Impact of clinical pharmacist services on quality adjusted life years in head and neck cancer patients.

Abstract

BackgroundThe role of clinical pharmacists in the provision of patient care is evolving in developing countries such as India. However, their acceptance in health care setups remains debatable. Objective This study aims to investigate the change in quality adjusted life-years after providing clinical pharmacist services in head and neck cancer patients. Setting Oncology speciality private centre in West India. Method It was a prospective, multi-centered pre-post study. Patients were recruited into the control group and intervention group. Clinical pharmacist services were provided only to the intervention group. The quality adjusted life-years was measured by incorporating the EQ-5D-5L instrument. Patients have been provided with the EQ-5D-5L questionnaire at the pre-determined intervals i.e. before beginning of each chemotherapy cycles till the completion of treatment. The analysis was carried out using descriptive analysis and student's t-test. Main outcome measures Change in quality adjusted life-years amongst control and intervention groups of head and neck patients. Results A total of 104 patients were recruited, out of which 50 patients were in control group and 54 patients in intervention group. Docetaxel, cisplatin, 5-fluorouracul regimen, paclitaxel-carboplatin regimen and weekly cisplatin were prescribed in majority of the head and neck patients (control group: 82%; intervention group: 74.1%). The majority of patients in the control group were facing medication-related problems such as irrational administration of chemotherapy (18.9%), lack of optimal supportive care (18.9), negligence of co-morbid conditions (16.1%), improper chemo-drug calculation (14.9%) and drug interaction (13.2%). The remedial action was provided by clinical pharmacist to overcome these medication-related problems in intervention group. The quality adjusted life-years significantly decreased in the control group from 0.012 to 0.005, however, it remained constant in the intervention group from 0.013 to 0.014 after the completion of 6 chemotherapy cycles. Conclusion The incorporation of clinical pharmacist services has helped us in identifying and understanding the various types of medication-related problems and their potential causes in patients suffering from head and neck cancer. Moreover, it helped to improve the quality adjusted life-years and decrease adverse drug reactions, reflecting positive impact on patient care.