Impact of a Clinical Pharmacist-Led Guidance Team on Cancer Pain Therapy in China: A Prospective Multicenter Cohort Study

Context. Cancer treatment capacity in China is severely limited relative to the enormous size of the population; and many aspects of treatment, such as opioid protocols for pain control, are not standardized. To improve the quality of drug treatment, clinical pharmacists are taking a more active role in patient care. Objectives. This study compared the effectiveness of opioid treatment between cancer patients receiving interventions from Clinical Pharmacist-Led Guidance Teams (CPGTs) and a comparable control group. Methods. This was a prospective, multicenter, double-arm, controlled study conducted in China. Multidisciplinary guidance teams were established and led by clinical pharmacists with expertise in cancer pain therapy. The CPGTs provided pre-therapy consultation and drug education to physicians, monitored prescriptions during treatment, and conducted patient follow-up. The process and outcome parameters of therapy were collected and analyzed with overall statistics and logistic regression. Results. A total of 542 patients were enrolled, 269 in the CPGT intervention group (CPGT group) and 273 controls. Standardization of opioid administration was improved significantly in the CPGT group, including more frequent pain evaluation (P < 0.001), more standardized dosing titration (P < 0.001), and less frequent meperidine prescriptions (P < 0.001). The pain scores in the CPGT group were significantly improved compared with the control group (P < 0.05). The incidences of gastrointestinal adverse events were significantly lower in the CPGT group (constipation: P = 0.041; nausea: P = 0.028; vomiting: P = 0.035), and overall quality of life was improved (P = 0.032). No opioid addiction was encountered in the CPGT group. Risk analysis revealed that patient follow-up by pharmacists and the controlled dosing of opioids were the major factors in improving treatment efficacy. Conclusion. The CPGTs significantly improved standardization, efficiency, and efficacy of cancer pain therapy in China. In a country where clinical pharmacy is still developing, this is a valuable service model that may enhance cancer treatment capacity and efficacy while promoting recognition of the clinical pharmacy profession. (C) 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.