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Background: With patients developing more complex healthcare and medicine needs, it is imperative pharmacy professionals enhance their knowledge and skills to enable an advanced level of pharmaceutical practice, improving service provision and supporting patient care. The UK Royal Pharmaceutical Society (RPS) is urging employers to incorporate protected time within the working week to facilitate this development. Currently protected development time (PDT) is not well established within the pharmacy profession and there is little qualitative data available about the utility of this. Objective: To explore how pharmacy professionals in primary care currently utilise planned protected 'development time' and their perception of this. Methods: One-to-one semi-structured interviews were conducted between February and March 2023 via Microsoft Teams® with pharmacists, pharmacy technicians (PTs) and pharmacy support workers (PSWs), working in a large Health board area in Scotland who had established PDT since August 2021. Interview recordings were transcribed verbatim and analysed using an inductive thematic framework approach. Results: Interviews were conducted with 13 participants (12 female); 6 pharmacists, 5 PTs and 2 PSWs. Five core themes were derived from the data: logistics, competing priorities, methods for development, inequalities and benefits. Participants utility of PDT was variable, most focused on self-development to improve clinical knowledge however, supporting the development of others often taking precedence. Disparities in utility and inequity of protection from service delivery were highlighted. All participants befitted from PDT reporting a self-assessed improvement in confidence and competence. Conclusion: The experience of participants who had PDT was typically perceived as positive including supporting development and improving wellbeing however, it fostered inequalities which needs addressing. Educational input is required to provide direction for development across all four pillars of professional practice; clinical practice, leadership, education and research, promoting advanced practice. Further research is required to assess the impact of PDT on health outcomes of the local population.

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BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting toxicity of several commonly used chemotherapy drugs including taxanes, vinca alkaloids, and platinum compounds. Development of CIPN is highly variable, both in self-reported symptoms and functional consequences, and can be severe enough to alter dose intensity. PURPOSE: To describe the natural histories of both patient-reported symptoms of CIPN and functional impairments in breast cancer patients undergoing taxane-based chemotherapy. METHODS: Thirty-three breast cancer patients (32 female/1 male; 47.8 ± 11.2 years; n = 17 stage II/n = 16 stage III) were enrolled. Patients completed self-reports of symptoms and function (e.g., EORTC QLQ-CIPN20) and objective measures of physical function (i.e., balance and gait testing) in an outpatient oncology clinic at five timepoints: (1) baseline-prior to starting chemotherapy, (2-4) before starting subsequent chemotherapy cycles, and (5) 1-3 months after receiving their last taxane infusion. RESULTS: Significant negative changes in both patient-reported outcomes and objective functional measures were observed. Decreased balance was observed after the first chemotherapy cycle (28% increase in medial-lateral excursion of the center of pressure, p = 0.016) and progressed with cumulative exposure (43% increase, p < 0.001). Patients also demonstrated slower walking speeds (5% decrease, p = 0.003) as they progressed through treatment. These functional deficits were mirrored with increased patient-reported symptom severity for all EORTC QLQ-CIPN20 subscales (all p < 0.05). CONCLUSION: This study longitudinally assessed patient-reported outcomes concurrently with balance and gait testing in patients undergoing taxane therapy. Taxane treatment was associated with the development of clinically relevant problems in both CIPN symptoms and patient function.

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Over 230,000 new cases of breast cancer are expected to be diagnosed in the United States in 2015. Taxane-based chemotherapy is often an effective treatment, but can also cause adverse symptoms in patients due to neurotoxicity. These side effects can impair postural control in patients; however, this instability has scarcely been quantified. The purpose of this pilot study was to gain insight into the natural history of postural instability in breast cancer patients being treated with taxane-based chemotherapy. Thirty-two breast cancer patients (31 female/1 male; 47.6±11.2 year; 16 stage II/16 stage III) completed eyes open and eyes closed quiet standing trials in the oncology clinic where they were being treated. These trials were collected at five timepoints throughout their chemotherapy treatment: (1) before initiating chemotherapy to provide a baseline, (2-4) before starting subsequent chemotherapy cycles, and (5) 1-3 months after receiving their last taxane infusion. After the first chemotherapy cycle, patients demonstrated increases in 95% confidence ellipse area of center of pressure (CoP) [45.2%, p=0.01] and root mean squared CoP excursion [18%, p=0.006] compared to baseline values for the eyes closed condition. These balance deficiencies progressed with cumulative taxane exposure. Postural instability persisted 1-3 months after completing chemotherapy with increases in 95% CoP ellipse area [86.8%, p=0.002], root mean squared CoP excursion [32.6%, p=0.001], and mean CoP velocity [30.4%, p=0.024]. The balance impairments demonstrated by patients in this study appear to be clinically relevant when compared to balance impairments previously reported in other patient populations.

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