Pharmacies will now need to review new services and evaluate their impact on patients and on staffing in order to decide which to take forward. Ms Walters-Davies expects to keep all the new services in some form. “Oncology pharmacy services were able to make decisions and influence changes with pace, so long as we were given the autonomy to do so. We were given the flexibility and the use of innovation to make these changes….. I would like to have the autonomy to continue to make decisions about our services in this way”, she says.

However, other measures will also be needed to support further development of oncology pharmacy services.  For example, the pharmaceutical industry currently provides very good patient information leaflets and [symptom] diaries but so far there is a lack of electronic material. As patients are likely to make fewer visits to the hospital in future, Ms Walters-Davies foresees a need for electronic patient education material to complement the virtual consultations that have been introduced.  “I think there’s a way of us working with pharma to tailor the education to patients’ needs and linking it with the information that we need to give about services from the cancer centre”, she says.   Turning to the role of community pharmacy, Ms Walters-Davies says, “I’d like to see more integration between oncology services and community pharmacy”. During the pandemic, community pharmacists stood out as being the healthcare professionals that patients’ could see face-to-face on an ad hoc basis. “We, as an oncology service need to link more closely with them to be able to maximise on those touch points that they have with patients to make sure that patients are signposted correctly so that there is earlier diagnosis and prevention.  We know that cancer referrals went down during the pandemic because fewer patients were going to see GPs and being picked up that way so we need to see if we can use community pharmacy as a way of bridging that gap. We need to work more closely with them to enable that to happen”, she explains.

During the covid pandemic, oncology teams throughout the National Health Service made both operational and clinical changes to limit patient exposure to the risks of the virus whilst maintaining good governance. “Patient safety is fundamental to good patient care”, says Ms Walters-Davies.

Operational measures were designed to minimise the time that patients spent in hospital. There was widespread expansion of homecare services for both intravenous and oral treatments. The National Medicines Homecare Committee specifically prioritised oncology services. Some trusts also used courier services to deliver medicines to patients.

At Velindre Cancer Centre a drive-through pharmacy service was introduced so that patients could collect medication without having to leave their cars.

From the clinical perspective, some treatments were switched from intravenous to oral administration, for example, oral tyrosine kinase inhibitors were introduced as first-line treatment in in renal and melanoma settings.  Less frequent administration was another approach  – exploiting the option to use larger doses at longer intervals.  One example of this was nivolumab for lung cancer, which is normally given every two weeks, requiring twice monthly hospital visits. After taking advice from the National Institute for Health and Clinical Excellence (NICE) an off-label dosing regimen was introduced that involved four-weekly administration using a double dose.  “This meant that patients had to visit the hospital only once a month instead of twice”, explained Ms Walters-Davies. “There were also other examples of extending administration schedules, particularly in area of immunotherapy”, she added.

Patient education

The use of drive-through services and couriers removed the traditional  ‘touch point’ that pharmacists have when handing out medicines and the team at Velindre Cancer Centre realised that an alternative mechanism  was needed to answer patients’ questions and provide patient education about drug treatment.  “We built on our existing patient education service, which is led by pharmacy technicians, and moved to a virtual model where we offered patients counselling by telephone or video consultation so that they got the same level of contact and counselling that they had under previous system”, explains Ms Walters-Davies.  The service is also provided on an ad-hoc basis, so if patients have questions about drug treatment they can enter a virtual waiting room and be admitted electronically when a pharmacist or technician is available for a consultation. Non-medical prescribers undertaking medicines’ reviews also moved to a virtual model using telephone and video consultations. “The digital platform is something that works really well – with a lot of good feedback from patients”, says Ms Walters-Davies.