Cross-sectional survey on cancer patients' concerns and consultation needs with pharmacists at the time of initial diagnosis.

Background

Cancer remains the leading cause of death worldwide [ 1 ], and receiving a cancer diagnosis imposes a significant physical and psychological burden on patients [ 2 , 3 ]. In particular, the period immediately following diagnosis is not merely a pre-treatment phase but represents a uniquely vulnerable and decisive moment in a patient’s life [ 4 ]. During this time, patients often experience overwhelming psychological distress due to prognostic uncertainty, confusion about treatment options, disruption of livelihood, and financial anxiety—all occurring simultaneously [ 5 , 6 ]. In such a critical situation, the presence or absence of timely and appropriate support from pharmacists may substantially influence subsequent treatment behaviors and medication adherence [ 7 – 10 ].

However, most previous studies have focused on the middle or terminal stages of cancer treatment, and only a few have systematically investigated patient needs during the “critical window for supportive intervention” immediately after diagnosis [ 11 – 14 ]. Notably, no published studies—either in Japan or internationally—have directly compared patients’ consultation preferences for hospital pharmacists versus community pharmacists using a consistent set of indicators.

With the advancement of outpatient cancer pharmacotherapy and growing emphasis on community-based care, pharmacists are increasingly expected to provide holistic support that goes beyond conventional drug therapy and addresses patients’ psychosocial concerns as well [ 15 , 16 ]. Particularly in the early stages following diagnosis, it is crucial to establish a support framework that can promptly and effectively respond to patients’ questions and anxieties before this limited window of opportunity closes.

This study aimed to clarify the specific concerns patients face immediately after a cancer diagnosis and directly compare their consultation needs regarding hospital and community pharmacists using a unified set of indicators. By identifying the types of support expected from each group, the study seeks to highlight key issues for enhancing the professional role of pharmacists in cancer care.

Methods

Survey period and participants

The survey was conducted over 7 days from January 23 to January 29, 2025. Participants were recruited from the panel maintained by Macromill, Inc. (Tokyo, Japan), a marketing research company. As of January 2025, the company's registry included approximately 36 million monitors. A total of 22,419 individuals aged 17 years or older who had been diagnosed with cancer and had received treatment in Japan were invited to participate in the web-based questionnaire survey. Ultimately, 1,031 valid responses were obtained.

To prevent fraudulent responses, Macromill implements two quality control measures: a trap question survey conducted every 6 months, and mandatory annual updates of monitor registration information [ 17 , 18 ].

The required sample size was estimated to be approximately 400, assuming a 50% response distribution, 5% margin of error, and 95% confidence level. The number of valid responses obtained ( n = 1,031) exceeded this threshold.

The questionnaire included items categorized into four areas, reflecting concerns that pharmacists may assist with during cancer treatment. These items were refined based on feedback from public health professionals and family members of cancer patients in a previous study.

Questionnaire items

The questionnaire used in this study was partially modified from the item titled “Concerns and Problems of Cancer Patients that Pharmacists Can Support” (Table 1 ), which was originally included in a previous study, “Survey on the Role of Hospital Pharmacists in Outpatient Cancer Treatment,” conducted by the Department of Pharmacy at Kyoto University Hospital in September 2023 [ 19 ]. Notably, the items in the original questionnaire had already been refined prior to that study, based on feedback from public health professionals and family members of cancer patients.

The classification used in the previous study—Cancer and Cancer Treatment (CCT), Medications Other Than Cancer Treatment (MOCT), and Daily Life During Cancer Treatment (DLCT)—served as the basis [ 19 ]. In this study, to more comprehensively capture patients’ concerns, items related to cancer pain and palliative care were reclassified from CCT and added as a new domain, Cancer Pain and Palliative Care (CPPC).

The questionnaire consisted of two main questions:

Whether the respondent had any concerns at the time of initial cancer diagnosis (multiple responses allowed).

For each selected concern, whether the respondent wished to consult a hospital pharmacist or a community pharmacist (yes/no).

