Clinical pharmacist interventions on pain management in cancer patients (PharmaCAP) in low resource settings: a multicenter feasibility-pilot randomized controlled trial

• Published in: Supportive care in cancer 2024-12, Vol.32 (12), p.828
• Main Authors: Shrestha, Sunil, Sapkota, Simit, Teoh, Siew Li, KC, Bhuvan, Paudyal, Vibhu, Lee, Shaun Wen Huey, Gan, Siew Hua
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anxiety; Cancer; Cancer Pain - drug therapy; Clinical trials; Feasibility; Feasibility Studies; Female; Humans; Intervention; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasms - complications; Nepal; Nursing; Nursing Research; Oncology; Pain management; Pain Management - methods; Pain Measurement; Pain Medicine; Patient Care Team - organization & administration; Patient compliance; Patient satisfaction; Pharmacists; Pharmacists - organization & administration; Pilot Projects; Professional Role; Quality of Life; Rehabilitation Medicine; Resource-Limited Settings
• ISSN: 0941-4355; 1433-7339; 1433-7339
• DOI: 10.1007/s00520-024-08989-z

Introduction Cancer pain management is frequently insufficient worldwide, especially in low- and middle-income countries where significant challenges related to workforce resources persist. Clinical pharmacists could potentially enhance outcomes in this context, yet their role remains largely unexplored. Objectives This study aimed to assess the feasibility and acceptability of integrating clinical pharmacists into the multidisciplinary team (MDT) to manage cancer pain and assess preliminary outcomes in cancer patients receiving pain treatment. This pilot study was undertaken to inform a future definitive randomized controlled trial (RCT). Methods The protocol was registered with ClinicalTrials.gov (NCT05021393). The PharmaCAP trial was conducted in two oncology centers in Nepal, where patients were randomly enrolled into usual care (UC) or an intervention group (PharmaCAP). The latter received a clinical pharmacist-led medication review, which involved a comprehensive assessment of the patient’s current medications, identification of potential drug-related problems, and personalized recommendations for optimizing pain management. This was accompanied by pain assessment, education and counseling on pain management strategies. Baseline and 4-weeks post-intervention assessments measured primary outcomes, i.e., feasibility metrics (recruitment of the patients, retention of patients, patient satisfaction). Secondary outcomes included pain intensity, health-related QoL, anxiety, depression, barriers to pain management, and medication adherence at 4 weeks. Results Out of 140 screened patients, 108 were evaluated for eligibility, with 16 opting out primarily due to lack of interest ( n  = 11) and communication barriers ( n  = 5). A total of ninety-two participants with cancer pain were randomized into two groups, with 91 patients successfully recruited and 85 (93.4%) completing 4 weeks post-intervention assessment). Completion rates for the UC and PharmaCAP groups were 91.3% and 93.4%, respectively. The primary feasibility outcomes were positive: 100% of patients found random allocation acceptable. Retention rates were high, with 91.3% in the UC group and 93.4% in the PharmaCAP group, despite a few dropouts due to being unreachable, COVID-related issues, and changes in treatment centers. No evidence of contamination between groups was found, as participants did not discuss interventions or influence each other’s attitudes, ensuring effective isolation of interven