Expanding Oncology Pharmacy on a Global Level

Kathryn Yee, PharmD
Department of Clinical Pharmacy, School of Pharmacy
University of California–San Francisco
San Francisco, CA

In 2013, the Global Burden of Disease Center Collaboration report­ed 14.9 million cancer cases and 8.2 million deaths worldwide.¹ With the rise in overall cancer incidence and increased lifespan through improved prevention and treatment of communicable diseases, cancer poses a major threat to public health. Low- and lower-middle-income countries will feel this burden dispropor­tionately because their health systems are not designed to treat complex and expensive disorders such as cancer.¹ There is a grow­ing need for pharmacists worldwide,² but stable infrastructures, education, and resources are required for developing countries to address this need. Local pharmacists in all countries need to be motivated to ensure pharmacy involvement in the evolution of cancer prevention, treatment, and supportive care.

I am fortunate to have developed a partnership with a local pharmacy initiative through my participation in the University of California–San Francisco (UCSF) Global Health Clinical Scholars Program³ as a PGY-2 oncology pharmacy resident. Through this experience, I learned about the challenges of global health and the continual need of pharmacist involvement to help solve these issues. The University of Namibia School of Pharmacy (UNAMSOP) was established in 2010 and is the first pharmacy training program in Namibia. Its vision is to build a sustainable workforce with the skills to increase access to and improve the use of essential medicines by having pharmacists at the forefront of patient care.⁴ The role of pharmacy is currently in development, and clinical pharmacy expertise is limited to a few disease states. With the increased incidence of cancer, UNAMSOP and the local hospitals are invested in developing oncology pharmacy specialists as part of a multidisciplinary team. Therefore, my global health project was a clinical audit of the standard-of-care practices at the AB May Cancer Centre at the Windhoek Central Hospital (WCH) in Windhoek, Namibia. The purpose was to help UNAMSOP develop a clinical-based rotation for its postgraduate master’s of pharmacy (MPharm) students to participate in clinical training in oncology.

Serving a population of 2.1 million,⁵ Namibia now has three state hospitals and four private hospitals.⁶ WCH is centrally located and is currently the only cancer center collecting data for the Na­mibia Cancer Registry.⁶ As a result, almost all patients with cancer are assessed and treated at WCH. Within the past year, approxi­mately 14,000 cancer patients were treated in the medical oncol­ogy unit.6 Namibia is a lower-middle-income country, with access to cytotoxic chemotherapy agents and monoclonal antibodies to provide many patients with standard-of-care treatment. The most common malignancies treated at WCH’s medical oncology unit are breast cancer, leukemia, and lymphoma. After patients are seen by a physician, a nurse will compound the prescribed treatment, including cytotoxic agents, on the countertop in the clinic. The role of the pharmacist is to dispense supportive care medications at the outpatient pharmacy. Because of workflow issues and limited personnel, the pharmacist compounds chemotherapy agents in the laminar flow hood for pediatric patients only. All of the healthcare staff understands the safety risk of not using the hood, but with the current workflow, there is a lack of appropriate training and staffing. It was encouraging to know the lead physician and nurse recognize the value of pharmacy and want the pharmacist to have greater involvement. With my review of current workflow in both the pharmacy and oncology clinic, I made suggestions for the development of an oncology rotation with the goals of having pharmacists round on the wards, help develop workflow models to integrate pharmacy, and improve the education of pharmacists in oncology. I gave didactic lectures on oncology and led small-group case discussions for current students. Although one of the major barriers to implementing this rotation is having the resources to provide a dedicated oncology pharmacist, I hope the small contri­bution I made will make a lasting difference for future pharma­cists in Namibia.

Not only has this been a life-changing experience for me per­sonally and professionally, but it also has confirmed my passion for providing health care on a global level. I learned that volunteering in medical missions or donating supplies may help address an im­mediate problem, but it does not create a stable system that gives low- and lower-middle-income countries the ability to provide for themselves. What I love about UNAMSOP is that the institution hired a group of individuals who understand the importance of training Namibian pharmacists and is passionate about promoting and creating a sustainable profession of pharmacy. This should be the ultimate goal of global health initiatives, and I am glad the Global Health Scholars Program and my experience in Namibia have taught me this distinction for impactful global health care.

Global health issues should be a topic covered in the education of future pharmacists around the world. Through global collabora­tion, information and ideas can be shared to expand the profession of pharmacy locally and internationally. We also should be open to practices we might learn through these collaborations. Pharmacists can look for institutions or organizations with global health pro­grams established like UCSF, join organizations like the Interna­tional Pharmaceutical Federation, or find nonprofit organizations. I am hopeful pharmacy involvement on a global level will expand, especially in the field of oncology, as there is a growing need. I hope I will be able to continue to be involved in global health, especially at UNAMSOP, throughout my career, and I am grateful for this wonderful opportunity.

Special thanks to Timothy Rennie, PhD MPharm; Dan Kibuule, MSc BPharm; Mwagana Mubita, MSc BPharm; Tina Brock, EdD MS BSPharm; Mimi Lo, PharmD; and Lauren Jonkman, PharmD MPH.

References

1. Global Burden of Disease Conrol Collaboration. Fizmaurice C, Dicker D, et al. The global burden of cancer 2013. JAMA Oncol. 2015;1(4):505-527.

2. International Pharmaceutical Federation (FIP). Global Pharmacy Work­force Intelligence: Trends Report 2015. The Hague: International Phar­maceutical Federation; 2015. www.fip.org/files/fip/PharmacyEducation/Trend/FIPEd_Trends_report_2015_web_v3.pdf

3. UCSF Global Health Clinical Scholars Program. http://meded.ucsf.edu/gh/residents-grad-students-and-fellows-0

4. Brock T, Wuliji T, Sagwa E, Mabirizi D. Technical Report: Exploring the establishment of a pharmacy course at the University of Namibia, March 12–27, 2009. Submitted to the U.S. Agency for International Development by the Strengthening Pharmaceutical Systems (SPS) Program. Arlington, VA: Management Sciences for Health. 2009.

5. Census Projected Population. www.gov.na/population. Accessed June 16, 2016.

6. Namibian Cancer Registry. African Cancer Registry network. http://afcrn.org/membership/membership-list/125-ncr. Accessed June 16, 2016.