A key year for patients and the profession

The 2013 BOPA Annual Symposium was opened by BOPA Chair Ian Costello. In his welcoming address, Ian remarked that the 2013 meeting had attracted more than 500 delegates, and he thanked them all for their continued support.

He reminded the attendees that the BOPA Symposium was ‘their’ conference, and urged everyone to use the event as an opportunity to exchange ideas with colleagues, and to provide feedback or ask questions during sessions.

He also encouraged delegates to visit the exhibition hall throughout the following days, to support the pharmaceutical industry sponsors who are essential to the Annual Symposium.

Introduction Video

The conference got underway with a plenary session focusing on the crucial topic of access to cancer drugs. Several other key themes emerged throughout the 3 days, not least the importance of keeping the patient at the centre of everything that pharmacists do.

The packed agenda included further plenary sessions, a series of lively workstreams, workshops, poster discussions and industry-sponsored satellites. Plus, of course, the BOPA Symposium would not be complete without the time-honoured Myths and Pearls presentations, the Succinct Lecture and the Gala Dinner (complete with ceilidh).

The BOPA Annual General Meeting (AGM), held on Saturday 19 October, included an update on BOPA’s education and training initiatives, and an important announcement on the possibility of closer ties with the Royal Pharmaceutical Society (RPS). View the AGM report

Access to cancer drugs

Issues in NHS Scotland

Professor Angela Timoney (Chair, Scottish Medicines Consortium [SMC]) reminded delegates of the structure, purpose and roles of the SMC, and presented an overview of the outcomes of SMC decisions, along with a comparison of access to anticancer drugs in Scotland and England.

The SMC is a consortium of Area Drug and Therapeutics Committees (ADTCs) that provides advice to NHS boards and ADTCs on new medicines, including new formulations of existing medicines and new indications for existing medicines. The aim of the SMC is to improve patient care, and help to ensure the most cost-effective use of resources. To this end, it provides three categories of advice on new medicines in NHS Scotland:

  • Accepted for general use
  • Restricted use
  • Not recommended for use

Oncology drugs represent approximately 20% of submissions to the SMC, accounting for 108 of 554 medicines considered in 2013. Of these, 22 oncology drugs were accepted, 45 were accepted with restrictions, and 41 were not recommended for use. Compared with non-cancer drugs, submissions for oncology drugs generally had less supporting data from randomised trials, and a higher mean cost per quality-adjusted life year (QALY) gained. Angela remarked that overall acceptance rates for medicines have remained generally unchanged since the advent of the SMC, while the acceptance rates for oncology drugs had decreased slightly.

In England, drugs are reviewed by the National Institute for Health and Care Excellence (NICE), but there is additional access to oncology drugs via the £200 million/year Cancer Drugs Fund (CDF). There is no CDF in Scotland, although £20 million was set aside in the Rare Conditions Medicines Fund in January 2013. As yet, it is unclear what conditions this fund will cover, but it has been interpreted by many as a ‘Scottish CDF’.

Angela concluded by noting that the SMC has been strengthened by being provided with the resources needed to take a flexible approach and implement required changes, and has an opportunity to perform health technology assessments (HTAs) for medicines treating rare diseases. However, many challenges remain for both Scotland and England around medicines used to treat patients with terminal illness.

Presentation Slides

The patient’s perspective

​Eric Low (Myeloma UK) continued the theme of access to treatments, noting that a diagnosis of cancer was a life-changing event for patients, who have to deal not only with the burden of their disease, but also with the negative effects of treatment. Furthermore, there is considerable variation between patients and between different cancers, meaning that patients should be treated as individuals.

Eric continued by highlighting some of the issues and challenges of managing patients with cancer, particularly the need to balance the benefits of treatment, such as extending life and improving symptoms, with the negative effects of treatment and disease burden on patients’ quality of life. He commented that choices made by patients often focus on life and family.

