By Nathan Ohiomokhare

My first inclination was to title this article "THE DRUG CALLED EMPATHY". I joggled between that and the current title and finaly chose to settle for a more catchy one involving dosage.

There are two areas of patient management I do not like and I do my best to avoid them. They are Oncology and Psychiatry. The reasons are obvious. There is too much pain, cost and stress on all sides of the divide viz the patient, treatment provider and caregivers/family. The emotional costs are way too high and the disease conditions are psychologicaly draining to the relatives of patients.

So when I summuned the courage to visit a friend at the National Hospital Oncology unit I wrote myself a prescription for a large supply of Empathy. Not that I would be attending to any patients drugs related needs that day, I just wanted to have in store an ample storage of my drug Empathy just in case. You see when you enter an Oncology clinic you have to project confidence not pity. You project hope and confidence because your attitude is very infective especially to an already burdened patient and the relatives. But one very important character you also need to project is Empathy.

When an individual has a Neoplasm (abnormal growth of cells) he/she is compelled to visit the outpatient clinic as a result of unbearable symptoms. Following presentation at the outpatient clinic a comprehensive physical examination is conducted after which a tentative diagnosis is reached by the attending Physician. The patient with a malignant tumour will be refered to the Consultant Oncologist who will order diagnostic tests and necessary scans (like a mammogram and Magnetic Resonance Imaging) to arrive at a definitive diagnosis. Such Physicians will almost always request for Biopsy to assertain malignancy.

Aside general blood chemistry some of these tests may likely involve scans and tissue sampling (Biopsy) to confirm if the tumour is malignant. Following difinitive diagnosis a care plan will then be drawn up after formulating a strategy involving one or a combination of close observation for a period, Adjuvant or Neoadjuvant Chemotherapy, hormone therapy, Radiotherapy or even surgery. The decision on the treatment strategy to adopt is done by a multidisciplinary team involving the attending Physician, nurse Pharmacist and Radiologist. The strategy will carefully put into consideration the stage classification of the cancerous organ. The Pharmacist in particular will provide information on available medications for malignant tumour, cost benefit analysis including considerations for side effects and toxicity profiles, potential Adverse Drug Reactions vis-a-vis any renal, cardiovascular or hepatic impairments. In cancer chemotherapy female patients are also considered for pregnancy, hormone levels, hormone deficiency and replacement therapy. It is usualy important for the team to clear any underlying ailments such as the usual culprits hypertension, diabetes, hypercholesteremia, Congestic Heart Failure(CHF), Sickle cell Anaemia and Imunocrompromised conditions (HIV/AIDs). The drugs and/or Radiotherapy dosage calculations are sensitive and bring to play Pharmacokinetic parameters that consider patients age, weight, Body mass index (BMI), organ function, hepatic metabolism, Kidney elimination rates, drug history, allergies to drugs fruits or foods.

The patient goes through a long period of testing and dosage titration until stable dosage regimen is attained. Weekly appointments for intravenous chemotherapy sessions are common and could become more or less frequent depending on the patients response to treatment. Radiotherapy sessions are also an option and the Radiopharmacist is usualy very busy in his/enclosure.

It was during one of these very busy chemotherapy sessions I visited a coleague at the Oncology ward. I was delighted to get the opportunity to observe one of the sessions as I needed to brush up on my knowledge of chemo drugs. All medications were being reconstituted realtime by the Oncology Pharmacists. I asked my host a few questions as she reconstituted contents of ampoules. She was fully kitted in personal protective gear reconstituting a cocktail of Cisplatin / Carboplatin + Ondasetron + Dexamethasone. There was also a session with Epogen -(Erythropoietin).

I took a look at the I.V line that had been set for the patient, a huge middle aged man who had a massive growth in his right leg. I observed the colour signaling on the infusion bag and asked questions about it. Unknown to me the patient was paying close attention to my curiousity. My scrutiny of the infusion bag gave him some concern and he asked if I observed a problem. I said "absolutely not". But he was not satisfied with my answer. You see he mistook me for a supervising Pharmacist who briefly came to check on the work being done. He felt I was being evasive and appealed that I tell him imediatley if there was a problem otherwise he would be worried. I almost started to panick. Here I was, inocent me trying to learn something from the Oncology Pharmacist and the patient mistook me for the Supervisor querying the Pharmacists actions. But I remembered I had a full bag of Empathy so I decided to come streight with him as requested. I told him I was not even part of the team and was trying to learn since that area was not my specialty. I told him I had absolute confidence in the Oncology Pharmacists work thats why I came to ask a few questions.

