Pharmacists Can Improve Adherence, Counsel Patients With Breast Cancer

Aislinn Antrim: Hi, I'm Aislinn Antrim with Pharmacy Times. Today I'm speaking with Lakyn Husinka, a staff pharmacist at Alliance Rx Walgreens Prime, about the role that pharmacists can play in breast cancer treatment. So, the breast cancer treatment space has been evolving very quickly over the last few years. What are some key developments that pharmacists should be aware of?

Lakyn Husinka, PharmD: Absolutely. So, one thing we're really seeing is a decreasing use of chemotherapy infusion, when possible, for patients. There's been a big shift of focusing more on targeted therapies, specifically oral medications, just kind of allowing patients have less harm to their normal cells and really just honing in on those cancer cells. Also, by decreasing the chemotherapy, they're using gene assays and really just looking at patients. Specifically, if they have a risk of reoccurrence then they might need it, and if they have less of a recurrence risk, they will kind of stay away from chemotherapy as well. Again, some patients have breast cancer that have hormone receptors that are positive to it and they really feed off of hormones. So, by using estrogen blocking agents like letrozole or fulvestrant, we kind of then can use that to block that receptor and starve the tumors. So, we're seeing a lot of that used as dual therapy in these patients as well. We're also seeing a lot of immunology, so actually giving medications that boosts the patient's own immune system to help fight the cancer, instead of just focusing on the work of the medications. Overall, by using these forms of therapies versus chemotherapy, patients are having a lot more tolerable side effect profiles. So, not as much of the weight loss, hair loss, neuropathy that’s kind of more severe. We're focusing more on just the casual nausea, cough, fatigue that is seen with most medications in general.

Aislinn Antrim: Wonderful, those are all really exciting developments. And what are some key considerations when deciding on a treatment plan for patients?

Lakyn Husinka, PharmD: Yeah, so one thing you want to look at is the hormone base they might be having. So, whether it's hormone receptor positive or negative, HER2 positive, that'll kind of let us know which one of those targeted agents we should be using, since we know what receptors we should be focusing on. And we also want to look specifically at that patient. Is this their first time with breast cancer? Are they naive to treatment? Or have they been treated before and let us know what line of therapy we're looking at and how aggressive to be? Also with their age, and if they have a very good prognosis or they're a little older, you won't be as aggressive as with someone who has a worse prognosis and who’s is much younger. You also just want to look at their allergies and their medication list as it stands to see what classes would work well together, what might interact. Of course, unfortunately, you do have to look at cost. So just kind of seeing what medication classes their specific plan will cover for them.

Aislinn Antrim: Absolutely. What are current recommended screening and preventative measures for breast cancer?

Lakyn Husinka, PharmD: Yeah, so one thing you really want to look at is, in general, just your lifestyle. When preventing any type of cancer, especially here, you'll see that just maintaining that normal activity level and weight, staying away from smoking, or decreasing alcohol intake, when possible, will all prevent the risk of breast cancer. Additionally, in a lot of women you're seeing an increase in genetic testing, specifically for women who have had breast cancer in the family, whether it be a mother, grandmother, aunt. They're able to do genetic testing to see if they carry those same genes, so that they can be more aware, and kind of start looking into prevention earlier on. The main way to prevent it, though, is really looking at the use of a mammogram. So, that X-ray will really give us better imaging for early detection of the cancer before it would result into spreading to other parts of the body or causing any systemic symptoms. And most women will start getting that around the age of 45 years old and will get it yearly from there. But patients with high risk will start earlier. So, it's always good to talk to their doctor or their pharmacist to kind of see when they should specifically start getting that looked at.

Aislinn Antrim: Definitely. Mammograms, as you said, are very important. But they were a major area where we saw delays and missed scans during the peak of the COVID-19 pandemic. How could this impact the breast cancer space in the coming years?

Lakyn Husinka, PharmD: Yeah, so unfortunately, as you said we've had a lot of patients miss their mammograms. And like I said, the mammograms are really used to get that early detection. So, by missing out on those and kind of waiting until that cancer has spread or progressed, the tumors are larger. Or if you're having systemic symptoms, you're going to have a worse prognosis, you're going to need to have heavier, more aggressive treatment as well. So, by using the mammograms and not having the worsening prognosis, we're able to have better outcomes for patients. There was actually a study done over 16 years that looked at women who received mammograms regularly and those that had missed one or two or both mammograms leading up to the year that they were diagnosed. And it showed that the women who had missed both leading up to it actually had a 50% higher risk of fatality from having breast cancer, versus those who regularly got their mammograms each year.

Aislinn Antrim: That's very interesting. Finally, what is the specialty pharmacist’s role in breast cancer treatment and how do they add value to the patient experience?

Lakyn Husinka, PharmD: So, I think our big thing here is really just helping patients increase adherence by taking their medications routinely and appropriately. That's really when they're going to have the best benefit from their therapies. And we really do that through the use of just looking at if they have any side effects that we can help them prevent and just manage. So, if we have patients coming in with, you know, nausea, diarrhea, we can recommend an over the counter [medication] or lifestyle change. And a lot of times these patients, if they're having side effects, then they really want to steer away from their medication versus seeing it play out and seeing how effective it can be. So, by helping them manage those side effects upfront, they can stay on these therapies longer and get longer benefit before having to move on to additional class. I really think we're able to benefit our patients, especially here at Alliance, we do outreach to our patients, especially in the beginning of therapy. So, every couple of weeks, just calling and really checking in on them to see if there's anything we can help them with. And just in my experience, I've seen that patients are a lot more likely to open up and let you know what's going on with them, if you kind of are prompting them and like really wanting them to know that you want to work with them. It's just a little easier for them sometimes if you go to them versus them having to you know, wait in line or on hold on a phone call, trying to reach out to someone. And I think just having that additional support system for them [is important]. Someone else they can talk to you that's not their doctor or their family member that they see all the time. It's just, you know, that added benefit for them. And like I said earlier, costs can be a concern. So here at these pharmacies, we are able to look into financial aid programs and any assistance that they might be able to use just to kind of take that cost burden off their mind and one less thing they have to worry about.

Aislinn Antrim: Thank you so much for speaking with me about this.

Lakyn Husinka, PharmD: Thank you so much for having me today. I really appreciate being here.