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Expert Views on Colo-Rectal Cancer

Pharmist Source:
Nanette Njoroge
17/04/2012 2:15 pm
17th April 2012
Almost everyone has had to deal with pharmacists at one point in their lives when getting medicine from a hospital, chemist or any other medical institution. On Saturday April 14th , I had a golden opportunity to sit down with a group of professional pharmacists for.a workshop on colorectal cancer. This was an event organized by HOPAK (The Hospital Pharmacists Association of Kenya) and sponsored by Sanofi Aventis. HOPAK is an organization that works towards promoting best standards in hospital pharmacy practice. It also provides a dynamic platform for the exchange of knowledge among sector players to enhance their contributions to health. In addition to this they provide timely scientific programs, ongoing education, opportunities for networking, and professional development.

In line with their theme for this year “Need for Specialization” HOPAK invited a number of professionals to give an expert view on the topic of colo- rectal cancer. The event kicked off with a key note presentation by Prof Guantai , (Ag Dean Pharmacy School University of Nairobi) who took us through some of the programs that the school offers. She stressed the need for pharmacy students to first and foremost weigh their strengths as well as competencies before choosing a given line of specialization as the only way through which glory in the pharmacy field can be reclaimed.

She noted that it is only through such soul searching and self evaluation that most people will get to learn that pharmacy goes beyond the instructions of taking 2 tablets per day. Some of the courses that the institution offers include:

Post graduate diploma in pharmaceutical analysis- this was introduced to attract working students as in the past, only 4 people would apply.
Masters in pharmaceutical analysis – The Master of Pharmacy degree course in Pharmaceutical is intended to train highly qualified analysts involved in both quality assurance and quality control of pharmaceuticals and related substances.
MSC in pharmacognosy and complimentary medicine. Msc in molecular pharmacology.
Msc pharmacy in pharmacepidiolody and pharmacovigilance.
Msc in clinical pharmacy.
M. Pharm in Industrial Pharmacy.
Doctor of Philosophy degree programme (PHD).
Masters in industrial pharmacy
Other Departments

Msc Topical and infectious diseases.
Post graduate diploma in tropical diseases.
Msc clinical psychology.
MSc biomedial research methodology.
Msc leardership and health systems.
Masters of public health.
Msc clinical cytology.
Msc medial microbiology.
The key speaker, Dr. Kiarie , a Medial Oncologist gave an overview of colo-rectal cancer. She explained that cancer starts from a small cell and is caused by uncontrolled cell division. Some of the factors that are put into consideration when the medical team is choosing the mode of treatment include the size, site, grade, T-stage (extent of wall penetration), N stage and M stage. Diagnosis of the cancer mostly depends on:

Clinical signs and symptoms,
Barium Enema
Biopsy
Flexible sigmoidoscopy/colonoscopy.
She further noted that the cancer could be managed by

I. Surgery,

II. Adjuvant chemo

III. Radio therapy

IV.Metastic disease

V. Metasectomy

VI. Stomas

VII.By pass surgery

VIII.PEGS

She also pointed out that cancer patients do not really need chemo especially if there are no lymph nodes. Tests however have to be thorough before getting to the conclusion. It is also important to note that at stage II of adjuvant chemotherapy, continuous infusion is normally better than biolysis. Patients can also get pumps that can be used at home so that they do not have to stay in the hospital.

Aims of Chemotherapy for advances colo-rectal cancer include:

Reduce or delay symptoms
Delay progression
Shrink tumor
Prolong survival
Maintain and improve patient’s life
People involved in the management of colo rectal cancer

Gastraentrologists
Surgeon,
Medical oncologist,
Radiation oncologist
Oncologist nurses
Palliative care professionals,
Counselors
Nutritionist.
Methods of preventing the disease

a) Clinical tests

b) Barium Enema

c) Colonoscopy

d) Polypectopy

e) Diet

f) Exercise

g) Asprin/celecoxib

Dr Munyoro who is the head of Palliative care at the Kenyatta National Hospital was the third speaker to address the information hungry crowd. She had lots of insightful information on the topic considering that she is the only professional in Kenya. She started by explaining what palliative care is: – active total care of patients whose disease is not responsive to curative treatment. This normally involves the control of pain and symptoms, psychological, social and spiritual problems. The main aim of this type of care is to get the best possible quality of life for patients as well as their families. It also helps to get rid of the panic that is caused when a patient is told they are suffering from cancer to prepare them for the treatment process.