In this study, the term “hospital pharmacist” refers to pharmacists working at medical institutions that provide cancer treatment, without differentiating between inpatient and outpatient settings. The aim was to assess patients’ consultation preferences for hospital pharmacists involved in cancer care as a unified professional group.

Statistical analysis

Descriptive statistics were used to summarize respondent characteristics, including age group, sex, and cancer type. To compare consultation preferences between hospital and community pharmacists, the McNemar test was applied to paired binary data. When the total number of discordant pairs was < 25 or when the frequency of any cell was < 5, the mid-P method was used to enhance the accuracy of the analysis.

Descriptive statistics were calculated using Microsoft Excel (Microsoft Corp., Redmond, WA, USA), while the McNemar test and mid-P method were performed using JMP Pro 18 (SAS Institute Inc., Cary, NC, USA). Given the large sample size and high statistical power of this study, the significance level was conservatively set at P < 0.001 to reduce the risk of identifying trivial differences as statistically significant.

Results

Background of the study population

Age distribution, sex, and cancer types of the respondents are presented in Table 2 . Of the participants, 62.1% were male and 37.9% were female. The most common age group was 60–69 years (33.1%), followed by 70–79 years (23.7%), and 50–59 years (22.8%), indicating that 83.4% of respondents were 50 years or older. Breast and colorectal cancer were the most frequently reported cancer types, accounting for 20.0% of the responses, followed by stomach cancer (16.0%), prostate cancer (13.0%), and lung cancer (12.0%).

Concerns at the time of initial cancer diagnosis

Figure 1 shows the response rates for concerns reported by patients at the time of their initial cancer diagnosis. Overall, 89.2% of the respondents indicated that they had some type of concern or burden.

The items classified under CCT had the highest response rates. The most frequently selected concerns were “Side effects associated with cancer treatment” (49.2%), “Cost of cancer treatment” (48.0%), “Psychological distress (e.g., anxiety and worries related to cancer and its treatment)” (41.6%), “Mechanisms, indications, and effects of anticancer drugs” (38.8%), and “Medications to relieve physical discomfort” (32.0%). In contrast, “New cancer treatments (e.g., clinical trials)” was selected by only 12.8%.

This was followed by items related to DLCT, with relatively high selection rates for “Work or academic responsibilities” (32.1%), “Changes in appearance” (23.3%), “Nutrition and diet” (20.4%), and “Precautions in daily life” (20.0%).

Among items classified under CPPC, “Cancer pain” was selected by 16.7% of respondents, whereas “Use of medical opioids” (5.6%) and “Home care or hospice” (3.2%) were selected less frequently. Items under MOCT all had response rates of < 10%, including “Drug interactions” (8.1%), “Correct use of medications” (6.1%), and “Regular medications not related to cancer treatment” (5.1%).

Pharmacist consultation intentions at the time of cancer diagnosis

Table 3 shows the proportion of respondents who expressed a desire to consult hospital and community pharmacists about their concerns at the time of initial cancer diagnosis, along with the comparative results between the two groups.

The need for consultation with hospital pharmacists was significantly higher than that with community pharmacists for five of the six items classified as CCT, except “The cost of cancer treatment” ( P < 0.001). In particular, “Side effects associated with cancer treatment” (34.7% vs. 13.8%), “The mechanism of action, efficacy, and effects of anticancer drugs” (39.3% vs. 18.5%), and “Medications to alleviate physical discomfort caused by cancer or its treatment” (36.1% vs. 17.0%). The need for consultation with a hospital pharmacist accounted for > 30% of the total responses, which was significantly higher than that for the other items.

In contrast, for all items classified under DLCT, the percentage of respondents wishing to consult hospital pharmacists was < 30%, and there were no statistically significant differences between hospital and community pharmacists. In contrast, for all items classified under DLCT, the percentage of respondents wishing to consult hospital pharmacists was < 30%, and there were no statistically significant differences between hospital and community pharmacists.

Although no significant differences were observed for MOCT items, > 40% of the respondents expressed a desire to consult both hospital and community pharmacists for all MOCT-related concerns, indicating a generally high level of need for consultation in this category.