One major issue in Cancer chemotherapy is that many at times the drugs are not available in the hospital and have to be sourced within and without the city, Sometimes interstate and internationaly. There are obviously huge cost implications to this. This is a threat to Compliance and medication therapy persistence. Also a lot of Drug Therapy Problem (DTPs) plague cancer patients. Most of these DTPs are unavoidable and go with the territory. So Oncology Pharmacists have specialized training particularly because :

  • - Oncology drugs are cytotoxic and will not discriminate between good and bad cells,
  • - of Inevitable DTPs which include side effects, ADRs which are both reversible and irreversible
  • - The chemotherapy sessions are usually tedious requiring realtime reconstitution of parenteral medications during Intravenous infusion.

Of all the DTPs the one known as Chemotherapy Induced Nausea and Vomiting is the most common. It occurs because most cytotoxic drugs stimulate the Chemoreceptor Trigger Zone(CTZ) in the Central Nervous System. Antiemetics come in handy here.

This is why Clinical Pharmacists are advocating for Targeted Drug Delivery Systems (TDDS) in the form of nanoparticles (micelles) and biomolecules that can be preprogramed to target specific types of cells (cancerous) based on physicochemical properties of the tissue organ systems they comprise and the interstitial characteristics. Don't worry its not magic or science fiction its just simple Pharmaceutics……..maybe not so simple (laughs). Its not robotics just ordinary Nanotechnology ……maybe not so ordinary (laughing). Another strategy to managing cancer would be to take advantage of patients genetic predipositions to target specific imposter cancer cells, this is an area called Pharmacogenomics. For example one very promising Antineoplastic (cancer) drug already in use that simulates TDDS is Liposomal Doxorubicin.

Oncology Pharmacists of the furture will be trained to screen patients for disirability towards application of Drug Targeting. Oncology Pharmacists will be able to recomend from a cocktail of Targeted Drug Delivery Systems the most effective regimen for the patient. TDDMS will eliminate side effects, Adverse Drug Reactions and will be more cost effective. Let me ask you something, do you foresee a time could come when an Oncology Pharmacist will need to reconstitute a cytotoxic drug to customize it into a TDDS to fit a patient specific need in the Oncology Clinic? I do.

But these are all futuristic for now, getting to that destination will take a combination of ingenuity and prayer. Dont fret, we'll get there. (………laughs!!!).

Don't forget to drop a comment in the comment section


American Cancer Society, Chemotherapy for Breast Cancer, Available at

Barbour S.Y, Oncology, Duke Cancer Institute Durham, North Carolina Oncology, ACCP Updates in Therapeutics® 2012: The Ambulatory Care Pharmacy Preparatory Review and Recertification Course

Canadian Cancer Society, 2021 Canadian Cancer Society All rights reserved. Registered charity: 118829803 RR 0001, available at

Cancer Research UK, Loposomal Doxorubicin, Available at on 18th January 2021

National Comprehensive Cancer Network (NCCN), Clinical Practice Guidelines in Oncology – Breast Cancer Risk Reduction, version 3.2011. Available at

Khushwant S.Y, Dinesh K.M, Ashwini D, Anil M.P, 2019, Lavels of Drug targeting, Targeted Drug Delivery, Science Direct, Available at

Khushwant S.Y, Dinesh K.M, Ashwini D, Anil M.P, 2019, Lavels of Drug targeting, Targeted Drug Delivery, Science Direct, Available at

Wikipedia, 2021, Targeted Drug Delivery, Available at

Yvette B, 2019, News Letter, Medical News Today, Available at


  1. Very interesting write up
    laden with empathy. The future Pharmacy practice holds lots in stock for management of neoplastic conditions for improved treatment outcomes and minimal side effects. We will get there.

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