Integrating pharmacists into uro-oncology care: Evaluation of patient satisfaction and well-being.

Abstract

714 Background: Uro-oncology patients are particularly vulnerable due to age-related comorbidity and polymedication while receiving complex cancer treatment regimens. As a result, therapy safety, efficacy and patient-reported outcomes may be at risk. Pharmacists are rarely part of standard care teams, representing a gap in supportive management. This trial assessed the impact of integrating a pharmacist into uro-oncology care on patient satisfaction (PS) and health-related quality of life (HRQoL). Methods: The prospective, investigator-initiated, single-center pre-post trial included adult outpatients with urothelial (UC), prostate (PC), or renal cell cancer (RCC) either starting or modifying systemic therapy. Following a 6-months observational phase (OPh), a pharmacist was added to the multidisciplinary care team in a 12-months intervention phase (IPh). In IPh, medication reconciliation, symptom burden assessment and individualized drug information was carried out by the pharmacist during a 12-week follow up for each patient. The primary endpoint was PS, assessed by the PS-CaTE questionnaire (Patient Satisfaction with Cancer Treatment Education). HRQoL served as a secondary endpoint, measured using the EORTC QLQ-C30 questionnaire and evaluated according to the Thresholds for Clinical Importance (TCI; Giesinger et al.). Results: Each phase included 79 patients (87% male; median age 71 years [IQR 65.5-79] in OPh vs. 69 years [IQR 62-77] in IPh). The majority suffered either from UC (49% vs. 42%) or PC (43% vs. 53%), whereas RCC prevalence was low (8% vs. 5%). The PS improved markedly with pharmaceutical support after 4 weeks (mean 3.9 vs. 4.5 on a Likert-scale 1-5, mean difference +0.6, p < 0.001) and continued to rise after 12 weeks (3.9 vs. 4.7, +0.8, p < 0.001). Further differentiating by treatment status, PS improved in treatment-naive patients after 4 weeks (4.0 vs. 4.6, +0.6, p < 0.001), whereas pretreated patients showed significant improvement after 12 weeks (3.8 vs. 4.7, +0.9, p < 0.001). HRQoL overall was stable between phases after 12 weeks (mean 56 [SD = 25] vs. 60 [SD = 20] on a 100-point scale, p = 0.212). On the functional scales, the proportion of patients reaching the TCI showed a trend in favor of IPh for physical, role, social and cognitive functioning. Moreover, clinically relevant burden in emotional functioning was significantly lower in IPh (45 vs. 27 patients, p = 0.005). Conclusions: Integrating a pharmacist into the uro-oncology care team significantly improved patient satisfaction and emotional well-being without compromising overall HRQoL. The greatest benefit was observed in treatment-naive patients, while pretreated patients required longer follow-up to achieve similar gains. These findings underscore the clinical value of pharmaceutical support in multidisciplinary uro-oncology care and advocate for its broader implementation in routine practice. Clinical trial information: DRKS00033062.