Discussion

Statement of key findings

This study revealed that nearly 90% of cancer patients experienced some form of distress during the highly burdensome psychological period immediately after diagnosis. Concerns categorized under CCT were the most prevalent, particularly reflecting a strong need for specific information on cancer pharmacotherapy and a high demand for consultation with hospital pharmacists. On the other hand, although concerns categorized under MOCT were less frequently selected overall, consultation needs exceeded 40% for both hospital pharmacists and community pharmacists, indicating that pharmacists are expected to provide support for pharmacological management other than cancer. These findings suggest that hospital and community pharmacists play complementary roles in addressing patients’ diverse concerns at the time of diagnosis, and that collaboration between them is essential in supporting cancer patients [ 14 , 20 ].

Interpretation

Concerns classified as CCT immediately after diagnosis were the most prominent, revealing the reality that patients strongly seek accurate information on treatment. The intention to consult hospital pharmacists was particularly high for concerns directly related to cancer drug therapy, such as “Side effects associated with cancer treatment,” “The mechanism of action, efficacy, and effects of anticancer drugs,” and “Medications to alleviate physical discomfort caused by cancer or its treatment”. The fact that hospital pharmacists have a high level of expertise and are able to promptly provide pharmacological interventions, such as prevention and management of side effects and suggestions for supportive care in collaboration with physicians and nurses, is thought to have increased patients'trust in them and led to their need for consultation [ 21 ]. The relatively low willingness to consult with community pharmacists may be due to the fact that such pharmacists are generally recognized as a position that delivers and explains medications, and are not easily recalled as a provider of professional consultation regarding cancer pharmacotherapy [ 14 , 22 – 24 ].

It is noteworthy that despite the relatively high selection rate of concerns classified as DLCTs, the need for consultation with pharmacists was limited. Concerns such as nutrition management, coping with changes in appearance, and lifestyle precautions are areas where pharmacists can provide assistance from a ‘comprehensive perspective’ [ 16 ]. However, they are considered areas that are handled by other healthcare professionals, such as physicians, nurses, and dietitians, and the idea of consulting a pharmacist may not have taken root in patients [ 25 , 26 ]. In addition, the limited number of pharmacists who can provide appropriate answers and assistance in these areas at the same level as other healthcare professionals may also contribute to the low willingness to consult. Unlike hospital-based healthcare professionals, community pharmacists are able to engage with patients on a daily and ongoing basis, and are in a position to identify minor changes and problems in daily life at an early stage [ 27 ]. Therefore, the active involvement of community pharmacists in the area of DLCT may lead to early detection and response to problems and contribute to the maintenance and improvement of patients'quality of life. The acquisition of skills by pharmacy pharmacists to deal with daily life-related support and the raising of awareness that community pharmacists can also provide support will lead to a deepening of expertise that differs from that of hospital pharmacists and contribute to the establishment of a practical role for pharmacists in the community. These findings also reaffirm the importance of pharmacists within the framework of multidisciplinary cancer care. While physicians and nurses play central roles in diagnosis, treatment planning, and psychosocial support, pharmacists are uniquely positioned to contribute through monitoring patients’ medication use and providing medication counseling [ 28 – 30 ]. Community pharmacists are expected to offer feedback to physicians regarding patients’ medication-related information [ 30 ]. Close collaboration and effective information sharing between hospital and community pharmacists – and with the broader care team – are essential to delivering coordinated, patient-centered care throughout the cancer care continuum.

Although the selection rate for problems classified as MOCT was relatively low, this may be because these items are not directly related to cancer treatment, making them less prominent in patients’ minds. Nevertheless, more than 40% of respondents expressed a desire to consult with hospital pharmacists, and a similar proportion wished to consult with community pharmacists. This indicates that support was expected from both types of pharmacists. In particular, issues such as drug–drug interactions and the appropriate way to take medications are expected to become increasingly important as cancer treatment continues over time. While hospital pharmacists are responsible for advanced medication management during hospitalization, community pharmacists are expected to provide ongoing support in the outpatient setting, including daily medication management and the provision of drug information [ 14 , 31 ]. Establishing a support system in the area of MOCT is essential to ensure the safe and continuous implementation of cancer treatment, and this area should be further developed as part of future pharmacy practice.