He also noted the uncertainty around access to treatments. Not all aspects of value are captured in current HTAs, and studies have shown that society is willing to consider more factors than health gain when allocating resources.
Access to Cancer Drugs Video Presentation Slides

The RPS Faculty—professional recognition in action

Catherine Duggan (Director of Professional Development, RPS) and Geoff Saunders (Consultant Oncology Pharmacist, The Christie NHS Foundation Trust) presented a session on the RPS Faculty, a body designed to recognise pharmacists’ professional development.

The session began with a brief presentation by Geoff looking at what makes a pharmacist an oncology pharmacist. He concluded that being an oncology pharmacist is far more than an ‘alphabetti-spaghetti’ of qualifications. He looked back over the establishment of competencies for the specialty, which were developed initially by BOPA, and more recently taken under the wider umbrella of the RPS.

The RPS was set up in 2010, with a mandate to offer membership to all pharmacists, plus special memberships for students and pharmaceutical scientists. Following the lead already created by BOPA and other specialty groups, the RPS aimed to improve recognition for the work of pharmacists. The latest development is the RPS Faculty, launched in June 2013 to enable pharmacists to advance their professional practice—and to have that advancement recognised.

Presentation Slides

The RPS Faculty defines three stages of specialty advancement for pharmacists and pharmaceutical scientists:

  • Faculty member stage I, for those in the early part of specialisation training
  • Faculty member stage II, for those who are an expert in their area of practice
  • Faculty fellow, for those who are a nationally recognised leader in their area of expertise

Advancement through each stage is based on knowledge, skills, experience and behaviour.

The government of the Faculty includes professional curricula, professional credentialing and professional accreditation panels, which report to the Faculty board, chaired by Peter Kopelman. So far, the first set of Faculty assessor training days, and the first Faculty board meeting have been held, 580 Faculty members are building portfolios for assessment, and 75 members have made submissions for assessment.

The RPS Faculty Video

The pharmacist’s role in commissioning: getting the best value

Jacky Turner (Area Team Cancer Pharmacist NHS England London Region, Member of Chemotherapy Clinical Reference Group [CRG]), Steve Williamson (Member of Chemotherapy CRG) and David Thomson (immediate past BOPA Chair) presented a session covering the pharmacist’s role in commissioning.

Jacky explained that in England most drugs are commissioned at local level by the clinical commissioning groups. However, certain specialised medicines, such as cancer drugs, are commissioned and funded centrally by NHS England, which also runs the CDF. Issues that need to be addressed in the commissioning of cancer medicines include: identification of current gaps in commissioning policy; ensuring that funding streams for cancer medicines are consistent in NHS England, including the use of the CDF; identifying the correct source of funding for individual funding requests; and provision of ‘signposts’ to help providers and clinicians navigate the new commissioning structures. Addressing these issues is important for developing a policy that will be fair to everyone.

Centralised commissioning of specialised services is supported by 10 area teams—all but one of which have a cancer pharmacist in post. The area team cancer pharmacist helps with understanding chemotherapy expenditure and financial flows, with the aim of supporting the area teams through monitoring of chemotherapy expenditure in 2013/2014, and ensuring consistency in process. The role also includes updating chemotherapy algorithms, harmonising supportive medicines funded by chemotherapy procurement, and developing common currency to determine pharmacy costs associated with chemotherapy procurement. Area teams are in the process of evaluating potential models of service delivery, understanding the current position of clinical trial funding, and supporting the running of the CDF.

Steve explained that the commissioning of specialised services is supported by therapeutic area-specific CRGs, 15 of which are devoted to blood and cancer. The aim of each CRG is to ensure clinical- and patient-led development and delivery of commissioning products. These products include the scope, service specification, commissioning policy(s) and quality measures for each service. The role of the CRG members is to provide expert advice and guidance, communicate with the professional groups they represent, and assist with identification and consideration of innovations within their relevant areas.

The chemotherapy CRG has released a draft service specification, which includes key service outcome measures, such as survival rates and waiting times, compliance with peer-review measures, and e-prescribing of chemotherapy. Non-compliance with service specifications will result in derogation (a temporary reprieve to allow providers to bring their services up to the required standard).

