CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Melanoma is a type of cancerous tumor that originates from the uncontrolled growth of pigment-producing cells called melanocytes (Lerner and McGuire, 1964; Abdel-Malek et al., 1999; Abdel-Malek et al., 1995; Tsatmali et al., 2002). Although it is commonly found on the skin, melanoma can also develop on mucosal surfaces, the uveal tract, and leptomeninges. People with fair skin and light hair who live in environments with high sun exposure are at the highest risk of developing this condition.
Malignant melanoma is the most fatal form of skin cancer (Linos et al., 2009). In the past, melanoma was a rare form of cancer, but over the last five decades, its incidence has increased at a faster rate compared to almost any other type of cancer (Surveillance, Epidemiology, and End Results [SEER], 2015; Erdei and Torres, 2010). Melanoma, which is the third most prevalent type of skin cancer, is responsible for more than 9,000 deaths annually. Although most cases of skin cancer can be prevented, the rates of this disease continue to rise in the United States and worldwide, despite efforts to address risk factors.
Timely identification of melanoma is essential since it enables the successful elimination of the tumor, resulting in improved chances of survival. However, melanoma is an aggressive cancer that often spreads to other parts of the body from its initial site (Califano and Nance, 2009). Once melanoma reaches an advanced stage, surgical intervention alone is no longer sufficient, making the disease more challenging to treat (Califano and Nance, 2009; Filippi et al., 2016).
The long-term prognosis for melanoma after it has metastasized is generally bleak, with a median survival of 8 to 12 months when treated, including the use of immunotherapeutic drugs like Ipilimumab (Filippi et al., 2016). However, more recent advancements in combined treatments involving immunotherapy and radiation therapy have shown promise in improving survival rates to several years (Filippi et al., 2016).
In addition to the significant impact on public health, the costs associated with managing melanoma are substantial (Tripp et al., 2016). In the United States alone, the annual expenses for melanoma treatment have skyrocketed by 288% in less than ten years (Linos et al., 2009). As new, expensive pharmaceutical treatments enter the market, it is likely that costs will continue to rise at an even higher rate (Linos et al., 2009).
Melanoma accounts for $3.3 billion of the total $8.1 billion spent on direct costs related to skin cancer each year (Linos et al., 2009). Additionally, the estimated annual indirect costs associated with melanoma are as high as over $3.5 billion (Linos et al., 2009). As the incidence and mortality rates of melanoma continue to rise, the expenses for treatment and indirect care are expected to increase in parallel (Linos et al., 2009). However, with the implementation of more preventive strategies to combat the growing incidence, there is potential to reduce the economic burden by $2.1 billion annually (Guy et al., 2015).
Due to its complex and potentially life-threatening nature, melanoma requires a multidisciplinary approach to ensure optimal outcomes for patients. Providers have estimated that more than 80% of patients experience adverse effects (AEs) while undergoing combination immunotherapy for melanoma (Cancer Treatment Centers of America, 2022). Close communication and collaboration with the medical team are essential not only to prevent these AEs but also to effectively manage them when they occur.
Considering the likelihood of patients developing AEs during therapy, it is crucial for pharmacists to proactively educate patients and equip them with tools to mitigate and manage these AEs. Pharmacists can also play a valuable role in clinical interventions when necessary, bringing their expertise to the healthcare team in the field of melanoma care and education. This study aims to explore the role of clinical pharmacists in melanoma care and education.
1.2 Statement of the Problem
The global incidence of melanoma continues to rise, generating increased interest in the disease and the care provided to affected patients. The introduction of BRAFV600E inhibitors like vemurafenib and dabrafenib has significantly improved the outlook for melanoma patients. However, it is the use of immune checkpoint inhibitors such as ipilimumab, nivolumab, and pembrolizumab that has made melanoma a prominent example of successful immune-based treatment.
Significant progress has been made in both basic and clinical research over the past few years, leading to a better understanding of melanoma and advancements in its treatment. These advances are also being applied to other types of cancer. Despite these achievements, the rates of melanoma incidence, recurrence, and death remain unacceptably high. There is still much work to be done in addressing fundamental questions related to melanoma, including prevention, early detection, accurate diagnosis, metastatic dormancy and progression, and understanding the response and resistance to targeted therapies and immune-based treatments (Atkins et al., 2021).
Healthcare systems frequently encounter obstacles that hinder optimal care, including challenges such as restricted availability of specialized services, insufficient patient education, and inadequate medication management. These factors can lead to issues such as low treatment adherence, disease advancement, and escalated healthcare expenses. Therefore, it is crucial to explore and understand the role of clinical pharmacists in melanoma care and education to address these challenges effectively.
1.3 Aim of the Study
The aim of this study is to assess and evaluate the role of a clinical pharmacist in melanoma care and education.
1.4 Objectives of the Study
The specific objectives of this study are as follows:
- To identify the roles of clinical pharmacists in melanoma care and education.
- To evaluate the impact of clinical pharmacist-led interventions on patient outcomes, treatment adherence, and quality of life.
- To propose recommendations for improving the role of clinical pharmacists in melanoma care and education.
1.5 Research Questions
- What are the roles of clinical pharmacists in melanoma care and education?
- What is the impact of clinical pharmacist-led interventions on patient outcomes, treatment adherence, and quality of life in melanoma care?
- What recommendations can be made to improve the role of clinical pharmacists in melanoma care and education?
1.6 Research Hypothesis
H0: Clinical pharmacists do not play significant roles in melanoma care and education.
Ha: Clinical pharmacists play significant roles in melanoma care and education.
1.7 Justification of the Study
The role of a clinical pharmacist in melanoma care and education has received limited attention in the literature. By conducting this study, we can bridge this knowledge gap and provide evidence-based insights into the potential benefits and impact of pharmacist involvement in melanoma care. This research has the potential to inform healthcare policies and clinical practice, leading to improved patient outcomes and enhanced interdisciplinary collaboration.
1.8 Scope of the Study
This study will focus on the role of a clinical pharmacist in melanoma care and education. The research will delve into the roles and impact of clinical pharmacists within the context of melanoma care and education in the Nigerian healthcare system.
