Could a clinical pharmacy service improve the quality of life and use of medicines among oncology patients admitted to the National Cancer Institute, Sri Lanka?

The study will be carried out in two medical oncology wards at National Cancer Institute, Sri Lanka. The study will be carried out for the period of one year. Within the time period participant recruitment, intervention and six months follow-up will be done.

• During the 1st phase, the male ward will house the intervention group and the female ward will house the control group (Patient recruitment will be carried out until the sample size reaches 44 for each group). • There will be a washout period to minimize cross-contamination. The washout period will not have a fixed period and will be adjusted according to the duration of the treatment cycle of each patient. Precautions will be taken to ensure that all patients assigned to each group previously will not overlap at the time of the swap between wards. • During the 2nd phase, the female ward will house the intervention group and the male ward will house the control group. (Patient recruitment will be carried out until the sample size reaches 44 for each group). At the end of the study each arm will have 88 oncology patients.

Patient recruitment within a single ward will follow a simple randomization process using a computer-generated random sequence (patients within the "intervention" ward will be randomly allocated to the intervention group and patients within the "control" ward will be allocated randomly in to the control group).

The intervention group will receive the services from a ward-based pharmacist in addition to the existing standard care available in the medical oncology ward. The standard care includes the current existing care provided to patients in the ward. It includes all the available medical and non-medical services except the service provided by the ward-based pharmacist.

The pharmacist will carry out the following interventions. • The pharmacist will obtain a detailed medication history from the intervention group by conducting a face-to-face interview with the patient and/or caregiver on the first day of admission i.e. within 24 hours of admission. It will take approximately 15 minutes in each interview. • The pharmacist will prospectively review the hospital drug chart until the patient is discharged to identify any drug-related symptoms. The pharmacist will meet the patients daily and discuss the current clinical conditions and occurrence of new symptoms to further identify any unreported drug-related problems or adverse drug reactions. • The identified drug-related problems will be discussed with the corresponding healthcare staff to optimise the treatment. • The intervention arm will receive chemotherapy counselling by the ward-based pharmacist throughout the chemotherapy cycle three times at three phases; at baseline (before starting the chemotherapy cycle), mid of the cycle and at the end of the last cycle. Each counselling session will last approximately 15 minutes. The chemotherapy counselling mainly focuses to enhance patient awareness regarding the following aspects. -Purpose of the chemotherapy treatment -The goal and benefits of chemotherapy -The name, dosing schedules, duration (number of cycles planned and length of the treatment) and types of chemotherapy -The potential side effects patients can experience during and later of the treatment -How the patient can manage or ease these side effects (foods to help with side effects) -When does the patient need to notify the doctor about the side effects. -How does the treatment affect his/her daily routine life (Ex: Can I work during chemotherapy?)

• The pharmacist will provide drug information to the medical staff and nursing staff when needed.

The intervention will be provided by one pharmacist (intervention pharmacist) and the outcomes will be assessed independently by another pharmacist (assessment pharmacist).”

1. Patients age 18 years old or above
2. Male and female patients
3. Patients diagnosed with cancer at any stage by an oncologist
4. Patients undergoing their 1st and 2nd cycles of chemotherapy

1. Patients re-admitted during the study period
2. Patients with poor cognition with no caregiver to manage medicines
3. Patients who unable/unwilling to give informed written consent
4. Patients who already undergone 3rd cycle of chemotherapy onwards
5. Patients who have speech and communication disorders