Patient Education and Counseling xxx (2014) xxx–xxx

G Model

PEC-4936; No. of Pages 1

Letter to the Editor

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Patient Education and Counseling

jo ur n al h o mep ag e: w ww .e lsev ier . co m / loc ate /p ated u co u

Pharmacist-led nonpharmacological interven-tion in cancer chemotherapy

Sir,

An earlier survey showed that more than 30% cancer patientsexperience anxiety, depression, and fear during their chemothera-peutic period [1]. The latest survey performed in a cancer center ofShanghai further showed that 50% cancer patients feel anxious,fatigued and uncertainty. More than 40% cancer patients feelfear and psychological fluctuation at different levels due tounawareness of their chemotherapy (http://www.jkb.com.cn/news/industryNews/2014/0731/346926.html).

Pharmacist, as a member of clinical treatment team, isresponsible for rational use of drugs. However, rigid and dogmaticpharmaceutical service has been unable to meet the needs ofcancer patients, especially those patients with psychologicalproblems. It is quite a challenge for pharmacist to providehumanistic care for cancer patients. Here we briefed our pharma-cist-led nonpharmacological intervention practice.

Firstly, we realized that cancer patients and/or their familymembers usually use up all their resources to see a doctor. Theycrave ‘‘the best of the best drug’’ in the world and the best outcome.Although many of them understand that the present medicaltechnology and skill is limited, they expect their cancer can be curedby miracle [2,3]. In our clinical pharmacy practice, we started to setthese misconceptions straight. We educated cancer patients that thecurrent medical technology can only cure some types of cancer;meanwhile the others cannot be cured. Up to now there is noso-called ‘‘magic drug’’ in this world [2,3] – no matter in the modernWestern developed counties or in the mysterious oriental world.

Secondly, we found that most cancer patients cannot endure theside-effect or toxicity of chemotherapy. Hearsay and experiencednausea, vomiting, and hair loss bring them a considerable fear.At this time we were careful to inform cancer patients of adversedrug reactions with positive suggestion [3]. For these suggestiblepatients – old men and women, we paid particular attention thatnever lead patients expect side-effect. If a medicine has a knownside-effect, we just mentioned the specific incidence (such as 0.01,0.1, 1%) rather than verbal (rare, infrequent, common, etc.)frequency descriptors. We emphasized that ‘‘good attitude, goodmeals and good rest would lessen your side-effect’’. Numericalrather than verbal frequency descriptors would help patients makemore accurate predictions of their personal likelihood of experienc-ing a particular reaction. When verbal descriptors were, side effectfrequency was often overestimated [4]. We never induced cancerpatient to expect a headache, nausea, or vomiting.

Last but not least, at right time and in right place, with great care,we discussed the conception of life and death with cancer patients.

Please cite this article in press as: Wu H, et al. Pharmacist-led nonphaCouns (2014), http://dx.doi.org/10.1016/j.pec.2014.11.014

http://dx.doi.org/10.1016/j.pec.2014.11.014

0738-3991/� 2014 Elsevier Ireland Ltd. All rights reserved.

Death is a taboo topic in China. We tried to help cancer patientsshape a positive view of mortality. We told them that advancedmedicine help a human being only live out the quality rather thanlive forever. All human beings are mortal. Since most Chinese haveno spiritual beliefs, it is difficult to discuss death with them.

In general, good communication is essential to build up a gooddoctor–patient relationship [5]. Whenever and whatever patientsconsult, we would never reply in this way like ‘‘business is business’’or ‘‘consider something as it stands’’, but show the warmth andconcerns to them. We believe that patients would benefit from ouremotional support [6]. Our compassion would definitely benefitspatients get through a difficult and frightening time. In clinicalpractice, we should take full advantage of nonpharmacologicalmethods to intervene cancer patients [7]. A harmonious healthcare environment would improve cancer patients’ chemotherapycompliance. We should always empathize with patients.

Conflicts of interest

The authors declared that they have no conflicts of interest tothis work.

References

[1] Zhou T, Duan JJ, Zhou GP, Cai JY, Huang ZH, Zeng YT, et al. Impact of depressionmood disorder on the adverse drug reaction incidence rate of anticancer drugsin cancer patients. J Int Med Res 2010;38:2153–9.

[2] Xu F. Caution in prescribing antidepressants for patients with cancer. Am JHealth Syst Pharm 2008;65:700.

[3] Xu F. Informing patients about drug effects using positive suggestion. J ManagCare Pharm 2008;14:395–6.

[4] Dyck A, Deschamps M, Taylor J. Pharmacists’ discussions of medication sideeffects: a descriptive study. Patient Educ Couns 2005;56:21–7.

[5] Faller H. Patient-centered communication in the physician–patient relation-ship. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz2012;55:1106–12.

[6] Xu F. Importance of emotional support from pharmacist for cancer patients.J Oncol Pharm Prac 2008;14:163–4.

[7] Bingel U. Avoiding nocebo effects to optimize treatment outcome. J Amer MedAssoc 2014;312:693–4.

Huimin WuHongyan Wei

Feng Xu*

Department of Pharmacy, Fengxian Hospital, Southern Medical

University, Shanghai, China

*Corresponding author at: Department of Pharmacy, FengxianHospital, Southern Medical University, Shanghai 201400, China.

Tel.: +86 21 57422032; fax: +86 21 57422032E-mail address: andrewfxu1998@gmail.com (F. Xu).

Received 7 August 2014

rmacological intervention in cancer chemotherapy. Patient Educ