Strengths and weaknesses

The strength of this study lies in the fact that it was conducted on a large scale, targeting a broad patient population, without limiting conditions such as cancer type, stage, age, or gender. In particular, the fact that the study focused on the period immediately after cancer diagnosis, when psychological burden is high and concerns are likely to become apparent, is a significant feature of this study. Furthermore, by comparing the consultation needs of hospital pharmacists and community pharmacists using the same index, we were able to clearly capture the differences in their respective professions and patients'expectations. In addition, the fact that the study was not limited to pharmacotherapy support, but also included psychological, social, and economic aspects as evaluation targets, enhances the significance of this study in that it was able to grasp the actual status of pharmacists’ multifaceted role.

However, there are several limitations. First, this study was conducted using a web-based self-administered questionnaire, which may have introduced selection bias favoring individuals with higher IT literacy. Second, we did not collect information on the time elapsed since diagnosis. Therefore, participants’ responses – particularly regarding consultation preferences – may reflect their current impressions rather than those at the time of diagnosis, introducing potential recall bias. Third, information on treatment modalities, for example, oral versus injectable therapies was not collected, limiting our ability to explore differences in support needs by treatment type. Fourth, over 80% of respondents had one of five common solid tumors – breast, colorectal, gastric, prostate, or lung cancer – potentially underrepresenting the concerns of patients with hematologic malignancies or rare cancers. Lastly, the sample size was insufficient to support detailed subgroup analyses, such as by region or age group.

Further research

To address these limitations, future research should adopt longitudinal designs that consider the time elapsed since diagnosis, enabling clarification of how patients'concerns and support needs evolve across treatment phases. To improve representativeness and reduce selection bias, surveys should combine web-based, paper-based, and in-person approaches, particularly to reach older adults and patients with rare or hematologic cancers. Collecting more detailed clinical information – such as treatment modality and timing since diagnosis – will allow for more nuanced, stratified analyses. Integrating qualitative methods and medical record data can complement self-reported data and help mitigate recall bias. Lastly, expanding sample sizes will support subgroup analyses by demographics, region, and cancer type, contributing to the development of tailored, evidence-based support strategies.

Conclusions

This study demonstrated that patients have a strong need to consult hospital pharmacists for issues related to cancer pharmacotherapy, while they have greater expectations for community pharmacists regarding medication management and daily life support. These findings align with societal trends, such as the shift to outpatient cancer care and development of integrated community-based care, and may serve as a foundation for clarifying and expanding pharmacists’ professional roles. In the future, building collaborative and continuous support systems involving both hospital and community pharmacists will be essential to meet the diverse needs of patients with cancer. These efforts may contribute to the ongoing development of multidisciplinary cancer care frameworks, where pharmacists collaborate with physicians, nurses, and other healthcare professionals by incorporating diverse clinical perspectives and fulfilling complementary roles to deliver more comprehensive, patient-centered support.

Acknowledgements

The authors would like to thank all the participants who took the time to complete the survey. We also appreciate the support of Macromil, Inc. (Tokyo, Japan) for facilitating the data collection.

Abbreviations

Cancer and Cancer Treatment

Cancer Pain and Palliative Care

Daily Life during Cancer Treatment

Medications Other Than Cancer Treatment

Over the counter

Authors’ contributions

TW and AS contributed to the conceptualization and methodology of the study. TW, AS, and TA were responsible for formal analysis and investigation. TW prepared the original draft. TA, MK, KY, and SY contributed to the manuscript review and editing. HT supervised the project. All authors read and approved the final manuscript.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan. This study was approved by the Research Ethics Committee for Human Subjects at Hoshi University (Approval No: 2024–31; Date of approval: November 25, 2024).

