New Roles for Oncology Pharmacists

These pharmacists have specialized knowledge about pharmaceuticals and their use in treating cancer and its comorbidities, and they work collaboratively with the health care team to optimize outcomes.

Oncology pharmacists, having historically played a vital role in supporting oncology health care teams, now have expanded their team responsibilities. With the increasing number of oncology drugs forecasted to arrive on the market over the next few years—and with the increasing complexity of many of the new oncology therapies—the demand for motivated, qualified oncology pharmacists will increase as well. A review of what most oncology pharmacists’ responsibilities are today and some of the emergent oncology practice opportunities would be enlightening.

Oncology pharmacists have specialized knowledge about pharmaceuticals and their use in treating cancer and its comorbidities.¹ Pharmacists on the oncology health care team work collaboratively to optimize outcomes by ensuring that the correct drug is used in the most appropriate dose for individual patients and in adherence to the correct treatment dosing schedule. “Dosing schedule” refers to taking the correct drug in the correct dose at the correct time and in concert with concurrent cancer treatment and diagnostic procedures. In addition, today’s oncology pharmacists educate patients and direct caregivers regarding what they should expect from the cancer drugs during the course of treatment.^1,2

Managing Complications of Cancer Treatments

A particularly important component of this education is how to manage complications of cancer treatment side effects and toxicities. With adequate pre- and post-treatment planning and education, many of these untoward events can be minimized and even self-managed in the home, thus minimizing unscheduled and costly visits to an urgent care center and/or hospital emergency department.

Professional tasks critical to accomplishing this are the provision of services such as comprehensive medication therapy reviews to identify drug-drug, drug-lab, and drug-nutrition interactions with a given cancer therapy regimen and to design appropriate plans, along with other health care team members, to minimize the chance of a significant problem occurring. It is worth noting that a great deal of the oncology pharmacist’s provision of supportive care in the home and oncology office is focused on managing analgesia, gastric distress, nausea and emesis, and neuropathies associated with cancer and/or cancer treatments.

Many oncology practices, particularly those employing 5 or more oncologists, have sterile compounding done in the office, using intravenous admixture pharmacy technicians (IVTs).³ All sterile cancer chemotherapy compounding must be done in an ISO 5 (Class 100) biologic safety cabinet. The more advanced of these practices employ at least 1 pharmacist to supervise the IVTs and ensure that sterile compounding is compliant with current USP Chapter 797 requirements. In many of these practices, the oncology pharmacist’s role has been expanded to encompass drug inventory control, which includes purchasing drug and compounding supplies, minimizing overstocking, and finding alternatives to items in short supply. These pharmacists also coordinate patient-specific in-office sterile compounding with scheduled in-office medication administration, approximating a just-in-time compound/delivery process to minimize drug wastage and delays in medication administration.

For those cancer patients receiving cancer medications in the home, the oncology pharmacist usually ensures that patients are contacted and asked about drug adherence, which includes obtaining doses-remaining counts and reminding patients of the importance of consistently taking medications as prescribed.¹ The oncology pharmacist’s actions are documented in the medical record and are verbally reported to other health care team members.

Evolving Role

As important as these responsibilities and tasks of oncology pharmacists continue to be, the pharmacist’s role has continued to evolve. Oncology pharmacists are more frequently included as part of the clinical oncology team, rounding with the other team members and contributing key drug information in the development of patient-specific and often innovative care plans.¹ As an extension of the oncology pharmacist’s involvement in inventory management and sterile compounding, many of those pharmacists with strong business backgrounds—often having advanced academic degrees in business or health care administration—migrate into practice and clinic management while maintaining clinical involvement. Clinic management involves responsibility for ensuring that patient assessments are done, specimens for laboratory testing are drawn, treatment orders are written and executed, and follow-up visits are scheduled and occur. Such clinic management responsibilities are usually associated with a written collaborative practice agreement that satisfies all health regulatory board criteria for the state in which the oncology practice is located.

Although a relatively small number of pharmacists have been intimately involved in research, it is forecasted that there will be an increasing demand for oncology pharmacists to be co-investigators or principal investigators in clinical trials, including trials involving patients whose site of care is the home and the oncology office. Such oncology pharmacists typically have extensive research training and related credentials obtained at the postgraduate level and with oncology specialty board certification.

Another emergent role for the oncology pharmacist is in the field of pharmacogenomics, where pharmacists are intimately involved in studies of how variations in the human genome affect the response to oncology medications and how specific laboratory tests can be used to determine which patients will have the best chance of receiving benefit from certain drugs and which patients will not realize any clinical benefit from the same drug.

As another extension of the oncology pharmacist’s role in ensuring both safe and effective cancer and supportive care drug therapies, it is forecasted that these pharmacists will have an important role to play as either members or leaders of continuous quality improvement (CQI) teams, both hospital and oncology practice based. Such pharmacists will optimize their contribution to such CQI teams by having prepared themselves through formal CQI training programs, for example, Six Sigma and Lean Six Sigma, which offer recognized certificates of proficiency. Also, oncology pharmacists who have a specialty in pharmacovigilance have a great deal to contribute to CQI teams, particularly through their application of data-driven analytic methods commonly used in their practices.

In summary, the role of the oncology pharmacist has evolved and will continue to grow. With the volume of oncology drug information expanding exponentially, the need for more emphasis on medication safety monitoring and assurance, and an increasing need for oncology pharmacists’ unique expertise, it is forecasted that the demand for highly motivated, well-trained and properly credentialed pharmacists in oncology will continue to increase for the foreseeable future.

References

1. Chen B, Harvey RD, Liewer S, Valgus J. ASCO expert corner: the role of an oncology pharmacist. Cancer.net. www.cancer.net/print/29391. July 2013.

2. Sessions JK, Valgus J, Barbour SY, Lacovelli L. Role of oncology clinical pharmacists in light of the oncology workforce study. J Oncology Practice. 2010;6(5):270-272. http://ncbi.nlm.nih.gov/pmc/articles/PMC2936477

3. Clinical pharmacists in oncology practice. J Oncol Pract. 2008;4(4):172-174. http://jop.ascopubs.org/content/4/4/172.full.

About the Author

Royce A. Burruss, RPh, MBA, FASCP, is the senior director of clinical specialty pharmacy services at Cardinal Health OncoSource Rx. Prior to this, he practiced clinical and administrative pharmacy in managed care, home infusion, retail, and hospital settings. He has 11 active pharmacist licenses and since 1999 has been an assistant clinical professor of the University of Maryland, School of Pharmacy. He graduated from Virginia Commonwealth University, Medical College of Virginia, School of Pharmacy with a bachelor of science in pharmacy and received an MBA from the University of Richmond.