detection of cancer through raising awareness of the symptoms.

Results from a RPS audit carried out during last year’s ‘Be Clear on Cancer’ campaign, which focused on bowel cancer, revealed that pharmacists were able to identify patients who were suitable for referral.

These results join evidence from a clinical audit in 2010, which showed that pharmacists could accurately distinguish between individuals with possible lung cancer symptoms and those whose symptoms could be self-managed.

Community pharmacy can also increase early detection rates by encouraging uptake of screening. For example, only just over half of the 21 million testing kits sent out through the NHS Bowel Cancer Screening Programme had been returned by November 2013, suggesting a need for greater education about the importance of screening.

Living with and beyond cancer

Pharmacists have always been an integral part of the cancer care team and have a vital role in ensuring that patients understand what to expect from treatment. A few innovative pharmacy initiatives are expanding this role, by increasing the amount of support that pharmacists can provide to people living with and beyond cancer.

As part of the Boots-Macmillan Cancer Support partnership, specially trained Boots Macmillan information pharmacists have been introduced in several of its pharmacies.

“The role aims to help the millions of people affected by cancer access the information and support they need, signpost and connect them to services in their local area and offer support in an accessible, trusted, familiar and informal environment, at a time when they need it most,” explains Boots Macmillan information pharmacist, Angela Chalmers.

Support following treatment

In a recent survey from Bupa, two-fifths of cancer patients said that they would have benefited from more information about what to expect after treatment.

“We are so focused on treating cancer that all the support is geared up for that time, so once treatment is finished many patients can be left feeling destabilised and confused about what happens next,” says Dr Justin Stebbings, professor of cancer medicine at Imperial College London.

According to Stebbings, many people experience a range of physical and psychological symptoms after cancer treatment, including neuropathy, depression, anxiety and cancer-related fatigue.

Half of the cancer patients surveyed feared that the cancer would return, while over a quarter felt emotionally drained and one in three felt under pressure to ‘bounce back to normal’ quickly.

“People are so desperate to put it behind them that they often have unrealistic expectations to get back to their normal lives,” says Stebbings. “It’s important to tell them that it’s okay not to feel normal straight away, that the end of treatment is not the end of the journey.”

‘Living with and beyond cancer’, a free e-book published by Bupa, is available to download here.

Palliative care

As well as supporting patients who have survived cancer, pharmacists are also getting involved in pharmaceutical palliative and end-of-life care.

Following a successful pilot scheme, pharmacists are working to improve palliative care services for patients with cancer and other long-term conditions across NHS Greater Glasgow and Clyde.

Jointly funded by the NHS board and Macmillan, the service involves 10 Macmillan pharmacy facilitators (pharmacists and technicians) who deliver palliative care training to pharmacy teams in the area, increase awareness of the community pharmacy palliative care network – a group of 70 local pharmacies that stock an agreed list of specialist palliative care medicines and provide out-of-hours access – and promote appropriate prescribing and dispensing of palliative care medicines.

“The service ensures that care is joined up and is aligned with the Scottish Government’s ‘Living and Dying Well’ action plan, which aims to provide high quality care based on patient needs, not diagnosis,” says Kate McCusker, lead pharmacist for the Macmillan Pharmacy Service, NHS GG&C.

“It empowers patients, helps them through their journey in a community setting and allows them to die at home.”