Pharmacists Play Essential Role in Tolerability for Patients on Oral Anticancer Agents

In an interview with Pharmacy Times® at the American Society of Health-System Pharmacists Summer Meetings and Exhibition, Tina Saleh, PharmD, PGY1 specialty pharmacy resident at the University of Illinois Hospital and Health Science System, discusses how oral anticancer agents differ from infusions and how pharmacists can improve tolerability for patients.

Q: How are oral anticancer agents different from infusions in terms of tolerability for patients?

Tina Saleh: Oral and infusion anticancer agents both have a lot of toxicities associated with them. In general, with the infusion anticancer agents, a lot of those have more acute toxicities because they're getting a bolus dose, they might have infusion related reactions.

With the oral anticancer agent side effects, they might be a little bit slower to come on. but there's also a lot of toxicities with the oral meds, and there's financial toxicity. So, a lot of the copays of those medications can be in the 1000s, and so we have to do a lot of work to get them grant assistance and find them funding to help with that as well.

Q: How can a pharmacist help to improve the tolerability of these agents for patients?

Tina Saleh: I think the 2 biggest roles here that pharmacist play are, first, education, so before the patient even starts to medication, we give them so much information about the side effects and how they can manage those side effects. We're also making sure that they have supportive therapy with them. With any time we dispense an oral anticancer agent, we're always making sure that they might need an anti-diarrheal or anti-emetic, and we make sure we dispense those as well and educate the patient on how to use those. We give them all the tools to manage any side effects that may come up.

Q: How can a pharmacist within a health system’s specialty pharmacy effectively communicate with physicians to achieve optimal patient outcomes?

Tina Saleh: Being a health-system-based specialty pharmacy, we have a lot of systems in place that help us to directly communicate with the whole medical team in the cancer center. We're able to contact them via our EMR or via telephone or face-to-face, and then we use that communication to let them know of any issues that come up because every time before we dispense a medication each month, we're looking at their labs, we're making sure that they are not having any acute visits in between their clinic visits. Anytime an issue comes up, we're able to let the doctors know and then maybe adjust the medication or dose or things like that.

Q: How can pharmacists help manage or improve adherence with these oral agents?

Tina Saleh: Being a specialty pharmacy, we're calling the patient each month and even if they miss 1 dose, we find out, and then the pharmacist can call a patient and counsel them and find out if it was due to forgetfulness, so maybe they'll need a pillbox, which we can send them or a phone alarm. If it was due to a side effect, we can make sure that they have the correct supportive therapy that goes along with that.

Q: Can you speak to the growing importance of oral anticancer drugs, particularly during the pandemic?

Tina Saleh: I think over the past couple of decades, there's been a huge shift towards oral anti-cancer agents. The future of oncology is definitely oral medications, and then, in terms of the pandemic, it was really great because patients didn't have to come into their clinic visits to get the infusion every few weeks, they were able to start their oncology medications from the comfort of their own home. So that was a big help.

Q: Why is pharmacist intervention important, especially in hematology and oncology?

Tina Saleh: I think pharmacists play a vital role in the hematology and oncology space. Physicians will diagnose and they treat, but we have a huge role in making sure that they're on the correct medication, making sure that they know how to take the medications correctly, that they're not having any side effects, that they're adherent, so I think being a specialty pharmacist in oncology, we have a pretty significant impact in those patients and their entire chemotherapy regimen.