David completed the session with an update on the CDF. The CDF was introduced in England as an interim measure to enable the funding of cancer drugs until the introduction of value-based pricing in April 2014. £600 million was allocated to the fund in April 2011, for use over a 3-year period, with a further £400 million over 2 years announced in September 2013. So far, the CDF has improved patient access to drugs within England.

There are three routes for gaining access to drugs via the CDF. If the drug is already on the national CDF cohort priority list, there is a simple notification process. If a drug is not on the list, and the patient is part of a cohort, an application can be made to the national CDF panel. If a patient is exceptional to these cohorts, an individual funding request can be submitted.

David concluded by noting that applications to fund a drug via the CDF are scored on the basis of the effects on survival and quality of life, toxicity, and the degree of unmet need. Evidence of clinical benefit is the key determinant of successful funding.

Presentation Slides The Pharmacist’s Role in Commissioning Video

Poster presentations

The Faculty of Cancer Pharmacy in association with BOPA hosted this year’s poster discussion session, which showed excellence in oncology pharmacy research. Six presentations were made, featuring the best posters in the categories of original research, audit and innovation.

Best Oral Presentation, as voted by the audience, was awarded to Clair Clark, who received a £2,000 travel scholarship to an international conference, while the vote (by BOPA delegates) for Best Abstract Poster was won by Conor Doyle.

Dahlia Salman (Kingston University, London) evaluated the solubility and stability of ifosfamide. Currently, patients need to return to the pharmacy every 7 days to receive a new pump, because the physicochemical stability of ifosfamide solution has not been demonstrated. Evaluation of ifosfamide 80 and 100 mg/ml solutions showed the appearance of degradation products of ifosfamide in the solution over a 10-day period, with a greater reduction in concentration in the 100 mg/ml solution versus the 80 mg/ml solution, as well as formation of large insoluble particles.


Presentation Slides

Alastair McMurray presented a poster on behalf of Dan Mellor (Peter MacCallum Cancer Centre, Melbourne, Australia). Dan used pharmacy records to compare the outcomes of a cohort of patients with melanoma who had received ipilimumab in clinical practice with those observed in clinical trials. Dan concluded that the available data show generally comparable survival and tolerability outcomes in the community-treated patients and the MDX010-20 study. However, he recommended that, because of the frequency of adverse events, ipilimumab treatment should occur under the supervision of an experienced clinical team.

Presentation Slides

Clair Clark (Beatson West of Scotland Cancer Centre, Glasgow), presented her audit of neutropenic complications in breast cancer patients receiving neoadjuvant or adjuvant treatment with fluorouracil + epirubicin + cyclophosphamide followed by docetaxel (FEC-D) in the West of Scotland after a protocol change stopped automatic prophylaxis with granulocyte colony-stimulating factor (G-CSF) during the FEC phase of treatment. The audit met its first criteria, i.e. all patients who received G-CSF prophylaxis had risk factors for neutropenic sepsis; the audit also met its secondary and tertiary criteria of delays to FEC-D treatment. Clair recommended further study into the use of FEC-D in obese patients, as her data suggested that this population are at higher risk of developing neutropenic sepsis.

Presentation Slides

Emma Riches (University College London Hospital, London) presented her study of TICTAC, a tool for identifying clinical trial capacity within pharmacy cancer services. The tool scored trials based on a number of complexity variables, such as phase and number of treatment arms, and tasks undertaken by the pharmacy were timed, and captured with the TICTAC tool. Over the 9-month period the tool was in use, data were collected from 19 trials that were set up in their entirety. The complexity score for each trial was shown to explain almost half of the time taken to set up each trial, with each trial taking a mean of 14.25 hours to set up.

Presentation Slides

Dahlia Salman presented her second poster, an evaluation of the performance and accuracy of Easypump elastomeric devices for home chemotherapy. Dahlia tested the effects of environmental temperature and diluent viscosity on the performance of elastomeric pumps available on the UK market, finding that the measured flow rate could vary considerably from the expected flow rate, depending on these factors.