Palliative care works on the quality of life concept- this is the inverse relationship between the expectations that individuals have and what actually happens. The smaller the gap between the two the better

Key concepts of palliative care

v Recognition and relief of pain and other symptoms regardless of their cause,

v Recognition and relief of spiritual suffering.

v Recognition and relief of psychological suffering including care and support of family and friends.

v Sensitive communication.

v Respect for truth and honesty.

Dr Munyoro stressed the fact that a lot of research is needed to come up with the best way to manage cancer patients.

She noted that through research, some of the issues that were raised by Kenyans on the topic of cancer included:

Physical suffering especially pain,
Acceptance rather than anger,
A lot of community support,
Comfort and inspiration by belief in God.
Patients are concerned about being a financial burden, lack of medical support and the fact that specialist palliative care is not available.
Goals of palliative care

Respect and support patient preference
Improve communication techniques among health workers.
Role of pharmacists in palliative care

Give advice on the side effects of medicine.
Teach patients how to take their drugs
Expound on doctors advice
The doctor also advised that pethidine usage needs to be stopped. This is because it has adverse effects like gastritis coagulation, renal complications, seizures and personality change. In its place morphine should be encouraged.

Some of the steps that can be taken to ensure medication availability include:

v Having a national essential medications list.

v Laws and regulations to control the import, manufacture, storage, distribution and prescription of opiod analgesics.

v Improving the balance between minimizing opiods and false statements; this is mostly because opiods have been known to hasten death, have maximum dosage, increase tolerance, patients are likely to get withdrawal symptoms as a result of addiction. She also said that pharmacists need to be well equipped on the best ways to eliminate addictions.

Palliative care has proved over the years to be very important as patients who go through it report less depression, happiness and they also make better decisions when it comes to treatment.

Future of palliative care

Drug availability
Safe use of opiods
Enhanced team work to ensure that patients get seamless care
Clinical trials for patients so that they can have choices even at the end of life
Dr Nganga was next on stage and her presentation focused mostly on medication related issues. She emphasized that colo-rectal cancer usually starts at the large intestine. She further noted that there is no single cause for the cancer but some of the risk factors include;

Age- individuals who are above the age of 60 are most likely to be diagnosed with the cancer.

Red and processed meat.

Existing cancer in the body.

Consumption of alcohol and cigarettes.

Medicines used for the cancer include:

ü Oxiplatin

ü Leucorovin

ü Capecitabine

ü Irinotecan

The medicines usually have various side effects and below you will find some of the ways to manage them:

Mucositis- good oral hygiene and saline/sodium bicarbonate gurgles
Diarrhea- hydration delay in treatment loperamide
PPE-supportive/use of emcillents pyridoxine, patients should avoid source of friction, heat, harsh chemicals, delay in treatment and dose reduction.
Neuropathy- exacerbate by cold, calcium gluconate and magnesium sulfate IV before oxiplatacin.

Adjuvant medications

These are used to control and prevent side effects and can be used both for pre and post chemo treatments.

i. 5HT3 antagonist

ii. Corticosterois

iii. Metoclopramide

iv. Antihistamine

v.H2 blocker

Dr Nganga pointed out that medication errors can happen at several stages such as prescription, dispensing, preparation and administration. These are usually caused by

Look alike and sound alike drugs for example cistplatin- carboplatin
Illegible handwriting and abbreviations
Clarifying terms
Preparation errors that can arise from use of incompatible fluids, omission of bolos FCC and not enough protection from light
Administration errors can be caused by wrong administration of IV, use of wrong solvents, wrong route of administration and daily course doses given as single doses.
Prevention of medical errors

Cpoe- computerized orders
Writing out orders instead of using abbreviations
Tall man letters for instance CISplatin
Having complete information like patient biodata, protocol and labwork
Use of cautionary/bright auxiliary labels
Role of pharmacists

a) Reviewing prescriptions

b) Ensuring they go through biodata

c) Ascertaining that pertinent lab work is done

d) Intervening as necessary

e) Counsel patients on medicine and side effect management prior and during treatment

Dr Nganga concluded by saying that it is very important to encourage early testing because colo-rectal cancer is curable.

The event was concluded by Alice from Sanofi who gave a detailed presentation about exolatin one of the drugs that is used for cancer treatment and its usefulness to the management and treatment of colo-rectal cancer.

It was evident that the event was a success owing to the high turn out and the questions that were raised during the session. Trust me Kenyans can sigh in relief as pharmacists in the country are really working hard to ensure that they get the best services available from them.

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One Response to "Expert Views on Colo-Rectal Cancer"

  1. dalmas okonji says:

    i was diagnosed with colorectal cancer in april this year. i have been able to do only one cycle of chemo and could not do more due to financial constraint, i would like to know if there was a way i could get financial assistance.

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