Dr Inge Kriel explains the role of a compounding pharmacist in survivorship care.

Breast cancer survivors have unique needs after active cancer treatment.

Hair loss, dry skin, brittle nails, burning and tingling in hands and feet (peripheral neuropathy), and vaginal dryness are only some of the myriad afflictions that a cancer survivor may need to deal with day-to-day.

These conditions are distressing and can have a significant impact on a patient’s quality of life. Many breast cancer survivors do not seek help for these conditions, either because they feel that their complaints are too trivial or embarrassing to discuss with their oncologist, or they fear having to take more pills (with their own ensuing side effects). They also worry about any potential interactions any medication may have with their ongoing cancer treatment, for example, tamoxifen. This is where an oncology care physician comes into play.

Side effects of menopause

Post-menopausal symptoms are particularly worrisome for breast cancer survivors. Chemotherapy and endocrine therapy may launch a patient into early menopause with all the accompanying side effects: irritability, dry skin, hot flushes and vaginal dryness. These symptoms can have an overwhelmingly negative effect on the overall quality of life, adding to concerns around body image, sexual function and fertility.

Easing side effects

• Oestradiol gels for vaginal dryness, and gels to enhance orgasm can significantly improve sexual function.

• Specialised skincare products can help to nourish dry skin. Brittle nails, often as a result of Herceptin, can be managed with Biotin capsules.

• Peripheral neuropathy after taxane-based chemotherapy can be particularly bothersome and may lead to balance disturbances. This can impact a woman’s ability to exercise. This can lead to a significant negative impact on her overall health and risk of cancer recurrence. A ketoprofen/gabapentin gel formulation can significantly improve symptoms of peripheral neuropathy.

What is a compounding pharmacist?

A compounding pharmacist is an individual who personalises a medication for a patient by mixing up individual ingredients in the exact dosage and strength as required by the patient.

The medication is then administered to the patient through a variety of routes: oral, rectal, intranasal (through the nose), and transdermal (through the skin). The benefit of the transdermal mode of delivery is that many of the side effects of the oral route can be avoided, as the medication is absorbed directly through the skin and therefore bypasses the gut, liver and kidneys. Only a small amount of the drug is absorbed into the bloodstream. This is particularly important for cancer patients who may already have some degree of organ impairment due to the cancer or the cancer treatment.

Working together

Typically, I will assess the patient’s unique survivorship needs during the initial survivorship consultation. I will then email a script for the appropriate treatment, as well as the patient’s contact details, through to the team of compounding pharmacists with whom I work.

The pharmacists contact the patient and arrange for a quote to be sent through to the patient. The cost of the products range anywhere from R40 to R400, depending on the cost of the raw materials that need to be obtained to formulate the products. A small delivery fee is charged and the products are couriered directly to the patient, once the patient has made payment.

I follow-up with the patient to determine their response to the treatment. If response is sub-optimal, I adjust the strength or dosage of the treatment and the pharmacists will re-formulate the product, according to my specific instructions. I obtain feedback from the patients regarding ease of application, as well as any other comments/criticism, and send this information through to the pharmacists. This helps the products to be improved or adjusted accordingly. This ensures that the patient remains adherent on the treatment, as she feels her specific concerns are being addressed.

Women do not have to suffer debilitating side effects as a result of cancer and cancer treatment. A range of personalised medications, tailor-made to suit a survivor’s unique needs are available to manage side effects.

Life will never be the same as before the cancer, but together we, oncology care physicians and compounding pharmacists, can help patients to find their new normal, and live a happy, fulfilling life after cancer.