Presentation Slides

Finally, Farida Butt (Kingston University, London) presented her study exploring the current practices of community pharmacies when supplying oral anticancer medicines. Approximately 25% of 300 community pharmacists responded to the survey, with 39 of the 76 respondents having dispensed oral anticancer medicines for cancer patients. The study concluded that some pharmacists are not complying with BOPA verification standards and guidance on oral anticancer medicines, suggesting that further training is necessary to support community pharmacists dispensing these drugs.

Presentation Slides

Clinical updates

Seven clinical update sessions were held throughout the conference, giving delegates an insight into the latest findings on the management of various cancers and the toxicities associated with anticancer therapy.

Dr Graham Dark (Senior Lecturer in Medical Oncology & Cancer Education, Newcastle University) presented an update on ovarian cancer, including its pathogenesis and treatment. He discussed highlights from various promising avenues of clinical research, including use of vascular endothelial growth factor inhibitors such as bevacizumab in combination with chemotherapy, the role of biomarkers such as CA-125, the potential of p53 mutation status as a prognostic indicator, and the use of poly-ADP-ribose polymerase inhibitors.

Ovarian Cancer Video Presentation Slides

Margaret Gibbs (Specialist Senior Pharmacist, St Christopher’s Hospice) presented a session on the management of neuropathic pain, a difficult-to-treat symptom affecting up to 40% of patients with cancer. There are various causes, including tumour growth, metastases in the brain or spinal cord and iatrogenises. The treatments available for neuropathic pain include antidepressants, antiepileptics, opioids, topical anaesthetics and N-methyl-D-aspartate receptor antagonists.

Management of Neuropathic Pain Video Presentation Slides

Dr Pam McKay (Consultant Haematologist, Beatson West of Scotland Cancer Centre, Glasgow) gave a presentation on the classification and treatment of rare lymphomas. As a group, non-Hodgkin lymphomas are the sixth most common cancer in the UK, although there are a large number of distinct lymphoma types with differing aetiology, characteristics and treatments. Treatment options depend on the likely clinical course of each lymphoma, and its suitability for specific therapies, such as rituximab.

Rarer Lymphomas Video Presentation Slides

Jennifer Laskey (Senior Clinical Effectiveness Pharmacist, Beatson West of Scotland Cancer Centre, Glasgow) talked about the toxicity of tyrosine kinase inhibitors (TKIs), discussing their mechanism of action and indications. Jennifer noted that the potency and specificity of each drug influences its side effects, which commonly include fatigue, cardiac effects, gastrointestinal toxicities and skin toxicities. TKI-associated toxicities should be proactively managed, by identifying those patients most at risk, providing symptomatic management where appropriate, and modifying doses when necessary to minimise the negative effects of treatment on patient quality of life.

Toxicity of Tyrosine Kinase Inhibitors Video Presentation Slides

Dr Robert Jones (Senior Lecturer & Honorary Consultant in Medical Oncology, University of Glasgow) presented an overview of the treatment of metastatic, castration-resistant prostate cancer. Approximately 30–40% of cases progress to metastatic disease, which is the sole cause of death from prostate cancer. Treatment options are limited, with the mainstay being docetaxel, which can be followed by abiraterone and cabazitaxel. Recent evidence suggests that enzalutamide is not only an effective substitute for abiraterone, but may also improve quality of life in this patient population.

Castrate-Resistant Prostate Cancer Video Presentation Slides

Dr Sally Clive (Consultant Medical Oncologist, Edinburgh Cancer Centre) considered the management of colorectal cancer (CRC). Treatment of CRC can have a number of aims, ranging from curative therapy for early-stage disease, to palliative treatment for metastatic disease, with the primary goal of maximising the duration of good quality of life. Treatments include targeted therapies such as bevacizumab and cetuximab, as well as oxaliplatin-based chemotherapy.

