99 problems and the medicines are one

This year when the three minute thesis competition came around I thought that I had enough of an idea of what I was doing in my PhD that I should challenge myself and participate. I did just that and came runner up in my heat...of three participants. Later I realised that I'd stupidly signed up for the wrong school heat so I owned up and withdrew from the finals. But it wasn't all in vain. The process did actually help me to condense the ideas behind what I'm doing and why I'm doing it. Here is what I ended up with...

Before I became a PhD student I worked as a pharmacist in a palliative care team. As part of that I’d visit people in their homes and talk with them about their medicines. Most of these people had terminal cancer, and many were having problems with medicines they were using for a long term condition.

Often it was because their circumstances had changed. They didn’t have the same amount of time and energy to spend looking after their long term medicines. Or side effects they’d previously tolerated, like fatigue and gut problems, became more significant as they got sicker.

Some people seemed to think it wasn’t worth mentioning these problems to their doctors. Others found it hard to find a one to help them because it didn’t fit with the specialists and they’d lost contact with their GP.

These problems mightn’t have been the highest priority, but they were problems that were contributing to ongoing symptoms and poor quality of life. And they were consuming finite resources of time, energy and money.

This experience made me reflect on my role as a pharmacist, and the profession more generally, in supporting people who are managing cancer and a long term condition. I thought, surely we can provide interventions that prevent these types of problems happening in the first place?

So I looked at what had been shown in the literature and I found very little. Vast majority of the literature on medicines in the context of cancer is about cancer treatments or managing specific problems like pain or nausea. There’s some literature looking at medicines use in geriatric cancer patients, but this problem isn’t confined to geriatric populations. Two thirds of people seen in Australian general practice aged 45 to 64 have a chronic condition, and nearly half have two or more. There are a few studies showing that adherence to medicines used for diabetes and heart disease reduces during cancer treatment, but there is little understanding of why or how.

My research will attempt to shed some light onto understanding how people who are managing a long term condition as well as cancer use their medicines, to identify and describe medicine-related problems that are predictable and amenable to intervention. People with cancer have a lot of problems to deal with in their lives. We should be able to make sure that the medicines they’re using are solving more problems than they create.