It’s essential to acknowledge that while the pharmaceutical industry has made significant strides in developing effective medications, it’s only guaranteed that some patients will respond favorably to traditional treatments. Studies indicate that merely 30 to 50% of patients achieve complete response rates. Therefore, more than a one-size-fits-all approach to medicine may be required to cater to everyone’s needs. Regrettably, some patients may not react to the treatment, leading to prolonged and costly trial and error. This can have grave consequences for these patients, not to mention the staggering number of tens of billions of dollars wasted on ineffective treatments.
For years, there has been a shift towards stratified medicine. This approach categorizes patients based on disease subtype, biomarker presence, responders versus non-responders, clinical characteristics, and single-gene mutations associated with monogenic disease. This strategy aims to provide personalized care and treatment for patients.
What Is Precision Medicine?
Precision medicine is founded on the understanding that patients’ response to treatment is significantly influenced by their genetic variability, complex biology, and external factors. As a result, precision medicine customizes the treatment of each patient based on an accurate diagnosis, a comprehensive understanding of disease mechanisms and treatment options, and a multitude of individual patient factors, such as a patient’s genetic and metabolic makeup, lab, and test results, and even environmental conditions, lifestyle, and treatment preferences. In other words, the objective is to provide “the right treatment to the right patient at the right time.”
In some cases, this will involve determining which extant treatment options are best suited for a patient based on the patient’s profile and known data regarding how certain patients respond to specific drugs. In other instances, it may entail creating an individualized medication, such as a personalized cell therapy or replacement tissue explicitly made for the patient. Despite their differences, attaining either of these examples is an impressive feat of data collection, analysis, predictive modeling, and clinical application.
Precision medicine’s ultimate objective is to fully leverage complex multimodal data and advanced technologies so that patients receive the exact care they require, which is a significant departure from the historical paradigm, in which it is estimated that only about 60% of care is deemed warranted, 30% is deemed wasteful, and 10% is deemed harmful. We can effectively treat diseases such as cancer only when we embrace and work with the individual expression of the disease, considering each individual’s unique genotype and phenotype.
Precision Medicine for Hospice and Long-Term Care (Hospice & LTC Pharmacy)
Precision medicine is an emergent medical treatment strategy that tailors healthcare decisions and interventions to individual patients based on their unique genetic, genomic, and environmental characteristics. This strategy seeks to maximize the efficacy of treatments while minimizing their adverse effects.
Precision medicine can offer significant benefits in the context of palliative and long-term care (LTC) pharmacy to patients with complex medical conditions and limited life expectancy. Here are some applications of precision medicine in palliative and long-term care pharmacy settings:
- Pharmacogenomics: Pharmacogenomics studies how a person’s genetic composition affects drug response. By analyzing a patient’s genetic profile, healthcare professionals can identify specific genetic variations that may affect drug metabolism, efficacy, and safety. Customizing medication regimens based on this information can help reduce adverse drug reactions and enhance treatment outcomes.
- Personalized Pain Management: Hospice and LTC patients frequently experience chronic pain due to underlying medical conditions. Taking into account individual patients’ genetic and metabolic profiles, precision medicine can assist in identifying the most appropriate pain medications and dosages. This strategy can result in more effective pain management and reduced risks of adverse events related to opioids.
- Disease-Specific Treatments: Precision medicine permits a greater comprehension of the molecular underpinnings of numerous diseases. Utilizing this information, healthcare professionals can target specific molecular pathways liable for the progression of the disease. This approach may result in more targeted and effective therapies, mainly when traditional treatments are ineffective or harmful.
- Risk Assessment and Early Intervention: Genetic testing and predictive analytics can assist in identifying patients who may be at a greater risk of developing certain diseases or suffering treatment-related complications. Early recognition of these risks can result in reasonable interventions and improved management of potential adverse events.
- Ethical Considerations: Implementing precision medicine in hospice and LTC contexts necessitates addressing ethical concerns such as patient autonomy, privacy, and the possibility of increased healthcare disparities. It is crucial to inform patients and their families of the benefits, hazards, and limitations of using genomic information to make treatment decisions.
- Collaborative Care: Implementing precision medicine in hospice and LTC pharmacies requires collaboration between pharmacists, physicians, genetic counselors, and specialists. Together, multidisciplinary teams can effectively integrate genetic information into patient treatment plans.
Precision medicine generally promises to enhance patient outcomes and life quality in hospice and LTC settings. As research and technology continue to advance, it is anticipated that the prevalence of precision medicine principles in pharmacy practice will increase. Nevertheless, it is essential to remain aware of ethical considerations and ensure patients’ rights and preferences are respected throughout the process.