Enhancing Quality-of-Life Care: The Vital Role of Pharmacists in Supportive Care During Cancer Treatment

In an interview with Pharmacy Times, Scott Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, director of pharmacy cancer care at Mayo Clinic, discusses the role of pharmacists in supportive care for patients with cancer. Soefje highlights key innovations, promising technological advancements, and the benefits of relying on pharmacists to provide patients with quality-of-life care.

Pharmacy Times: Can you provide an overview of the key innovations in supportive care for patients with solid tumors presented in your presentation?

Scott Soefje, PharmD, MBA, BCOP, FCCP, FHOPA: Our presentation is really focusing on a couple of areas that we thought were important in the solid supportive care space. The first is looking at oxybutynin [Oxytrol; Merck Consumer Care] use in prostate cancer patients to prevent the hot flashes that occur in men who are on hormone deprivation therapy, that ADT [androgen deprivation therapy] therapy actually causes significant hot flashes. This abstract was looking at whether this drug help reduce the number of hot flashes. And there's some interesting reports on that. The second is we're looking at the new GLP-1 receptor antagonists. These are the weight loss drugs. And there was a study at ASCO [American Society of Clinical Oncology] looking at weight loss drugs versus bariatric surgery, and the reduction of risk due to weight loss. And particularly in those tumors where weight loss or weight is a contributing factor—and they showed that there was some actual benefit—and the GLP-1s were starting to pop up all over ASCO this year looking at their benefits on weight, do they interact with immunotherapy, and those kinds of things. Others are some of the other solid tumors that we don't talk about in the bigger sessions. We have a couple of sessions on gynecological tumors, and then one session on a head neck study.

Pharmacy Times: How do promising technological advancements integrate into existing treatment frameworks, and what challenges might arise in their implementation?

Soefje: AI technology and automation are going to be a big part of healthcare going forward. The question is how we integrate things, like AI, into our electronic health records to help us identify those patients that would best fit a certain criteria, a high-risk patient that need to get this drug, or a low-risk patient that may not need to get this therapy, or a patient that had a higher risk of nausea and vomiting. Do we need to be more aggressive? And how do we integrate those kinds of things to help us move through that type of treatment algorithm? And then from the technological side, how do we use technology to improve our searches, our getting the drugs to the patient faster? All those other things that bog us down in healthcare, maybe we can replace those repetitive tasks with some automation or technology? I think that's what we're going to be looking at as we go forward.

Pharmacy Times: What innovations in psychosocial support have been developed to help patients with solid tumors cope with the emotional and mental health challenges of their diagnosis and treatment?

Soefje: Yeah, so one of the big problems with cancer care as we move forward is it's not always those things that are “which drug for which tumor”; we're getting better at that kind of stuff. It is, “how do we improve the quality of life for the patient? How do we balance that long term effect with the quality of life that everybody wants as they're moving forward?” We always hear from patients, “I don't want to be sick as a dog and in the cancer center the rest of my life if I'm having a short life,” and so how do you balance that? And then the new thing is the financial toxicity. The newer drugs are not cheap. There's no way around it. And what we're seeing is more and more cancer patients burdened with medical debt to the point of even bankruptcy. And so how do we begin to help Aleve financial toxicity? And this may come back to things like, how do we use AI to use the right drug to predict the right time? How do we discontinue the drug when it's necessary? All these things that are being discussed across all the different tumor types. It's going to be an important area of study over the next several years.

Pharmacy Times: What are the latest advancements in pain management for patients with solid tumors, and how effective are they compared with traditional methods?

Soefje: Pain management is one of those things has been around since the 80s and 90s, when I first started practicing, and as much as we like to say there are advancements, the opioids are still our workhorses. There are other things, though. We're starting to look at “how do we optimize optimally dose things? Are there other drugs?” I think the one that's going to be intriguing is, as more states legalize cannabis, how does cannabis start being used in oncology practice? Does it become a supplement for pain management? Then there is the whole psychedelic area in MDMA. And all of these things are being looked at. I don't think anything has come up to be that “home run” yet. But what we're starting to do is get better ways to identify pain, work with patients, find those different mechanisms and those different opportunities. And then, how do we maximize that process to get them through their treatments?

Pharmacy Times: What are some of the primary barriers to implementing these new supportive care innovations in clinical settings, and how can these be addressed to ensure patients have access to the latest supportive care advancements?

Soefje: The problem with supportive care a lot of times, as it takes backseat to those drugs, [becomes] the drug development for the “let's cure the tumor” type of thing. So, we really have to find something that the researchers, the pharmaceutical companies, get excited about. Then we can go out there and help with those supportive care areas. If you think about things like fatigue, we've been dealing with cancer related fatigue since the beginning of treatment, and we still haven't found anything that's successful. We think we know some things help a little bit, but nobody's doing the research on it. So, I think there's going to have to be some way to incentivize the quality of care, the quality-of-life type studies, so that we get that better supportive care, and get a focus on it. I think it's an area for pharmacists. Let the doctors do the newest and greatest and “bestest” and fastest new drug, let us look at how we improve quality of life. And that may be doing things like looking at the real-world data to say, “is this supportive care to really doing what we think it's doing? And if not, then how do we tweak it to make it better and then work with pharma as they develop new drugs to bring in the supportive care space?” I think it's a great role for us. And it's a role that I think most providers will be willing to turn over to us if we want to do it.

Pharmacy Times: Looking ahead, what do you envision as the next major breakthrough in supportive care for cancer patients, and what steps are needed to achieve it?

Soefje: I'm intrigued with the GLP-1 processes. There's going to be a lot of people on those drugs. And so, are we going to have any problems with significant weight loss for patients? Is it going to interfere with chemotherapy? Are there going to be drug interactions we don't even know about? I think we have to really pay attention to that. I think the next big thing is whether we can figure out a way to reduce the cancer level fatigue. When I started in practice, nausea, vomiting was the number one side effect. I think most patients will tell you now fatigue is the number one side effect, but nausea and vomiting still up there. So, we have to do better to make sure we're addressing that. But how do we find something that can offset the fatigue to really help people get through their therapy and continue to do the things of their daily life?