Caring for the treatment-experienced breast cancer patient: the pharmacist's role

The number of options for the management of metastatic breast cancer has expanded considerably during the past few years and are discussed here.

New treatments have helped to palliate cancer symptoms and improve quality of life for many patients, but they also are associated with several clinically significant adverse events, including myelosuppression, nausea and vomiting, and neuropathy. Neutropenia often develops within a few days of the onset of chemotherapy and is associated with an increased risk of serious infection, hospitalization, treatment delays, and increased treatment costs. Anemia affects many patients with metastatic breast cancer and may result in significantly diminished quality of life. Chemotherapy-induced nausea and vomiting (CINV) is consistently rated by patients as among the most distressing symptoms associated with cancer treatment. The risk of nausea and vomiting varies considerably among different chemotherapy regimens, and guidelines for the prevention of CINV emphasize the importance of developing an antiemesis regimen that is based on the emetogenic potential of the chemotherapy regimen. Peripheral neuropathy is often the dose-limiting adverse event with many cancer therapies. Neuropathy may affect the sensory or motor nerves and produces a broad range of symptoms. Due to the increase in the number of oral medications used in cancer therapy in recent years, patient adherence to treatment has become increasingly important.

Pharmacists have several important roles in helping patients with breast cancer to attain the best possible treatment outcomes and reducing the impact of adverse events. Some of these roles include patient education, participating in the development of institutional guidelines for the management of adverse effects, ensuring the appropriate laboratory tests have been performed, reconciliation of medications for patients who are hospitalized, and helping to improve treatment adherence for patients who are using oral therapies.