Cancer care pathways across seven countries in Europe: What are the current obstacles? And how can artificial intelligence help?

BACKGROUND: Cancer poses significant challenges for healthcare professionals across the disease pathway including cancer imaging. This study constitutes part of the user requirement definition of INCISIVE EU project. The project has been designed to explore the full potential of artificial intelligence (AI)-based technologies in cancer imaging to streamline diagnosis and management. The study aimed to map cancer care pathways (breast, prostate, colorectal and lung cancers) across INCISIVE partner countries, and identify bottle necks within these pathways. METHODS: Email interviews were conducted with ten oncology specialised healthcare professionals representing INCISIVE partner countries: Greece, Cyprus, Spain, Italy, Finland, the United Kingdom (UK) and Serbia. A purposive sampling strategy was employed for recruitment and data was collected between December 2020 and April 2021. Data was entered into Microsoft Excel spreadsheet to allow content examination and comparative analysis. RESULTS: The analysed pathways all shared a common characteristic: inequalities in relation to delays in cancer diagnosis and treatment. All the studied countries, except the UK, lacked official national data about diagnostic and therapeutic delays. Furthermore, a considerable variation was noted regarding the availability of imaging and diagnostic services across the seven countries. Several concerns were also noted for inefficiencies/inequalities with regards to national screening for the four investigated cancer types. CONCLUSIONS: Delays in cancer diagnosis and treatment are an ongoing challenge and a source for inequalities. It is important to have systematic reporting of diagnostic and therapeutic delays in all countries to allow the proper estimation of its magnitude and support needed to address it. Our findings also support the orientation of the current policies towards early detection and wide scale adoption and implementation of cancer screening, through research, innovation, and technology. Technologies involving AI can have a great potential to revolutionise cancer care delivery. POLICY SUMMARY: This study highlights the widespread delay in cancer diagnosis across Europe and supports the need for, systematic reporting of delays, improved availability of imaging services, and optimised national screening programs. The goal is to enhance cancer care delivery, encourage early detection, and implement research, innovation, and AI-based technologies for improved cancer imaging.

Shared decision making and experiences of patients with long-term conditions: has anything changed?

BACKGROUND: Medication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services. METHODS: A mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George's and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics. RESULTS: The response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service. CONCLUSION: Although patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals.

Impact of community pharmacists in COPD management: Inhalation technique and medication adherence.

BACKGROUND: Inhalation technique and medication adherence are highly important for the management of chronic obstructive pulmonary disease (COPD) since they are essential pre-requisites for achieving full therapeutic effect in patients. Community pharmacists are in the best position to deliver services in these two areas. METHODS: This is a ten-year period review of studies looking into the impact of community pharmacists in the management of COPD in relation to: inhalation technique and medication adherence in the period from 2005 to 2015. RESULTS: Ten studies are included in the review. The studies show that community pharmacists' interventions had a positive impact on improving patients' inhalation technique and adherence to inhaled medications. This was shown in some studies to be cost-effective in terms of reducing hospitalisation and severe exacerbation rate. Scarcity of studies in this domain is noted through this review. CONCLUSIONS: This review showed that community pharmacists can have a positive impact in the management of COPD especially on inhaler technique education and medication adherence. Nevertheless, their role is still not fully recognised in this area, thus there is a need for more research. There is also a need for more research to identify the optimal frequency for inhaler technique re-checking and education as a pre-emptive measure against technique deterioration in patients. The results highlight the need for healthcare systems to recognise more the role of community pharmacists in COPD management in two critical areas that are still challenging in real practice.

The role of the pharmacist in optimizing the use of erythropoietin stimulating agents.

PURPOSE: With the emerging new warnings surrounding the use of erythropoiesis-stimulating agents (ESAs), the pharmacist's role as health educator and risk communicator expands further to include patient scrutiny to check for eligibility and patient monitoring to check for response or toxicity. This review explores the benefits and risks linked to ESAs use, and the proposed role. SUMMARY: ESAs have been increasingly used for the treatment of chemotherapy-induced anemia because of its documented effect on decreasing transfusion dependency. However, their use has been associated with thromboembolic complications, tumor progression, and decreased overall survival. This review covers current recommendations and guidelines that surround ESAs use in the supportive care of cancer patients. CONCLUSION: To minimize or prevent the complications associated with ESAs use, cancer patients should be adequately monitored and counseled. This highlights the importance of the pharmacist's involvement to optimize patient care.

Risk of osteonecrosis of the jaw in cancer patients taking bisphosphonates.

PURPOSE: The risk of osteonecrosis of the jaw (ONJ) associated with bisphosphonate use in patients with cancer is reviewed. SUMMARY: ONJ is a relatively new complication of supportive care in cancer. Bisphosphonate-associated ONJ can be generally defined as necrotic bone exposure to the oral cavity and inflammatory reactions of the surrounding soft tissue in patients receiving bisphosphonates but not radiotherapy to the head and neck. The risk of development of ONJ varies with the type of bisphosphonate used and the duration of exposure, with more potent agents increasing the risk with shorter durations of exposure. From the current evidence, the incidence of this disorder in cancer patients receiving bisphosphonates can be as high as 10% when patients have more than one risk factor. Risk factors include type of bisphosphonate, duration of exposure, concomitant medications, comorbidities (e.g., hypertension, dyslipidemia, diabetes, rheumatoid arthritis, lupus), and lifestyle behaviors (e.g., smoking, obesity). To minimize the risk of ONJ, patients initiated on bisphosphonates should optimize routine dental care and have their baseline oral cavity status evaluated by both clinical and radiographic examinations before initiation of bisphosphonate therapy. Current management of ONJ is difficult and empirical. At present, a conservative approach is recommended, including systemic antibiotics, antiseptic oral rinses, pain control, and limited debridement. CONCLUSION: Cancer patients receiving bisphosphonates are at risk for developing ONJ. Clinicians should evaluate patients' oral integrity and existing risk factors before initiating bisphosphonate therapy. Once treatment is started, patients should be closely monitored for signs and symptoms of ONJ.