Pharmacists Play a Vital Role in Providing Care to Patients With Uterine Cancer

Uterine cancer is the most common malignancy of the female genital tract in the United States.¹ In 2024, the American Cancer Society estimates that there will be about 67,880 new cases of uterine cancer.² When caring for these patients, it is imperative to have a well-rounded care team; with the everchanging landscape of oncology treatment, the pharmacist plays a vital role in the care of these patients.

Outpatient oncology clinics all work differently and are designed to best fit the needs of their patients. In the field of gynecology oncology, the pharmacist has many roles and responsibilities, including but not limited to treatment selection, drug interactions, adverse effect (AE) management, personalized treatment plans, counseling patients, and providing education to the providers and clinic, as well as other pharmacy staff involved in the care of patients.

Over the recent years, advancements in the treatment of uterine cancer have changed the way these patients are managed. Image Credit: © Wayu - stock.adobe.com

Over the recent years, advancements in the treatment of uterine cancer have changed the way these patients are managed. Patients were historically managed with the use of surgery, radiation, and chemotherapy with platinum and taxane agents. Although these modalities still maintain the backbone of uterine cancer treatment, there are new agents including immunotherapy, targeted therapy, and oral therapies that have vastly changed the way uterine cancer is managed.¹ With studies like RUBY, DUO-E, NRG-GY018, and KEYNOTE 775, advancements have been made in the management of uterine cancer by implementing immunotherapy, including dostarlimab (Jemperli; GlaxoSmithKline), durvalumab (Imfinzi; AstraZeneca), and pembrolizumab (Keytruda; Merck), and targeted therapies, including oral medications such as lenvatinib (Lenvima; Eisai and Merck).^3,4,5,6 With these new treatments and the ever-growing landscape of oncology, pharmacists play a pivotal role in providing care for these patients. The role of the pharmacist is multifaceted; below are some of the roles the pharmacist can hold in the care team for patients with uterine cancer.

Treatment Plan Development and Selection

The profession of the pharmacist is one of a life-long learner, as pharmacists learn to educate themselves and adapt to changes in treatments based on primary literature and guideline-directed treatments—this is especially true in oncology, as advancements and standards of practice can shift quickly. Every year, more and more research are published in the field of oncology. By continuing to review the literature, pharmacists can help make sure that patients are receiving the correct care plans and that the regimens are applied appropriately based on patient demographics and outcomes. Pharmacists can also work to evaluate new agents and integrate them into the facility formulary and build the correct order sets or treatment plans in the electronic medical record based on the studied regimens. This is particularly important for practice-changing regimens that will be utilized more in comparison to historical standards of care to help prevent errors when building plans requiring heavy manipulation and to make sure patients receive the appropriate supportive care, such as hypersensitivity pre-medications and anti-emetics.

Education

Pharmacists can serve as an integral part of the clinic when it comes to education. Education includes, but is not limited to: patient education, provider and clinic staff education, pharmacist education, and infusion education. Pharmacists can serve in a large capacity when providing education to patients on their treatment regimens, including the necessary requirements for supportive care and expectations for their infusion experience. Multiple studies have reviewed the effects of having pharmacists complete patient counseling on treatment regimens and how it affects patient quality of life (QOL) outcomes.⁷ Studies have shown that having pharmacists provide initial counseling for patients with cancer improved QOL and decreased anxiety and depression.⁸

Education of new regimens and changes in treatment is important to share among providers, clinic staff, pharmacy staff, and infusion staff. With new regimens, providing education to the treatment team on these medications allows them to better manage all aspects of the patient’s care. For example, providers and clinic staff will be able to better manage AEs and understand what to expect for patients receiving these regimens. Providing education to the other pharmacy and infusion staff is important in terms of appropriate compounding and administration of the medication and ensuring that the medication is given to the patient as recommended by the manufacturer or studied regimen.

Individualized Treatment Plans

Patients with uterine cancer come in all shapes and sizes. Each patient requires an individualized treatment plan based on their age, comorbidities, performance status, and overall preference. The role of the pharmacist in the gynecology oncology space is not limited to only focusing on the treatment agents, however, as pharmacists also aid in comprehensive care.

