In the midst of the COVID pandemic, urgent treatment for cancer patients has continued. As part of our Off-label Cancer Medicines programme, Senior Pharmacist Rickie O’Connell tells us how a two-year test and development programme became a vital part of the response to ensuring patients received the care they needed while staying safe.
In November when I first went on secondment from my regular job as a pharmaceutical analyst with the Scottish Medicines Consortium to be a senior pharmacist for the Medical Directorate’s Off-label Cancer Medicines (OLCM) programme, I knew the work would be challenging. The programme had two years funding to develop and test an approach for improving national consistency in the use of cancer medicines in a way that is different to that described in their licence. I was looking forward to a tough but interesting couple of years. I never imagined we’d be pedal to the metal, trying to put guidance in place so people with cancer could be treated more safely in a pandemic situation.
Responding to the crisis
Patients receiving treatment for cancer were initially considered a vulnerable group for developing severe COVID-19. Not unnaturally, patients and clinical teams therefore wanted, and still want, treatment options that require fewer hospital visits, have fewer serious side effects or that can be taken orally at home rather than in hospital.
Clinical leaders within the OLCM group identified the need for a national governance group to help prevent local medicine governance systems becoming overwhelmed with requests for less familiar treatments which could meet patient’s preferences to avoid hospital visits. Such changes, if carried out at a local level, would likely result in duplication of effort at a time when the health and care system was focused on tackling COVID-19, and could result in inconsistencies in treatments available to people with cancer across Scotland.
A new project for our team
Our OLCM programme team was just four months in to our project at the time, but following this advice we were deployed to work on COVID-19 National Cancer Medicines Advisory Group (NCMAG) to help address this challenge. Like many teams in Healthcare Improvement Scotland, our team has skills in evidence review and project management, as well as links with cancer clinical teams across Scotland, so we were well placed to help.
Things moved rapidly once the group was set up. Within weeks we had all the processes and support tools in place so that clinicians could submit proposals for treatments not routinely available, we could prioritise the work and produce the guidance. We also quickly got all the key players in place, including representatives from regional cancer networks and NHSScotland National Procurement, to ensure there were sufficient supplies of the medicines the group were supporting for use, and also ways to get our advice out to those who needed it. Once issued, the advice would mean that patients could have ready access to cancer treatment options that were not previously routinely available, and with fewer hospital trips.
Going at 90 miles per hour
The benefits of this national approach were quickly acknowledged by practicing clinicians and our team received many proposals in a very short time. Fortunately, our colleagues within the wider Medicines and Pharmacy team and colleagues from Scottish Medicines Consortium kindly supported us through the heaviest workload.
From April to July, the team has been working at a pace I didn’t think was possible. The original aim of our OLCM programme was to produce up to 10 pieces of advice in two years. So far we have produced 21 pieces of advice in four months. It’s not been easy, but knowing the advice we’re producing is benefitting those who need it most makes the effort and long hours worthwhile.
Adapting to changing circumstance
Looking back, the few months have seen a lot of things change. Like most of you, I’m no longer office based, and have swapped the Glasgow commute to working from home. I even have a noisy new colleague – my daughter, Úna, turned one during lockdown and her birthday was a busy day of back to back video calls. Since then she has developed new hobbies of heckling and cyber-attacking daddy during work meetings – the broadband router now hangs high up on the wall out of the reach of her tiny fingers.
And I was right about the secondment. It has been challenging. But I’m glad our team have had the opportunity to contribute, with our individual skill sets, to the care of cancer patients during this uncertain time.
Rickie O’Connell is a Senior Clinical Pharmacist with the Off-label Cancer Medicines Programme and Area Drug and Therapeutics Committee Collaborative