Colorectal Cancer Video Presentation Slides

The final clinical update session was presented by Dr Jeff White (Consultant Medical Oncologist, Beatson West of Scotland Cancer Centre, Glasgow), and focused on gastrointestinal stromal tumours (GIST). This rare sarcoma is relatively well understood, with two main causative mutations identified. Medical management of GIST is based on treatment with TKIs, with imatinib used as first-line therapy and sunitinib in the second line. Several drugs have been shown to be effective as third-line treatment, including the recently approved kinase inhibitor regorafenib.

Gastrointestinal Stromal Tumours Video Presentation Slides

E-prescribing—what are the risks?

E-prescribing will be mandatory by April 2014, largely on the grounds of safety. However, it is not without its own inherent risks. These were discussed in a workshop, with presentations from Kavita Kantilal (Lead Pharmacist, East & North Hertfordshire NHS Trust), Marcus Warner (Specialist e-prescribing Pharmacist, CIS/Mosaiq) and David Barber (Oncology Pharmacist, Lancashire Teaching Hospitals NHS Foundation Trust).

The presenters noted that three areas of e-prescribing are associated with risk:

  • Regimen setup
  • Prescribing
  • Post-prescribing

Setup risks include problems with rounding of doses, incorrect entry of regimens into e-prescribing systems and version control. However, these risks can be managed by appropriate validation of regimens by clinical pharmacists, consultants and nurses. Prescribing risks include user error and failure to follow standard operating procedures, and these issues can be mitigated by appropriate training and allowing users time to practise with the system. Marcus also noted that an e-prescribing helpline staffed by a specialist pharmacist and technician can help to reduce prescribing errors. Post-prescribing risks are varied, and include problems associated with manual transcription of e-prescriptions, and incomplete entry of prescriptions into the system.

David concluded the session by noting that the effects of the e-prescribing system on workload are variable—time may be saved when entering long regimens, but entry of short regimens appears to be more time consuming than written prescriptions.

E-prescribing—What are the Risks? Video Presentation Slides

NHS, policy and access to drugs

Various key themes of BOPA 2013—notably access to treatments, patient-focused practice and the power of information—were further explored in the 2-day workstream ‘NHS, policy and access to drugs’.

Susanna Daniels (Lead Pharmacist, Cancer Services, University College London Hospitals) opened this well attended workstream with a detailed account of a prescribing error. The error arose during a clinical trial using two different regimens, both containing bleomycin, etoposide and cisplatin, and both named BEP on the e-prescribing system—despite differences in the bleomycin dose (45,000 vs 90,000 units of bleomycin). The delegates agreed that the error was all too easy to make—and several acknowledged similar errors and/or close shaves. Susanna highlighted the importance of liability insurance, emphasising that trust arrangements will not cover individual pharmacists for professional responsibility issues. At a vote, about half of the pharmacists attending indicated they did not hold such insurance.

Professor Michael Dooley (Director of Pharmacy, Alfred Health, Melbourne, Australia) and Robert Duncombe (Chief Pharmacist, The Christie NHS Foundation Trust) then explored the topic of key performance indicators (KPIs) for oncology pharmacists. Michael argued strongly that KPIs should focus less on measurements of what pharmacists do (e.g. interventions delivered or ward rounds conducted) and more on the impact that pharmacists have on patient outcomes. He stressed: “It’s not about measuring what you do. It’s all about impact of what you do.”

Robert focused on the importance of making sure KPIs are SMART, i.e. Specific, Measurable, Attainable, Realistic and Timely. He offered the following examples of SMART KPIs for the oncology pharmacist:

  • Make sure you are up-to-date with all mandatory training
  • Deliver at least two education sessions in the course of the year
  • Consistently check that patients have funding in place for their treatment
  • Be engaged in at least one piece of audit or research
  • Record all drug incidents where severity is moderate/major

Presentation Slides

An update on the National Clinical Capacity Project was presented by Denise Blake (Senior Lead Clinical Pharmacist, Cancer Services and Paediatric Oncology, Newcastle upon Tyne Hospitals NHS Foundation Trust). She outlined the many drivers, e.g. optimisation of medication, safety and patient empowerment, and the need for a pharmacy workforce sufficient to ensure standards, credentialing, training and advocacy. Communicating the wide-ranging roles of the professionals involved will be crucial to effective workforce planning in oncology pharmacy.

