Palliative care isn’t a fun topic, but it is essential. It involves providing compassionate, holistic support to people living with life-limiting illnesses and addressing the emotional, mental, and social challenges that patients and their families face. In hospital, community pharmacy, and aged-care settings, pharmacists play a crucial role in ensuring optimal medical treatment and appropriate counselling. And when possible, a compounding pharmacist can further support patients through customised medication.
Advanced conditions often compromise a patient’s ability to take standard medication. Sometimes, new physical limitations require customised dosage forms. Other times, patients may need a more tailored formulation to address a broader range of needs than what is commercially available. While there are limitations to how much a compounding pharmacy can contribute to palliative care, the supporting role it plays can be invaluable. In a context that prioritises comfort and quality of life, addressing patients’ specific needs helps ease burdens for both them and their families.
The Role of Pharmacists in Palliative Care
Pharmacists are uniquely positioned to support the comfort and dignity of patients receiving palliative care. They apply clinical expertise to adjust medication regimens, anticipate potential side effects, and recommend discontinuation of unnecessary treatments.
When patients move between hospital, home, and aged-care settings, pharmacists help coordinate prescriptions and maintain consistency in treatment plans. In some cases, they also collaborate with prescribers to keep essential end-of-life medications in stock, ensuring quick access to pain relief and other crucial therapies.
In addition, pharmacists serve as a vital point of understanding for patients and their families. The importance of explaining medication changes in plain language and sharing practical tips for day-to-day management is sometimes overlooked. A knowledgeable and empathetic pharmacist can greatly reduce the emotional strain that often accompanies a serious illness.
As with all aspects of palliative care, it’s a team effort. Consultation among doctors, nurses, and pharmacists is key to developing proactive treatment strategies that enhance comfort and quality of life.
How Tailored Formulations Help Patients in Palliative Care
When symptoms worsen or unique administration challenges arise, standard commercial medications may not meet every patient’s needs. Even palliative care patients whose treatments fall outside the scope of compounding often need general symptom relief and may face obstacles in taking standard medications. For instance, individuals with advanced disease can struggle with swallowing, or they may develop sensitivities to certain non-active ingredients. In such situations, creating personalised formulations is invaluable.
Symptom Relief for Complex Conditions
· Pain Management
Strong opioids like morphine are generally supplied through conventional channels where compounding is out of place. However, when other pain management is needed, compounds such as topical gels can be prepared for patients whose gastrointestinal absorption or tolerance is compromised.
· Gastrointestinal Symptoms
Patients with severe nausea or those who cannot swallow may benefit from rectal suppositories or transdermal gels. Compounded formulations ensure medication can be administered effectively, even when options are limited.
· Combination Therapies
Some palliative care patients need more than one active ingredient. When it’s allowed and safe to do so, combining treatments in a single formulation simplifies what might otherwise be a complicated routine, improving adherence and overall comfort.
Improved Medication Adherence
Adapting a medication’s route, dosage form, flavour, or texture often makes it easier for patients to continue treatment. In palliative care, factors like physical restrictions, organ failure, and drug tolerance can dramatically affect how an individual responds. Many patients:
- Have difficulty swallowing
- Experience significant nausea
- Require multiple prescriptions
- Become sensitive to dyes or fillers in commercial products
Compounded preparations can alleviate these barriers, helping patients maintain a consistent, tolerable regimen that bypasses potential risk factors.
Wound Care Compounding
Pressure sores (decubitus ulcers) and diabetic ulcers can cause significant distress for palliative patients. These wounds often heal slowly, produce excessive drainage, cause persistent pain, and may create social embarrassment due to odour. Commercial products can be too harsh on fragile skin or fail to simultaneously address infection, pain, and odour management.
One way to help mitigate these issues is to tailor wound care to the patient. Water-soluble gels, for example, rinse off easily during dressing changes, minimising disruption to healing tissue. Specially prepared ointments or “polyox bandage” powders can reduce dressing frequency and absorb excess moisture. And when needed, multiple active ingredients (such as antimicrobials, topical anaesthetics, or agents that promote circulation) can also be combined into a single preparation to simplify care and increase effectiveness.
Limitations of Customised Medication in Palliative Care
Personalised formulations can be a powerful tool, but they are not without limitations. Compounding is time-consuming and requires specialised training, equipment, and raw ingredients. In cases where a patient’s condition changes rapidly, it may be impractical to customise medicine that can’t be easily adapted day by day.
Additionally, many strong injectable opioids used in palliative care are heavily regulated and not suitable for compounding. Pharmacists typically rely on commercial products for first-line pain management. If we look at the NSW Core Medicines List for palliative care (which includes morphine, haloperidol, clonazepam, metoclopramide, and hyoscine butylbromide), these are almost always used in their readily available forms.
For patients who need fast solutions or have limited access to specialist services, compounded medication may not be feasible. Cost can also be a factor; the expense of preparing bespoke formulations may not be justified or affordable in all circumstances. In rural and remote areas especially, these practicality and cost concerns are often very legitimate.
Tailored treatments can still offer meaningful benefits for patients, especially if their condition has made it harder to administer or tolerate the standard options. But the nature of terminal illness means that compounding isn’t always an available or practical choice.
Final Thoughts
Palliative care revolves around compassion, communication, and collaboration among healthcare professionals, patients, and caregivers. Pharmacists, who are often at the crossroads of these interactions, have a unique perspective and skill set to enhance the quality of life for those with life-limiting illnesses. Their expertise is necessary for preventing medication misadventures, optimising dosing regimens, and simplifying complex therapies. These are all crucial steps for ensuring that patients remain as comfortable and supported as possible during every stage of the journey.
When applicable, compounding pharmacy services can also be an important resource. Many patients have specific challenges and requirements that necessitate customisations to dosage form, strength, and formulation (for example, they can no longer swallow pills effectively). For individuals who have difficulty swallowing, require specialised wound treatments, or need multiple active ingredients in a single formulation, compounding pharmacy services can be an especially important resource. Even within the limitations posed by regulation, cost, and the unpredictable nature of terminal illness, personalised medication solutions provide vital options when standard products fall short.
Ultimately, compounded medications are just one piece of the larger palliative care puzzle. Pharmacists play a crucial role in that puzzle, but patient comfort requires a broader interdisciplinary team with clinical expertise and passion.
Written By
Zen Xiao