Participation in the survey was entirely voluntary, and informed consent was implied by completing and submitting the questionnaire. Respondents were explicitly informed that collected data would be anonymized to protect their privacy and would not be used for any purposes other than statistical analysis.

Consent for publication

Not applicable” in this section.

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Tomofumi Watanabe and Atsunobu Sagara contributed equally to this work.

References

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. 10.3322/caac.21660.

2. Caruso R, Nanni MG, Riba MB, et al. The burden of psychosocial morbidity related to cancer: patient and family issues. Int Rev Psychiatry. 2017;29(5):389–402. 10.1080/09540261.2017.1288090.

3. Muraoka K. Psychological acceptance/adjustment in patients with cancer. Jpn J Rehabil Med. 2020;57(10):936–41. 10.2490/jjrmc.57.936.

4. Weisman AD, Worden JW. The existential plight in cancer: significance of the first 100 days. Int J Psychiatry Med. 1977;7(1):1–15. 10.2190/UQ2G-UGV1-3PPC-6387.

5. Hawkins NA, Pollack LA, Leadbetter S, et al. Informational needs of patients and perceived adequacy of information available before and after treatment of cancer. J Psychosoc Oncol. 2008;26(2):1–16. 10.1300/j077v26n02_01.

6. Otani K, Utitomi Y. Psychological and mental care of cancer patients. Nippon Jibiinkoka Gakkai Kaiho. 2010;113(2):45–52. 10.3950/jibiinkoka.113.45.

7. Sudou M, Morii H, Sakana M, et al. Introduction of pharmaceutical care and its effects in outpatients with cancer chemotherapy. Jpn J Pharm Health Care Sci. 2013;39(2):77–84. 10.5649/jjphcs.39.77.

8. Kimura M. Investigation into the establishment of indicators for pharmaceutical intervention in cancer pharmacotherapy. Yakugaku Zasshi. 2016;136(10):1379–84. 10.1248/yakushi.16-00169.

9. Tanaka K, Hori A, Tachi T, et al. Impact of pharmacist counseling on reducing instances of adverse events that can affect the quality of life of chemotherapy outpatients with breast cancer. J Pharm Health Care Sci. 2018;4(1). 10.1186/s40780-018-0105-3.

10. Kawasaki Y, Hirai K, Nii M, et al. Actual situation of decision-making support from medical staff when cancer patients make treatment choices. Future Oncol. 2023;19(33):2263–72. 10.2217/fon-2023-0335.

11. Harikae H, Yoshida H, Katayama H, et al. Research on pain control in cancer outpatients taking opioids dispensed by community pharmacies. Jpn J Pharm Health Care Sci. 2008;34(2):156–64. 10.5649/jjphcs.34.156.

12. Miura A, Onishi K. Analysis of the process of death acceptance in patients with advanced pancreatic cancer: a retrospective study of four patients who received cancer diagnosis. Mie Nurs J. 2009;11:53–61.

13. Imamura M, Matsui Y, Katayama K, et al. Function of and need for a pharmaceutical outpatient clinic run by oncology pharmacy specialists. Jpn J Pharm Health Care Sci. 2015;41(4):254–65. 10.5649/jjphcs.41.254.

14. Takano Y, Hanya M, Tatematsu M, et al. Qualitative research to investigate the needs of pharmacists and drug therapy of cancer patients. Yakugaku Zasshi. 2015;135(12):1387–95. 10.1248/yakushi.15-00172.

15. Nagashima F. Advances in cancer chemotherapy and outpatient/home-based cancer care. J Kyorin Med Soc. 2015;46(1):27–8. 10.11434/kyorinmed.46.27.

16. Ministry of Health, Labour and Welfare, Japan. Clinical training guidelines for pharmacists. 2024. https://www.jshp.or.jp/activity/jutakujigyo/sotsugorinsho-guide-1.pdf . Accessed 11 Apr 2025.