The average age of patients diagnosed with uterine cancer is 60.² By the time these patients present with their uterine cancer, they likely have a significant medical history that can impact treatment and management of AEs. Being able to evaluate a patient’s comorbidities and how that can affect their cancer care is very important. As the pharmacist, reviewing drug-drug interactions and how that can affect the efficacy of either agent involved is important; it is also necessary to be cognizant of the AEs caused by treatment and the supportive care regimens aligned with said treatment. For example, when increasing incidence of type 2 diabetes, the use of steroids for nausea and vomiting can pose an issue for those with pre-existing diabetes or pre-diabetes. The pharmacist can intervene in these scenarios to make an individualized plan for the patient to provide them with the appropriate cancer treatment and supportive care, while still working to manage their comorbidities.

In addition to the upfront review of drug-drug interactions and the individualization of the patient’s treatment plan, the pharmacist also has the ability to continually adjust the regimen to better meet the patient’s needs. For example, as patients continue to undergo treatment, each patient can experience a different number of toxicities at varying levels. As the pharmacist, the team and patients will often turn to the pharmacist for guidance on managing AEs and recommendations for treatment moving forward, whether proceeding with dose adjustments or changing therapy altogether.

Financial Assistance

Cancer care can be difficult for patients physically and emotionally but can also have significant financial impact on patients and their families. This is another point of care where the pharmacist can be useful in helping guide patients through the appropriate channels to make the treatment of their disease less financially toxic, ultimately improving the patient’s QOL.⁹ Depending on the structure of the system, the pharmacist can work with financial coordinators or the pharmacy team to provide potential solutions to financial toxicity associated with treatment. This could involve enrolling patients in patient assistance programs through the drug manufacturers, finding copay cards, or grants that the patient could use to offset some of the costs.

Pharmacy is an everchanging field and, as pharmacists, we can continue to push the boundaries on what we can do and how we can better serve our health care teams and patients. In the gynecology oncology space, there is a lot of room for pharmacists to make an impact on patients’ care and help them and their caregivers through the difficult diagnosis experience. As we continue to push forward in the future, developing a collaborative practice agreement to allow for billing for chemotherapy education and seeing patients for pre-chemotherapy visits or oral medication management can further expand our roles in this setting. Through these avenues, we can continue to grow our services and advance the career of pharmacy.

REFERENCES

1. Clinical Practice Guidelines in Oncology. Uterine Neoplasms, version 2.2024. NCCN. Accessed August 29, 2024. https://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf

2. Cancer Facts & Figures 2024. American Cancer Society. Atlanta. 2024. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/2024-cancer-facts-figures.html

3. Mirza MR, Chase DM, Slomovitz BM, et al. Dostarlimab for Primary Advanced or Recurrent Endometrial Cancer. N Engl J Med. 2023;388(23):2145-2158. doi:10.1056/NEJMoa2216334

4. Westin SN, Moore K, Chon HS, et al. Durvalumab Plus Carboplatin/Paclitaxel Followed by Maintenance Durvalumab With or Without Olaparib as First-Line Treatment for Advanced Endometrial Cancer: The Phase III DUO-E Trial [published correction appears in J Clin Oncol. 2024 Aug 9:JCO2401660. doi: 10.1200/JCO-24-01660]. J Clin Oncol. 2024;42(3):283-299. doi:10.1200/JCO.23.02132

5. Eskander RN, Sill MW, Beffa L, et al. Pembrolizumab plus Chemotherapy in Advanced Endometrial Cancer. N Engl J Med. 2023;388(23):2159-2170. doi:10.1056/NEJMoa2302312

6. Makker V, Colombo N, Casado Herráez A, et al. Lenvatinib Plus Pembrolizumab in Previously Treated Advanced Endometrial Cancer: Updated Efficacy and Safety From the Randomized Phase III Study 309/KEYNOTE-775. J Clin Oncol. 2023;41(16):2904-2910. doi:10.1200/JCO.22.02152

7. Avery M, Williams F. The importance of pharmacist providing patient education in oncology. J Pharm Pract. 2015;28(1):26-30. doi:10.1177/0897190014562382

8. Tanaka K, Hori A, Tachi T, et al. Impact of pharmacist counseling on reducing instances of adverse events that can affect the quality of life of chemotherapy outpatients with breast Cancer. J Pharm Health Care Sci. 2018;4:9. Published 2018 Apr 30. doi:10.1186/s40780-018-0105-3

9. Farano JL, Kandah HM. Targeting Financial Toxicity in Oncology Specialty Pharmacy at a Large Tertiary Academic Medical Center. J Manag Care Spec Pharm. 2019;25(7):765-769. doi:10.18553/jmcp.2019.25.7.765