Early cancer diagnosis – can outcomes in deprived areas be improved by involving community pharmacists?

Problem

The key to the success of cancer treatment and better clinical outcomes is early detection. Clinical outcomes from cancer are worse in deprived communities. The role of primary care is essential in early diagnosis as patients with cancer related symptoms most commonly present to primary care for initial consultation. The significantly increased workload in general practice and the difficulties deprived communities experience accessing general practice raise the possibility that other health service providers that are easily accessible, such as community pharmacies, can contribute to the recognition of symptoms representing cancer.

Approach

A scoping review of the available literature was conducted by searching PubMed using keywords “pharmacist” and “cancer”, and by handsearching relevant UK-based websites. We aimed to summarize the evidence from the UK, examining gaps in the available research outcomes.

Findings

The PubMed search identified 245 titles. Five of these were relevant. One of these studies was a systematic review with no UK-based studies included. Only one of the five publications was from the UK: an assessment of an online decision support tool that can be completed in community pharmacies.Hand searches identified the Accelerate, Coordinate, Evaluate (ACE) program, which includes five different projects contributing to the early diagnosis of cancer. Nine further studies reported on initiatives addressing raising awareness, providing education, or offering risk assessment (and in some cases referral to a GP or directly to secondary care). Methods varied, but, in general, outcomes were poorly reported or not at all.

Consequences

More evidence is needed to evaluate the effectiveness of interventions in community pharmacies aimed at recognising cancer symptoms early. Feasibility of such approaches, acceptability to patients and stakeholders, and particularly the effectiveness of the interventions and clinical outcomes need to be further characterised. In line with The National Institute for Health and Care Excellence (NICE) research recommendations, these would be best explored by comparing uptake in affluent and deprived populations to assess if the community pharmacy team can be part of a revised pathway of care.