17. Ikeshita A, Sagara A, Azechi T, et al. Evaluation of the relationship between pregnant/postpartum women’s characteristics and pharmacy use experience in terms of consultation needs with pharmacists. J Pharm Commun. 2023;21(1):6–13. 10.60408/pco.21.1_6.

18. Ikeshita A, Sagara A, Azechi T, et al. Survey on sharing information about health products/medicines between obstetricians and pregnant/postpartum women toward supporting pregnant/postpartum women by family pharmacy/pharmacist. Jpn J Community Pharm. 2023;11(1):1–8. 10.69297/jscpjjcp.11.1_1.

19. Sugimoto M. Survey on the role of hospital pharmacists in outpatient cancer care. Kyoto, Japan: Department of Pharmacy, Kyoto University Hospital; 2024. https://mhlw-grants.niph.go.jp/system/files/report_pdf/%E5%88%A5%E6%B7%BB%E8%B3%87%E6%96%996.pdf . Accessed 10 Oct 2024.

20. Satoh H, Miki A, Kazutoshi M, et al. Problems of collaboration between community and hospital pharmacists. Yakugaku Zasshi. 2014;134(4):563–74. 10.1248/yakushi.13-00216.

21. Ministry of Health, Labour and Welfare, Japan. Vision for securing safe and hopeful medical care. Tokyo, Japan: Ministry of Health, Labour and Welfare; 2008. https://www.mhlw.go.jp/shingi/2008/06/dl/s0618-8a.pdf . Accessed 11 Apr 2025.

22. Hayashi S. The expected role of community pharmacist in society. Yakugaku Zasshi. 2003;123(3):163–71. 10.1248/yakushi.123.163.

23. Ihara C, Miho N. Scaling and measurement of the image of pharmacists. Dep Bull Pap. 2014;32:27–50.

24. Hirata S, Onoue H, Kondo J, et al. Relationship between the work image of pharmacists and the evaluation of their contribution to the community through the penetration of pharmacist functions as indicated by the pharmacy vision for patients. Iryo Yakugaku. 2023;49(1):20–7. 10.5649/jjphcs.49.20.

25. Ministry of Health, Labour and Welfare, Japan. Fundamental concepts and practical case studies for promoting team-based medical care. Tokyo, Japan: Team-based Medical Care Promotion Working Group, Ministry of Health, Labour and Welfare; 2011. https://www.mhlw.go.jp/stf/shingi/2r9852000001ehf7-att/2r9852000001ehgo.pdf . Accessed 11 Apr 2025.

26. Iino K, Nagaoka N, Nozawa K, et al. Actual conditions, challenges, and training needs regarding nurses’ appearance care for cancer patients undergoing treatment. Palliat Care Res. 2019;14(2):127–38. 10.2512/jspm.14.127.

27. Ministry of Health, Labour and Welfare, Japan. Vision of pharmacies for patients: from "gatefront" to "family" and "community"-based pharmacies. Tokyo, Japan: Ministry of Health, Labour and Welfare; 2015. https://www.mhlw.go.jp/file/04-Houdouhappyou-11121000-Iyakushokuhinkyoku-Soumuka/vision_1.pdf . Accessed 11 Apr 2025.

28. Cifaldi I, Bernardo MA, Marchei M, et al. Role of the oncologist in prevention, diagnosis and treatment of neoplasms. Minerva Med. 1998;89(6):241–6.

29. Sheldon LK, Harris D, Arcieri C. Psychosocial concerns in cancer care: the role of the oncology nurse. Clin J Oncol Nurs. 2012;16(3):316–9. 10.1188/12.cjon.316-319.

30. Matsumoto N, Mizuno T, Aimiya Y, et al. Factors Related to Submission of Tracing Reports Regarding Cancer Chemotherapy by Pharmacy Pharmacists. Yakugaku Zasshi. 2024;144(1):143–50. 10.1248/yakushi.23-00146.

31. Ishiguro H, Koshiji M, Morizane T, et al. Drug interactions in medical oncology. Gan To Kagaku Ryoho. 2009;36(5):879–85.

Associated Data

Data Availability Statement

No datasets were generated or analysed during the current study.