[The pharmaceutical care and pain caused by cancer]

Pharmaceutical care is the philosophy of practice of the University of Puerto Rico, School of Pharmacy. Pharmacy students enrolled in the Oncology Clerkship providedpharmaceuticalcare to 35 patients with advanced cancer. The objectives were to provide pharmacy students the opportunity to practice pharmaceutical care and to implement published guidelines for the management of cancer pain. Activities included the assessment of pain intensity and of patients' educational needs, identification of drug related problems, intervention with patients and physicians to solve problems, and documentation of processes and outcomes measures. Thirty three patients had pain due to their disease with an average "worst pain" intensity of 5.5 on a 0-10 scale. Drug related problems were: subtherapeutic dosage, 24.2%; lack of treatment, 18.2%; adverse drug reactions, 12%; improper drug selection, 9.1%; and not taking the prescribed drug, 3%. Outcomes of pharmaceutical services were: reduction of pain, increased knowledge about therapy, improved compliance, improved physician prescribing, and change in cost of medication. Students evaluated the clerkship favorably. The study provides data that supports a randomized trial to further study the impact of pharmaceutical care on the management of cancer pain. Outcomes evaluation should include clinical, humanistic and economic measures.