Mark Evans (Associate Chief Pharmacist, The Royal Marsden NHS Foundation Trust) considered work that has already been conducted on pharmacy capacity, e.g. in critical care and renal services, and suggested that lessons could be learnt from these initiatives. Within oncology, models have been developed in Scotland, Australia/New Zealand and Canada, and BOPA verification standards have been benchmarked at various centres. Encouragingly, some common findings have emerged. Scotland estimated a need for one wholetime equivalent (WTE) pharmacy post for 25 inpatient oncology beds (or 15 inpatient haematology beds), and Australia/New Zealand estimated one WTE for 20–25 oncology beds (or 10–15 haematology beds).

Verification of prescriptions for cancer medicines using BOPA standards was estimated to require 10–12 minutes (North of England Cancer Network) or 8–13 minutes (The Royal Marsden), compared with the 12–18 minutes suggested by BOPA. As workforce planning moves forward, oncology pharmacists need to consider whether they are happy with (i) their level of input into medicines optimisation in the current chemotherapy pathway, and (ii) the amount of pharmacy-led research on medicines optimisation in oncology.

Presentation Slides

The topic of information—and its importance in oncology care—also came to the fore in a presentation on the Systemic Anti-Cancer Therapy (SACT) Database, presented by Paul Buckle (Senior Project Manager, Chemotherapy Intelligence Unit, Public Health England) and Marcus Warner (Specialist e-prescribing Pharmacist, CIS/Mosaiq). Delegates were reminded that, from October 2013, collection and submission of SACT data will be part of the NHS Contract in England. One of the key roles of oncology pharmacists will be to develop ‘regimen mapping’, i.e. entry of treatments onto the database using centrally agreed regimen names. This practice need not change how regimens are referred to locally, but will ensure accurate data collection nationally. And what is the reward for all of the hard work involved in participation? Delegates’ appetites were whetted with a brief preview of preliminary analyses to emerge so far from the SACT Dataset.

Presentation Slides

Ailsa Brown (Lead Health Economist, SMC) rounded off this workstream with an in-depth consideration of how we decide the value of drugs. Although she was speaking from the Scotland perspective, her presentation had relevance for delegates across all of the UK. Welcome light was shed on often used—but hazily understood—concepts such as QALY and cost-per-QALY thresholds. It is a field beset by challenges, not least the need to make very difficult decisions about the allocation of finite resources, as well as finding ways to engage with the public to demonstrate how value is defined and reflected in HTAs.

The Succinct Lecture—retaining human values in the face of technology

This year’s Succinct Lecture was presented by Professor Lord Robert Winston, Professor of Science and Society and Emeritus Professor of Fertility Studies at Imperial College London, and a well known television presenter on medical issues. He began with a discussion of how humans changed during the course of evolution, to the point where we began to develop technologies that in turn influenced our evolution. Examples included hunting, cooking, and most importantly, cooperation and communication. These advances led not only to expansion of the human brain, but also to expansion of the human mind. In fact, human advances have now reached the stage where it is impossible to predict which direction humanity is heading in.

Professor Winston moved on to discuss the effects of human values on science. Citing the example of nuclear fusion, he briefly considered recent milestones in the field, noting that fusion research in the USA is funded by the nuclear weapons programme. He then segued to the topic of eugenics, presenting examples ranging from the overt eugenics programme of Nazi Germany, to the more ambiguous modern example of offering tubal ligation to female prison inmates in California without adequate informed consent.

Turning to genetics and other biomedical advances, Professor Winston used media reports to illustrate the effects of culture and scientific literacy on how advances are interpreted. For instance, the human genome project was widely reported as an advance that would provide new insights into what makes us human, and revolutionise modern medicine. In reality, the project has told us little about what gives us our humanity. Furthermore, advances to date in epigenetics show that we are still a long way from understanding what makes us who we are, and that factors other than our genes, particularly our environment, may play an even more important role in defining our humanity.

