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7 Ways Oncology Pharmacists Impact Cancer Care
7 Ways Oncology Pharmacists Impact Cancer Care
Oncology Pharmacists Impact in Cancer Care
- Being an oncology pharmacist is incredibly rewarding.
- Besides, there are many opportunities to impact patient care whether you currently work in oncology or want to transition into this specialty.
- If you are new to oncology and looking for where to start.
- In this article will discuss 7 areas where an oncology pharmacist can have an impact that will give you ideas on how you can contribute to the care of these patients.
- Additionally, we all need to communicate the value of pharmacists to the greater healthcare community.
- Oncology pharmacists are vital in the multi-disciplinary care of patients with cancer.
- Moreover, pharmacists are of course drug experts but not everyone understands the impact they can have on the care of patients with cancer.
- Being an oncology pharmacist can be challenging, but it matters to our patients, to our colleagues, and to our profession.
- Here are 7 areas where Oncology Pharmacists Impact have the biggest one
- Furthermore, the Oncology Pharmacists Impact a wide range of clinical recommendations.
- Once we establish trust with physicians, we can impact all aspects of a patient’s cancer regimen.
Chemotherapy and supportive care regimens:
- Chemotherapy dosing, toxicity management, and long-term health maintenance.
- Moreover, our advice not often needed for the selection of front-line therapies.
- As the saying goes, the riches are in the niches and our niches are often in the gray areas of cancer treatment.
- Such as patients that have progressed on standard therapies or that have organ dysfunction, comorbid conditions, interacting concurrent medications, or pharmacogenomic considerations that preclude the use of certain drugs.
- Moreover, it often requires researching the literature for supporting data and presenting conclusions to the oncologist.
- This isn’t easy – it may be the most challenging part of being an oncology pharmacist.
- Furthermore, it requires a baseline knowledge of cancer biology, treatments, outcomes, and statistics.
- That is not born overnight as well as refined skills to communicate all this information in a concise and accurate way to the oncologist.
- It takes dedication to master this, but it absolutely can be done.
- Supportive care and toxicity management are the backbone of an oncology pharmacist’s role.
- We are, and should be, the experts in the prevention and treatment of all conditions caused by chemotherapy.
- This includes common and uncommon toxicities in the short-term setting.
- Such as chemotherapy-induced nausea and vomiting (CINV), cytokine release syndrome, venous thromboembolism (VTE), pain, hypersensitivity reactions, and others.
- Furthermore, for the longer-term toxicities in the post-treatment maintenance setting such as osteoporosis, hypertension, hyperlipidemia, diabetes, and many more.
We are the drug experts that can make recommendations when:
- A patient is refractory to the standard CINV drugs and who cannot keep any food or liquid down (this was Grams – she couldn’t eat more than a few crackers a day for weeks)
- A patient’s triglycerides are through the roof from asparaginase therapy
- Pulse dose steroids are wreaking havoc with a patient’s glucose levels and sleep cycle
- Moreover, an oral chemotherapy has a high risk of VTE, but the patient is persistently thrombocytopenia
- A patient is having a severe treatment-related reaction, but steroids should be avoided because they blunt the treatment’s effect
- The patient is persistently hypokalemic but cannot swallow the giant tablets and cannot stomach the liquid formulations (also Grams – we spent many 4+ hour days in the infusion center for IV potassium)
- Pill burden becomes overwhelming (many cancer patients and every HCT patient)
- Long-term health maintenance, toxicity monitoring, and survivorship care plans are important post-treatment follow-up that oncology pharmacists can participate in.
- Chemotherapy dosing is a vital component of the oncology pharmacist’s repertoire.
- Furthermore, we need to know where the standard dosing came from, in which patient populations it studied, what evidence supports it, and when it’s appropriate to stray from it.
Recommendations we make consider factors such as:
- Drug interactions
- Comorbid conditions
- Baseline organ dysfunction
- Tolerability of previous cycles
- Pharmacogenomics
- Patient weight
- Implications of under or over-dosing
1- Therapeutic Drug Monitoring:
- Importantly, the oncology pharmacists impact patient care by driving the drug use process, and that includes therapeutic drug monitoring (TDM).
