Profiling the Best in Oncology Care: Patients Are the Winners

As editor-in-chief of Directions in Oncology Pharmacy, I have had the privilege of selecting the finalists for the annual Next Generation Pharmacists Award over the last decade. Each year we review a bevy of entrants.

The applications are typically done by the entrant’s manager or peers. It never ceases to amaze me how these pharmacy professionals continue to advance patient care one year over the next. As expected, much of the focus is on the oncology space. Nearly all of the applicants have obtained multiple certifications in oncology and specialty pharmacy.

This month, I think it would be beneficial to share a handful of examples from among the many Next Generation-nominated candidates. Within each there are real-world experiences that many of our readers will hopefully find instructional and perhaps inspirational.

Examples of Innovation in Oncology Specialty Pharmacy

Our first candidate’s onboarding process establishes a relationship with each new patient and creates a patient profile where she is able to accurately assess new oncology therapies. She is able to clarify and adjust those therapies in collaboration with the oncology team where appropriate and counsel her patients thoroughly, including any adverse effect management. Importantly, our candidate is a board certified oncology pharmacist (BCOP) who is well trained to address any drug-related emotional ramifications on medication adverse effects that may present themselves. Most of this candidate’s oncology patients require a weekly check-in to assess progress with their medications, so she creates a strong familiarity and relationship with her patients and their families. Oncology is a complex disease state that often requires many high-cost medications. As a result, our candidate is well versed in working with insurance companies, manufacturers, and grants to eliminate as much cost to the patient as possible.

Our second candidate is managing a busy pediatric hospital pharmacy with a strong focus in oncology. Pediatric oncology patients require very careful dosing and frequent therapy adjustments based on the variability of younger and smaller patients. This candidate’s efforts have included a focus on reducing prescribing errors in pediatric oncology. The hospital is associated with medical and pharmacy schools, where students are often taught pharmacology classes in tandem between both institutions. This candidate has established a teaching program specifically focused on health care provider prescribing quality improvement, where future practitioners are trained side by side and collaboration becomes part of their future practice DNA. The program consists of oncology prescribing best practices with a pediatric focus. Her program includes information for newly trained pharmacists and medical residents on the best way to prescribe oncology medications and how to prevent potential medication errors. On a practice level, this candidate collaborates with all pediatric hospital departments to enhance bedside delivery. The impact of this activity over the past 12 months is that more than 1000 therapies are reviewed and optimized before the pediatric oncology patient is discharged. Truly, this candidate has a great influence on the care and medication delivery of her oncology pediatric patients.

Our third candidate is a specialty pharmacist and hospital pharmacy director at a large integrated delivery network (IDN) pharmacy. He and his team primarily serve oncology patients. This candidate has a passion for treating each patient holistically and addressing all of their care needs, not just pharmacy. Similar to our first candidate, he is known for going the extra mile to ensure that his patients’ oncology medications are approved through insurance, obtaining critically needed financial assistance through various foundations, as well as reaching out to assist in setting up patients with social support and transportation needs. He is known for creating a deep connection with his patients and the patient’s caregivers. This candidate’s efforts go beyond the institution and include serving on the local Susan G. Komen foundation community advisory board, which connects patients with breast cancer to their group’s support services. Additionally, this candidate has worked with a large pharmaceutical manufacturer’s program that supports patients with metastatic breast cancer to get better access to mammograms and preventive health. Recognizing the importance of integrating outreach programs into his practice, in addition to his work with the Komen foundation, this candidate is involved with the local Leukemia & Lymphoma Society, helping to lead fundraising efforts for its Light The Night and Team In Training initiatives in support of patients with blood cancer.