Myths and pearls

Music therapy

Andrew Stanley (Consultant Chemotherapist, Birmingham City Hospital; Honorary Senior Lecturer, Warwick University; and visiting Teaching Fellow at Aston University) admitted his own initial cynicism about music therapy, before going on to present evidence showing its effects on outcomes in patients with cancer.

A systematic review suggested that music therapy aids relaxation, helping patients approach their treatment with a positive attitude. Growing acceptance of the role of music therapy in cancer treatment has even led to degree courses on the subject.

However, Andrew also suggested that individual patients are likely to differ widely in their responses to different musical offerings, largely as a result of the memories evoked by various tracks. He offered his own, somewhat eclectic, Desert Island Discs playlist as a personal example of musical signposts throughout a life and career.


Myths of dosing

Max Summerhayes (Associate Head of Medical Affairs, Roche Products Ltd) talked about two myths of drug dosing, the first being that if patients experience toxicities at the starting dose of a drug treatment, then the dose is too high, and the second myth being that ‘better’ dosing methods produce better outcomes.

With regards to the first myth, Max talked about patients responding to drugs differently, and the need for individualised dosages.

A dose reduction in response to treatment toxicity is likely to result in the ‘correct dose’ for that individual patient, while a dose reduction for a patient who does not have toxicity would probably result in underdosing and a loss of efficacy. Moving on to the second myth, Max concluded that methods of dose calculation all have advantages and limitations, but are not intrinsically good or bad, with consistent dosing being the most important factor to consider when determining a regimen’s efficacy.


Timing of oral chemotherapy

“Take 1 hour before food.”

“Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food.”

“Do not take milk, indigestion remedies, or medicines containing iron or zinc, 2 hours before or after you take this medicine.”

It is easy to write instructions like these for patients prescribed oral chemotherapy, but how easy is it to comply? Bruce Burnett (Teacher Practitioner in Clinical Pharmacy Practice, University of Wolverhampton) talked about the timing of oral chemotherapy, the wide variation in the recommendations in relation to food and/or supplement intake, and the practical difficulties that these can cause.

Furthermore, these suggestions are based on the findings of trials, where patients’ food intake might bear little relation to what and when patients eat in real life. Bruce recommended giving better advice to patients, and carrying out more research into the effects of food on medicines.

Folinate dosing in CRC

Calum Polwart (Area Team Cancer Pharmacist, Cumbria, Northumbria, Tyne & Wear Area Team) rounded the Myths and Pearls with a presentation on folinate dosing, in which he noted that high-dose folinate generally appeared to offer no significant benefit over low doses, with the exception of very high-dose folinic acid in combination with bevacizumab-containing regimens.

When used in combination with bevacizumab, the combination appeared to add a significant clinical benefit, increasing progression-free survival by 6 months.






Closing remarks

The main themes of the 2013 BOPA Symposium were oncology pharmacists’ passion for improving the care and quality of life of their patients, the power of information for improving treatment, and the ongoing changes in the NHS, with a special emphasis on improving access to new treatments in Scotland. Ian Costello also commented on the quantity and quality of ongoing research presented at BOPA 2013, and urged delegates to build on this research for the benefit of their patients.

The 17th Annual BOPA Symposium will be held at the International Convention Centre in Birmingham on 17–19 October 2014. Make sure you add the date to your diary now.

Thank you once again to all of our sponsors for their financial support, without which the conference would not be possible.

Summary of Key Themes, Challenges and Close Video

Vox pop





Date for your diary

Make sure you don’t miss the 17th British Oncology Pharmacy Association (BOPA) Annual Symposium.

This year’s setting is the vibrant heart of Birmingham. The venue—the acclaimed International Convention Centre (ICC)—is ideally placed for the city’s attractions, including historic sites, restaurants, bars and everything the shopaholic could wish for. The programme is already being planned—and you are guaranteed a lively mix of presentations, workshops and debate, not to mention networking.

So make a date to join your colleagues at the key oncology pharmacy event of 2014.

visit the Symposium website here.



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