- The goal of TDM is to optimize drug dosing by monitoring relevant molecules (parent drugs, metabolites, etc.) to maintain therapeutic concentrations and efficacy while minimising toxicity.
- This is important when drugs have a narrow therapeutic range and wide interpatient variability.
2- Education:
- Oncology has so many drug approvals and new literature published that education is a never-ending need.
- Patient education is the most challenging, but the most rewarding part.
- Moreover, the oncology pharmacists often participate in the education of the treatment regimen, including the regimen selected, treatment schedule, toxicities to expect.
- Additionally, how to treat them, when to seek urgent care, how to prevent infections, and the overall expectations of their therapy.
- More and more cancer therapies are taken by the patient in their home, so education is a critical step in ensuring safety and efficacy of these therapies.
- Accurate and repetitive education is important to achieve good outcomes.
- The patient is often overwhelmed at the initial visit and may not have a family member with them.
- They need follow-up touch points to ensure not only compliance but adequate understanding for the safe use of these medications.
- Finally, educating our healthcare colleagues is also an important role of the oncology pharmacist.
3- Drug Compounding:
- Despite the onslaught of oral oncolytics, cancer centers will always need to compound drug products on-site for intravenous, intrathecal, subcutaneous, intravesicular, and other routes of administration.
- This is a vital sub-specialty of oncology that requires specialized knowledge of drugs, product supplies, sterile compounding, and workflows.
4- Clinical Trials:
- Oncology pharmacists can participate in clinical trials in many ways, including trial preparation (before the trial opens at an institution) and maintenance of an ongoing trial.
- Pharmacy notified when the study is ready to open and orders are needed.
- In the process of creating orders, there inevitably are questions that need to be addressed.
- If they aren’t specified in the protocol, communication must go out to the principal investigator.
- Time to opening a clinical trial is an important metric in cancer centers and oncology pharmacists can positively impact by thinking through all the steps of treatment and workflows during the preparation phase.
5- Specialty Pharmacy:
- Specialty pharmacies play a huge role in the care of oncology patients.
- Moreover, many oral oncolytics, particularly the new to market ones, put into limited distribution networks by the manufacturers.
- Which drives dispensing to specific pharmacies; rarely can patients pick up these treatments locally.
- ّInterestingly, one of the biggest challenges in this model is the risk of delays in patient care.
- Unresolved clinical issues and lack of clinical rationale documentation resolved by having an oncology pharmacist proactively review these prescriptions before they are sent to the pharmacy.
- However, the specialty pharmacist won’t often know if a review has been done so they will still require recent lab results and clinical documentation to perform their own review.
- Moreover, the efficient communication of clinical data is vital to a speedy delivery.
- There are great opportunities for oncology-trained pharmacists in specialty pharmacies.
- One way they can impact patient care is by facilitating communication with their cancer center counterparts to get the drug to the patient as quickly as possible.
- Finally, another way is through patient education.
6- Informatics:
- Clinical and technical teams are both critical to the success of any oncology program.
- While these teams typically have very different backgrounds, skill sets, communication styles, and day-to-day responsibilities, their top priority is patient care.
- Moreover, to deliver the safest and highest quality care, these teams must work together to develop robust technical solutions to support clinical practice workflows.
- The ability to effectively communicate requirements, expectations, limitations, and resolutions to both clinical and technical teams is paramount.
- This is particularly important in oncology with rapidly changing science.
- Moreover, with such different perspectives, the teams often don’t speak the same “language,” necessitating a translator who can ensure information shared by each team is well understood by the other.
- This clinical liaison – who has both a clear grasp of clinical requirements and technology – enables the functional flow and prioritisation of information.
- An oncology pharmacist is well-suited to serving this critical function of “interpreter” due to the complexity of EHRs, drug systems, treatment regimens, and really, just the vast amounts of drugs and formulations available; we are subject matter experts.