Our fourth candidate is an oncology pharmacist working in an IDN and managing its oncology clinical pathways program. This program aims to proactively provide patients with the education they need to be successful in their treatment journey and obtain ongoing assessments of a patient’s progress toward their treatment goals. The IDN’s clinical pathways program provides strategies designed around peer reviewed and approved treatment protocols by cancer type diagnosis, based on selections made by the broader oncology team. Using an implementation process, oncology patients are provided high-touch, patient-centered care pharmacy consultations, allowing the oncology team to intervene early if any issues are spotted, such as adherence, treatment efficacy, or adverse event mitigation issues. As a direct result of this candidate’s efforts over the past 5 years, she has built, updated, and maintained more than 175 unique medication and disease state-specific evidence-based clinical pathways, including oncology. In doing so, she increased the IDN’s clinical pathway program count in 2020 from about 120 clinical pathways to more than 170. As a result of this candidate’s efforts, the clinical pathways have aided in attaining an excellent proportion of days covered adherence rates year after year. As with our other candidates, this IDN’s program provides information for oncology staff to direct patients to co-pay assistance and patient assistance programs, as needed, to help individuals afford their high-cost oncology medications. It is important to note that 86.49% of patients participating in this IDN’s program were enrolled in co-pay or patient assistance initiatives and, in 2020, a total of $47,265,090 was saved for these patients.

Our fifth candidate also works in an IDN with a focus on clinical oncology program development. This candidate has created countless training guides, work instruction manuals, and checklists for placing oncology patients in the pharmacy system. Additionally, this candidate has helped implement a medical injectable program that allows the IDN’s pharmacy to efficiently work with providers and patients to get them infused or have physician-administered medications sent to providers, while also decreasing medication costs for employer groups. Lastly, this candidate created a workflow to promote the addition of manufacturer patient kits into new-to-therapy patient shipments, which helps patients obtain the information and tools to get started successfully on their new therapy.

Over the next few months, we will announce the final 3 candidates and, ultimately, the winner of the coveted Next Generation Pharmacist Award in October. In reality every candidate is a champion for the professional and, more importantly, the patient.

Training and Certification

If you are considering focusing your professional career toward an oncology practice, much like the examples above, you have many options. Although it is not mandatory to be certified to practice in oncology, certification has become the gold standard. Many oncology pharmacists turned to specialization in cancer, which led to the development of a certification in pharmacy oncology practice. BCOPs have become an essential member of the care team. Patients and providers have come to know the BCOP as someone who is always available to answer their questions and knows the ins and outs of complex treatment and the extras, such as providing new patient starter kits that contain manufacturer information, calendars, and pamphlets about adverse event management, pictorials of how the drug is dosed, diet advice, and drug monograph information that goes with oncology treatment. Patients are often overwhelmed because of the amount of information and the number of new situations and providers they are interacting with. The BCOP becomes their drug navigator. If you are a pharmacist interested focusing your practice in oncology, you might want to explore becoming a BCOP.

The Board of Pharmacy Specialties created a specific certification for oncology, BCOP, which focuses on the certification of specialists in oncology pharmacy. Certification allows the qualified specialty pharmacist to practice at an advanced level of pharmacy practice in a complicated disease state and work in multiple practice settings. Many BCOPs can be found working in a team-based practice alongside a medical oncologist. In this setting, BCOPs work side by side with oncology teams, review patient histories, and develop cancer treatment plans throughout their oncology patients’ disease. With this expertise in understanding the complex therapies, the BCOP can effectively monitor for, prevent, and manage oncology patient drug related adverse events. Becoming a BCOP means pharmacists become recognized by the pharmacy profession, their peers, oncology institutions, payers, and other oncology providers as someone who is well qualified to be an oncology therapy expert on the health care team.

ABOUT THE AUTHOR

Dan Steiber, RPh, operates Genesis Pharma Consultants, a practice responsible for commercial operations and trade-supply chain strategy development. Steiber has served in senior positions in pharmacy, distribution, and industry over the course of his 40-year career, and is a licensed pharmacist in Texas, Washington, California, and Pennsylvania. He is affiliated with several professional associations and publications and is a frequent speaker on behalf of many professional organizers. Steiber graduated from Washington State University College of Pharmacy and Pharmaceutical Sciences in Spokane. He has participated in a variety of postgraduate programs in law and business development/marketing at Harvard University and Northwestern University.