Pharmacists May See Patients With NSCLC More Often Than Other Care Team Members

When choosing medication regimens for patients with non–small cell lung cancer (NSCLC), driving factors for medication decision-making include guideline recommendations and drug cost, according to a panel of oncology pharmacists in a Pharmacy Times Clinical Forum. Moderated by Scott A. Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, director of pharmacy cancer care services at Mayo Clinic, the panel discussed the role of the pharmacist in decision-making around medication management for patients with NSCLC.

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Soefje started the conversation with the pharmacist’s role in chemotherapy for patients with NSCLC. Soefje noted that sometimes physicians will send the patient to a pharmacist for treatment and management of therapies so the physician can see a greater volume of patients. However, insurance coverage and cost can be a major barrier, so the pharmacist’s role can entail helping the patient choose an appropriate medication based on cost as well as investigating available financial assistance.

“If, for some reason, there are insurance issues, we’ll work directly with some of the manufacturers [and] see if there’s any drug coupons or if the patient is able to get any grants from a lot of the lung cancer services or awareness programs,” said Wiktoria Bogdanska, PharmD, BCOP, clinical pharmacy specialist for the Thoracic Oncology Department at Memorial Sloan Kettering Cancer Center. The panelists also discussed how pharmacists can help physicians choose medication for patients with NSCLC based on guideline recommendations. For managing immunotherapy, the panelists agreed that, typically, they will adhere to the guidelines for management.

Bogdanska noted that medication and medical history plays a large role in the consideration of therapy and will often be a reason a physician will ask a pharmacist to make decisions around medications. “[Physicians] come to us a lot of times regarding patient medication history or past medical history, [such as] if the patient has had an autoimmune disease. I have had patients with solid organ transplants, and we’ll look at if [therapy is] feasible within certain time limits. We try to look at any data [available], but I think knowing exactly which [medication to choose] is hard, especially for the adjuvant and neoadjuvant settings, because it definitely is a lot more multidisciplinary,” Bogdanska said.

Additionally, the panelists noted that clinical pharmacists are often asked by physicians to help order laboratory tests at the proper times. Bogdanska said these test results can help identify patients’ thyroid function and liver function, which can help with medication management decisions.

“I think being cognizant of what the patients are actually experiencing and talking about [is beneficial]. That’s why I think it’s important as the pharmacist to be involved not only in the discussions, but also in listening to what kind of symptoms the patients are having, and then seeing if a medication could be causing it,” Bogdanska added.

Marina Reed, PharmD, clinical pharmacy coordinator at New York-Presbyterian Brooklyn Methodist Hospital, explained that pharmacists may see patients more frequently than other members of the patient care team for treatment reasons. Because of this, the pharmacist may be more abreast of the occurrence of toxicities from medication or adherence issues. Syed Arafath, PharmD, BCOP, clinical pharmacy manager for outpatient hematology/oncology at New York-Presbyterian Hospital, noted that frequent visits also help pharmacists manage the occurrence of adverse events.

Marina Barsoum, PharmD, BCOP, hematology/oncology clinical pharmacist at New York-Presbyterian Brooklyn Methodist Hospital, worked previously as a lymphoma myeloma pharmacist, and she said it was easier to keep up with the latest guidelines and data updates in that space. In her current role, which she describes as “jack of all trades, but a master of none,” she can keep up with the bare bones of the guidelines, but keeping up with all the clinical trial data and information regarding the hematology and oncology spaces is nearly impossible.

“Cancer is like medicine and [is] ever evolving, as there continues to be new drugs on the market and new mutations that we’re targeting,” said Nina DiPierro, PharmD, BCOP, clinical pharmacist at Florida Cancer Specialists & Research Institute. “There’s no way we’re on top of all of it. So to have a pharmacist that is specialized in [the medical] space is very beneficial.”