Integration of Palliative Pharmacists to Standard Oncologic Care of Patients with Head and Neck Cancer

Brooke Brodzinski; Doug Laux; Lorin Fisher; Susan Fajardo; James Ray

doi:10.1080/15360288.2025.2533682

Background: In the past decade, the integration of palliative care services into the standard oncologic care of patients with advanced cancer has demonstrated an improvement in patients’ perceived quality of life, symptom burden, coping skills, and overall survival rate compared to standard care. Considering the physician shortage in the United States, oncologists have limited time to adequately assess cancer and treatment-related symptoms, discuss goals of care, and provide psychosocial support while also managing cancer treatment regimens. Integrating primary palliative care in an oncology clinic through a pharmacist has the potential to improve quality of care as well as patient and oncology provider satisfaction. Methods: This study was a prospective, proof of concept study conducted at a single-center large academic medical center. Two groups of patients diagnosed with head and neck cancer receiving or having completed goal-directed therapy were followed up to 6 months in the oncology clinic on a weekly basis. Patients who already had a full palliative care consult were excluded. Group 1 (G1) was followed by a PGY2 palliative care and pain management pharmacy resident and the primary oncology team. Group 2 (G2) was followed by the primary oncology team. The primary oncology team consisted of a registered nurse, a certified physician assistant, and a medical oncologist. Patient satisfaction was assessed through completion of a pre-/post-service implementation quality of life and symptom management survey, with questions adapted from previously published survey tools. Provider perceptions were assessed by a survey at the end of the study period. A retrospective chart review was completed to determine the number of emergency department (ED) visits or hospitalizations for each participant over the defined study period. The pharmacy resident tracked recommendations given and implemented via RedCap for any patient scheduled to see the medical oncologist. This study was reviewed and approved by the academic medical center’s institutional review board. Results: Ten patients enrolled and consented in G1 and nine patients in G2. One patient was lost to follow-up in G1. Two patients in G2 transferred their oncology care locally and one patient transitioned to comfort care. Comparison of responses for quality of life and treatment plans were similar between groups. In G1, one patient had four ED visits and three hospitalizations within 6 months for shortness of breath related to tracheostomy care and another patient had one hospitalization for bacteremia due to a port infection. In G2, one patient had one hospitalization for shortness of breath related to influenza. Over 18 clinic days, the most common interventions made by the pharmacy resident were symptom assessments (76 interviews) and counseling on symptom management (49 events). Most medication recommendations were optimizing bowel regimens and analgesia. Conclusion/Impact: The addition of a palliative care–trained pharmacist focused on symptom management enhanced the oncologist’s efficiency without compromising quality patient care. This also improved communication and transitions to specialty palliative care when needed. The limitations of this study included small sample size over a short period of time. Future focus will be expanding this service to clinics with supportive care gaps.

Integration of Palliative Pharmacists to Standard Oncologic Care of Patients with Head and Neck Cancer

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