Dear ESOP Members,

As we are approaching the end of EPIC project, we would like to inform you about two of the most important achievements, namely the implementation of educational program about oral anticancer drugs and e-tool - a database which assists pharmacists at counselling cancer patients on oral anticancer drugs.

We wish you a pleasant reading!

Best regards,

Andreja Eberl

Chair of EPIC project

Educational program

In Slovenia and Estonia most of oral anticancer drugs are dispensed by pharmacists in public pharmacies that are not specialized in cancer treatment. Before EPIC, not much training has been available on anticancer drugs, neither in undergraduate studies nor in postgraduate educational programs, so it's important that we have offered pharmacists the opportunity and enable easy access to education in the field of oral anticancer drugs.

The educational program was carefully and precisely planned. First working groups were created within ESHP (Estonian Society of Hospital Pharmacists) and LZS (Slovene Chamber of Pharmacies) with the aim to adapt, develop and modify the training programme for pharmacists. We also received the input from WP 4 of EPIC project (Analysis of current management of oral chemotherapy drugs and educational needs of pharmacists who dispense these drugs in the EU countries) to cover the potential topics in the training programme. Specific needs for the training programme have been discussed with stakeholders and relevant professionals' organizations.

Based on the collected opinions and data, we have introduced a very similar educational program in both countries, which covered following topics:

• aetiology, epidemiology, cancer biology (disease development, staging etc.), basic principles of solid cancer and most common haematological malignancies treatment (surgery, radiation, medical therapy, stem cell transplantation)
• the principles of chemotherapy, hormonal therapy, targeted therapy and immunotherapy
• overview of most common side effects of cytotoxic drugs, hormonal drugs and other oral anticancer drugs (TKI), counselling and action
• directions of use, how to find information (both pharmacists and patients), evidence of using alternative medicines, food supplements, herbal medicine
• drug-drug and drug-food interactions
• introduction of case reports
• principles of safe handling of medicines in a pharmacy and at the patient's home
• support of patients in the treatment with oncologic medicines by pharmacists, advice to patients in community pharmacy
• presentation of the EPIC database and instructions for the work

The programme was provided for the pharmacists as e-learning course in both countries and also as face-to-face one day educational event in Slovenia. The programme is divided to three modules and every part has been completed by passing the test.

We are pleased that in both countries participation exceeded our expectations. 504 pharmacists (28% of all pharmacists working in pharmacies in Estonia) were registered in the e-training course; most of them are working in the community pharmacies (88%). In Slovenia 260 pharmacists registered in e-training and 40 pharmacists participated at face-to-face lectures, which means that more than 22% of all pharmacists working in the community and hospital pharmacies took part at the education.

A survey was conducted after finishing the e-training to assess pharmacists' confidence in and knowledge to counsel cancer patients on oral chemotherapy. The majority of the participants have been satisfied with the structure, content and organization of educational program. The majority of pharmacists consider that they have improved their knowledge in the field of adverse drug reactions, interactions and counselling. Many of pharmacists increased their confidence in counselling and dispensing of oral anticancer drugs. Detailed analysis of results will be presented at ECOP4.

E-tool: Oral anticancer drugs database

Database as a pharmacist's tool was established and implemented. It is based on a German web based program, which was translated to Slovenian and Estonian language and modified to conform to local practices and legislation.

Database consist of three modules: a database of side effects, database of oral anticancer drugs monographies, which are present on market in Slovenia and Estonia and a module dedicated to pharmaceutical care of cancer patients.

The drug database consists of more than 50 monographs, with the basic information for the patients including general information on the drug, common side effect, instruction for use, interactions with other drugs. There are also additional information/warnings for the patient like safe handling of the drugs, pregnancy/breastfeeding and, if needed, warning of the effects on the ability to drive and use of the machines. Information for pharmacist on the different strengths and packaging of the drugs, with the pre-entered frequency of drugs to be taken by patient is also included in each monograph.

Database of most common side effects consists of monographies of more than 35 side effects. The information is provided for different target groups: more basic and easily understandable version for patients and more in-depth information for pharmacists. Monographies introduce symptoms, severity according to CTCAE classification, and information on management of side effects for the patient and when to consult a physician. These side effects are linked to the drug monographs and are ready to be printed by pharmacists when dispensing the drugs to the cancer patients.

The third module is database of patients, which can be managed by pharmacists. For each patient in the database following actions can be performed: appointments management, pharmaceutical care documentation, preparation of different print-outs for the patient (including patient's dairy, information on side effects and drugs), an patient�s adverse effects management.

There are currently pharmacists from 60 different pharmacies registered for the use of database in Slovenia (16,8% of all pharmacies). Based on results of survey conducted, we found out, that many more pharmacists plan to register to the database. Those already registered are satisfied with the structure, quality of information in the database and the process of registration. They agree, that the database helps them at dispensing of anticancer drugs. However we have also identified some problems, which pharmacists are facing at dispensing of oral anticancer drugs, of which the main is lack of time for counselling.

Future Steps

We will strive to present and implement the training program and the database in other members' countries of ESOP. In the future, we want to harmonize the contents of the database. To this end, we will set up a working group that will meet for the first time at ECOP4 conference in Nantes. We will soon inform you about further procedures.

For more information and suggestions, please send us an email: epic@esop.li

European Society of Oncology Pharmacy
Veritaskai 6, D 21079 Hamburg
Tel: 0049 - 40 466 500 300
Mail: membershipservice@esop.li

Fax: 0049 - 40 466 500 100
Web: www.esop.li