A Call to Pharmacists in the Delivery of Oncology Care

Cancer-associated morbidity and mortality continue to pose a significant public health issue. According to the American Cancer Society, 2,001,140 new cancer cases and 611,720 cancer-related deaths are estimated to occur in 2024 in the United States.¹ From 2015 to 2019, 6 of the top 10 cancers displayed increasing annual incidence rates, further demonstrating the existence of a public health crisis.¹ Additionally, health care costs related to the screening, diagnosis, staging, treatment, and monitoring of cancer place significant financial burdens on patients. Patients with cancer have been shown to have approximately 4 times higher annual health care expenditures compared to those without cancer.²

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Oncology pharmacists are in a prime position to improve cancer-related outcomes, improve patient quality of life, and reduce cancer-related financial burden. For nearly 50 years, oncology pharmacists have been involved in guiding patients experiencing extreme hardship created by cancer. Initially, oncology pharmacists were seen only in the inpatient and outpatient setting, limited to drug safety checks.³ However, the evolution of technology has enabled oncology pharmacists to have a greater role in patient care and ensuring that the patient is safe.³ The expanded role of oncology pharmacists includes the opportunity to work in ambulatory settings, infusion centers, delivery of specialized in pharmacy services, evaluation of investigational new drugs, and manager roles in drug chain supply and in coordination of care.³

One responsibility of an oncology pharmacist is oversight of individual patients’ medication adherence, as well as entire programs designed to improve medication adherence. Of course, adherence with some oncology treatment regimens is delicate as a result of medications’ adverse effect profiles and the condition of the patient. A systemic review found consistent evidence of the impact of depression and emotions, perception of illness, and lack of patient self-efficacy further potentiated by poor social support systems, all problematic for patients taking oral anticancer medications. The review found that effective interventions by pharmacists account for these issues, thus transcending mere clinical knowledge.⁴

Pharmacist leaders in this area also work to ensure that the health team is knowledgeable about cancer-associated treatment regimens, in addition to organizational policies and protocols for managing patients.³ The Hematology/Oncology Pharmacy Association suggests that oncology pharmacists coordinate medication therapy management programs, develop independent prescribing protocols, and coordinate communication with oncologists and other members of the health care team.⁵ Still evolving demands of pharmacists in oncology consist of adjusting chemotherapy dosing, assessing the response as well as the toxicity to the human body, managing chemotherapy-induced nausea and vomiting, and providing consultation on pain management inherent to the plight of many patients.

Cost burden can also be a momentous issue for cancer patients and their families. Pharmacist-driven cost savings in oncology have been demonstrated in multiple studies.³ A recent review of the financial impact of oncology pharmacists assessed 4686 interventions conducted by 9 oncology pharmacists in a 6-month time period.⁵ The yearly value of these interventions, after accounting for the cost of the pharmacists’ time, was approximated to be $1.1 million dollars.⁵ This exemplifies the importance of having more oncology pharmacists integrated into a patient’s care team.

A recently published latent profile analysis examined the issue of financial toxicity for cancer patients.6Financial toxicity refers to the significant personal financial burden faced by patients undergoing cancer treatment, objective financial burden, and subjective financial distress. It was observed that pharmacists and other members of the health care team should make regular follow-up visits to cancer patients discharged from hospitals for home rehabilitation to achieve continuous health management and provide psychological support such as interventions based on positive thinking and acceptance therapy for patients with high psychological burdens.⁶

With the complexity of cancer therapies, it is critical that pharmacists in oncology apply patient activation strategies to engage them in their own care.⁷ An activated patient is one who takes initiative, asks questions, and believes that their own actions can help facilitate better treatment outcomes. It is well documentedthat in oncology and a wide range of other conditions that patients who are activated are more likely to be adherent and often have improved recovery times and quality of life.⁷

Another facet of oncology practice deals with quality metrics. One study reported the impact that oncology pharmacists have on Quality Oncology Practice Initiative (QOPI) metrics.⁸ It was demonstrated that out of the 177 metrics, 66 were positively impacted by pharmacists.⁸ These included but were not limited to metrics in drug therapy, symptom management, and patient counseling.⁸ These metrics are important, as they are increasingly associated with quality care, rankings of health systems, various pay-for-performance measures, and can ultimately improve pharmacists’ standing as valuable members of the health care team and bolster any opportunities for acquiring provider status and/or perform billing in this area.

It has been predicted that as early as 2025, we might see a shortage of oncology pharmacists.⁹ This should be noted for the current and future opportunities to enter the arena of oncology pharmacy more formally. It also demonstrates, however, that pharmacists who are not necessarily board-certified in oncology might be called upon to assist health care teams in dealing with patients who face the extraordinary challenges associated with their condition. Greater knowledge of therapy, along with psychosocial factors impacting care, can elevate pharmacists’ position as well as enhance the well-being of the patients that we serve. Let’s answer the call.

References

1. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024 [published correction appears in CA Cancer J Clin. 2024 Mar-Apr;74(2):203]. CA Cancer J Clin. 2024;74(1):12-49.

2. Park J, Look KA. Health care expenditure burden of cancer care in the United States. Inquiry. 2019;56:46958019880696.

3. Holle LM, Segal EM, Jeffers KD. The Expanding Role of the Oncology Pharmacist. Pharmacy (Basel). 2020;8(3):130. Published 2020 Jul 25. doi:10.3390/pharmacy8030130

4. Lin C, Clark R, Tu P, Bosworth HB, Zullig LL. Breast cancer oral anti-cancer medication adherence: a systematic review of psychosocial motivators and barriers. Breast Cancer Res Treat. 2017;165:247-260.

5. Patel MP, Barbour SY, Moorman MT. Value assessment of oncology pharmacist interventions. J Adv Pract Oncol. 2023;14(4):329-331.

6. Xiao T, Zhong H, Xiao R, Chen T, Li L, Chen X. Profiles of financial toxicity and influencing factors among cancer patients: A latent profile analysis. Res Social Adm Pharm. 2024;20(2):137-144.

7. Palmer S, Chen A, Dennison T, et al. Impact of oncology pharmacists on the knowledge, attitude, and practices of clinicians to enhance patient engagement of self-administered oral oncolytics. Pharmacy (Basel). 2021;9(3):130.

8. Knapp K, Ignoffo R. Oncology pharmacists can reduce the projected shortfall in cancer patient visits: Projections for years 2020 to 2025. Pharmacy (Basel). 2020;8(1):43.

9. Griffin SP, Signorelli JR, Lasko A, et al. Oncology pharmacy practice in the United States: Results of a comprehensive, nationwide survey. J Oncol Pharm Pract. 2024;30(2):332-341.