Patient Treatment Experience and the Role of Oncology Pharmacists

EP: 1.Overview of Metastatic Bladder Cancer

EP: 2.Patient Experience and Collaborative Care in Metastatic Bladder Cancer

EP: 3.Frontline Treatments and Cisplatin Eligibility in Metastatic Bladder Cancer

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EP: 4.Patient Treatment Experience and the Role of Oncology Pharmacists

EP: 5.Emergent Data in Frontline and Maintenance Therapy for Metastatic Bladder Cancer

EP: 6.Immunotherapy Management for Metastatic Bladder Cancer

EP: 7.The Evolving Treatment Landscape and Patient Perspectives

EP: 8.Don’t Be Afraid to Ask Questions Along the Bladder Cancer Journey, Patients and Clinicians Advise

Transcript:

Rohit Jain, MD, MPH: So, Jeffrey, when we discussed…chemotherapy in the clinic, and we spoke about the cisplatin-based regimen with dose-dense MVAC, what were your concerns or questions about the therapy?

Jeffrey Ehas: How long would it take? How would it affect my body? Would I be able to tolerate it? Would I be able to do my daily routine or not? Would I be lying in bed all the time? I was concerned. I thought I'd be lying in bed for the entire time. I didn't know. It was an unknown territory. So, I was very pleased that even after chemotherapy…I was tired, but I was able to do my daily routine and function normally.

Rohit Jain, MD, MPH: Yes, absolutely. I think you tolerated the treatment very well. And how did your clinical care team, including the nursing, the pharmacy, and all, address those concerns or questions?

Jeffrey Ehas: I can honestly say everyone at Moffitt [Cancer Center] has been amazing. They're wonderful. I highly recommend it to anyone and everyone. If I had questions, I asked, and they answered. If someone didn't know the answer, they would find out. They were amazing. They were very helpful, very patient, very kind. Just amazing. Wonderful.

Rohit Jain, MD, MPH: That's good to hear. Thank you so much. And so, we did 6 cycles of chemotherapy. So, how did you think you responded to the cycles, or the chemotherapy, 6 cycles?

Jeffrey Ehas: I responded quite well. My bodily functions were pretty much normal. My blood was anemic. So, I'm just tired all the time. Neuropathy. Neuropathy in my hands, my feet, my legs. But after the chemotherapy had ended, the neuropathy slowly went away, and I was pleased with that and I got better.

Rohit Jain, MD, MPH: That's really good to hear that the symptoms and the toxicities, they slowly improve and don't limit the activities of daily living. So, that's always good to hear. Dr Shah, when you are providing counseling to the patients and obviously understanding that they are completely new to this world of treatment, what type of questions are asked by the patient and the family?

Anand Shah, PharmD, BCOP: Absolutely. And I think this…brings us back to where we started about this whole diagnosis. Now, you throw in another complication about chemotherapy and complex chemotherapy, tolerating the side effects. It's a lot of information for patients. And I tell my residents there is no such thing as overeducation when it comes to chemotherapy and oncology. And our nurses do a fabulous job of educating our patients. But our clinical pharmacists in our GU clinic—we have Amy, who's our clinical pharmacist in that clinic—they also educate the patients, along with the nurses. Now, there is going to be some overlap. But if you put yourself in the shoes of a patient, there is so much information that's being thrown at you that a little bit of overlap and a little bit of repetition is not a bad thing.

So, when we educate patients, we [don’t] only talk about the logistics. How long will your infusion take? How long do you expect to stay in the infusion center? What are your current medications? What premedications will you be receiving? And then we go into talking about the toxicity of chemotherapy and how to manage that toxicity, when to call for help. We provide the hotline number that Moffitt provides all of its patients that is a 24/7 number. So, we educate them about all of this. And then as pharmacists, we always make sure that patient's medications are up-to-date and there are no drug interactions. So, the final step that we do in our process is looking at patients' medications, making sure there are no drug interactions with chemotherapy, educating patients about taking herbal medications, if they are taking those, taking those safely and disclosing those with your pharmacist team. So, it's a lot of education effort. And I'm really glad that Moffitt has this multidisciplinary approach because I really couldn't think of a better way of making sure that [a] patient gets this education.

Rohit Jain, MD, MPH: And as Jeff recently mentioned about anemia and neuropathy…what adverse events do you commonly see in the practice that come from the chemotherapy exposure, and what actions can we take to mitigate these side effects?

Anand Shah, PharmD, BCOP: That's a great question. And it's a complex question because there are so many different types of chemotherapies. There [are] so many different types of adverse events that can happen. But we do take some general measures to prevent side effects and minimize side effects from chemotherapy. And one example that I can give you, I can't list everything, but I can give you one really good example that we've come leaps and bounds over the last 10 to 15 years with managing nausea medications.

Dr Jain mentioned cisplatin being the gold standard with chemotherapy for bladder cancer. And it really is, but it also causes significant nausea and vomiting to the point where, decades ago, we used to have to admit patients because we knew that they would be having a lot of nausea and vomiting. But now, not only have we made advances in cancer drugs, we've also made advances in supportive medications. And with the supportive medications that we have now, we can have patients like Mr Ehas who went through chemotherapy without a lot of vomiting. And that really is our goal with all of our patients. Not every patient is the same. But we have a lot of tools in our armamentarium to take care of nausea now.

Rohit Jain, MD, MPH: Thank you so much. That really helps. If these symptoms are mitigated early on, that allows us to stay on treatment and finish the course on time. Absolutely. Thank you so much for that information.

Transcript is AI-generated and edited for clarity and readability.