- Oncology pharmacists are skilled at understanding workflows and how a patient moves through a cancer center.
7- Oncology Resources for Pharmacists Looking To Develop Their Skills:
- FDA (Food and Drug Administration) Drug Updates
- OBR (Oncology Business Review) – daily email updates on priority oncology topics
- Helio – you can sign up for a variety of eNewsletters and alerts
- The Healthcare Loop – daily emails that you can customise by keyword
- ASCO (American Society of Clinical Oncology) – you can sign up for a table of contents push or daily/weekly news updates
Oncology Treatment Guidelines
NCCN (National Comprehensive Cancer Network):
You can sign up for a free account and get access to their guidelines that are grouped into:
- Treatment of Cancer by Site
- Detection, Prevention, and Risk Reduction
- Supportive Care
- Specific Populations
- Patients
ASCO’s guidelines:
They are developed by multidisciplinary panels of experts, including patient advocates
Here are the guideline categories they publish:
- Assays & Predictive Markers
- Breast Cancer
- Gastrointestinal Cancer
- Genitourinary Cancer
- Gynecologic Cancer
- Head & Neck Cancer
- Hematologic Malignancies
- Melanoma
- Neurooncology
- Patient & Survivor Care
- Resource-Stratified – these ones are unique and outline appropriate methods of treatment and care based on the level of healthcare resources available in a given country, region, or practice area
- Supportive Care & Treatment-Related Issues
- Thoracic Cancer
MASCC (Multinational Association of Supportive Care in Cancer):
MASCC has a list of oncology practice resources that include:
- Firstly, Guidelines – includes antiemetics, mucositis, and medication-related osteonecrosis of the jaw (you can access for free by providing your email address)
- Secondly, Assessment Tools – includes antiemesis tool, oral agent teaching tool, and EGFR inhibitor skin toxicity tool
- Thirdly, Clinical Apps – includes the antiemesis tool app and the Calculate by QxMD tool (app and online versions and includes many disease states outside of oncology)
- Then, Pain Management Center – includes a list of pain guidelines/position statements and pain/palliative care articles
- Finally, MASCC-Endorsed Practice Guidelines
ESMO (European Society of Medical Oncology):
ESMO has various guidelines in these categories:
- Breast Cancer
- Cancers of Unknown Primary
- Endocrine and Neuroendocrine Cancers
- Gastrointestinal Cancers
- Genitourinary Cancers
- Gynaecological Cancers
- Haematological Malignancies
- Head and Neck Cancers
- Hereditary Syndromes
- Lung and Chest Tumours
- Melanoma
- Neuro-Oncology
- Sarcoma and GIST
- Supportive and Palliative Care
Oncology Patient Education Resources
- Chemocare is a service out of Cleveland Clinic that has patient-friendly information about chemotherapy, regimens, managing adverse effects, and a host of other resources
- Oral Chemotherapy Education is a collaboration between NCODA (National Community Oncology Dispensing Association), ONS (Oncology Nursing Society), ACCC, and HOPA (Hematology/Oncology Pharmacy Association) to provide free access to patient appropriate educational information on oral chemotherapy
- ChemoExperts is a very useful resource created by oncology pharmacists that has:
- Treatment regimens which include acronym definitions, goals of therapy, schedule, side effects, monitoring, tips, patient assistance/copay coverage, and references
- Disease information, including blood disorders
- Side effect videos
- And my favorite, an editable treatment calendar
- NCCN Guidelines for Patients has many educational booklets for patients (in several languages), videos, and payment assistance information
- ASCO has patient education materials where you can download guides to cancer, survivorship, caregiving, and other topics
- ESMO has patient education guides in many diseases and supportive care topics and they can be accessed in many languages
- COG has a patients and families resource page with several different pages, including one on coping with cancer
Conclusion:
- Being an oncology pharmacist is incredibly rewarding.
- There are many opportunities to impact patient care whether you currently work in oncology or want to transition into this specialty.
- This article discusses 7 areas where an oncology pharmacist can have an impact.
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