Role of the Oncology Pharmacists Is ‘On the Cusp of Beginning to Evolve and Change’

Pharmacy Times interviewed Scott Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, director of pharmacy cancer care services at Mayo Clinic in Rochester, Minnesota, on the role and value of the oncology pharmacist on patient care teams at Mayo Clinic.

Pharmacy Times: What is the role of the oncology pharmacist on patient care teams at your institution?

Scott Soefje, PharmD, MBA, BCOP, FCCP, FHOPA: I think like most institutions, it's very based upon the care team. We actually have 4 different areas where we have pharmacists. We have an inpatient care team; we have an infusion center. We have research pharmacists, and we have ambulatory care pharmacists in the clinics. And so, the roles vary a little bit on our inpatient service. It's rounding with the team, taking care of patients, doing that acute care stuff that you do in the inpatient setting.

In the infusion center, it is about making sure the patient is getting the right treatment, reviewing their orders, counseling the patients, making sure that medications are there in a timely manner, those kinds of things. On the research side, it is developing protocols, making sure the patient meets the standards for the protocols, helping obtain the processes that we need to do to make sure the research is done correctly from the drugs perspective. And then our clinic-based pharmacists are in the clinic, shoulder to shoulder with providers.

They are doing face to face visits with patients. We actually have pharmacists that are seeing some patients on some cycles of chemotherapy independently. We've determined that there are certain cycles of chemo that only toxicity stops the patient from getting the chemo. And so, our pharmacist will see the patient, do the assessment. If the labs look good, the patient looks good, they will sign the chemo orders and send the patient off to get their infusion. So, again, it's kind of like the role of oncology pharmacist, it's very a variety of different jobs, depending upon your setting, depending upon how things are where you are practicing at that point in time.

Pharmacy Times: How does the oncology pharmacist work with patient care team members on treatment decisions?

Soefje: Most oncology these days is done on the outpatient side. The patient is seen in the clinic, the diagnosis is confirmed in the clinic, and then the treatment plan and all the scheduling are done in the clinic. And so, that's why we thought it was important to get them into the clinic side by side with the providers so that we can be faced to face with patients as those treatment decisions are made.

Our pharmacists are part of the care team—the care team discusses the therapy and decides on what's the best treatment for that patient. Our pharmacist is an equal member of that care team. It is expected at our institution that the pharmacist steps up and says, “Hey, wait a second, have you thought about…” or “That's not the best drug for this patient because…,” and go through that whole process with the providers as they're working through the care plan.

Our pharmacists are part of the care team—the care team discusses the therapy and decides on what's the best treatment for that patient. Image Credit: © Jacob Lund - stock.adobe.com

Then our pharmacists can do independent visits with patients. We have the authority to dose adjust based upon renal or hepatic dysfunction. Our pharmacists can even dose adjust in some situations based upon toxicity. We can add or subtract premedication [or] supportive care meds, based upon the therapy. We’re very reluctant to go out and just stop the therapy or change it. We do have the authority to hold it if the patient is in a toxicity type situation where it needs to be held. But in most cases, it's back to that collaborative work if the patient's progressing, or there's some reason they're not tolerating, then we get the care team together again and decide what's best for the patient.

Our pharmacists do have independent signature authority on chemotherapies. They have collaborative practice agreements with providers, so we can sign the chemotherapy, and we can sign the cycles when it's necessary. We tend to not want our pharmacist signing cycle one day one, we believe that the care team leader should be doing that. But once cycle one day one is done, then they're free to do what's necessary that the care team needs them to do to take care of the drugs [as a part of] medication management.

Pharmacy Times: What are some common misconceptions about the role of the oncology pharmacist?

Soefje: I think a lot of times one of the misconceptions of oncology pharmacist is that we either only dispense drugs or only educate patients about their drugs. But we do a whole lot more than that. I think it's one of those things that we're really trying to get pharmacists involved with patient care, so that the providers see us as those drug therapy experts, and the ones that are there, helping them make the decisions and helping the care team develop the right plan for the patient.

Then we're also there for the patient. We're a patient advocate, supporting that patient, making sure that they're getting the right therapy. So, I think we're more than just those dispensers. I actually heard somebody recently called the pharmacist “dispensers,” and I don't really like that term. And we're trying to get away from that.

Yes, we do have a dispensing role at times. But the idea is, how do you take it to that next step? How do you take it to that step where you are doing medication management at a comprehensive level for that patient their cancer care?

Pharmacy Times: What are some ways that oncology pharmacists could be better utilized on patient care teams?

Soefje: Yeah, I think one of the things that our pharmacists get frustrated with on our care teams as they get pulled in a lot of times to those administrative roles. Again, a lot of times, and this is this is one of those misconception type things as well, where it's a drug, the payers not paying for the drug—well, that's a pharmacy issue. Well, that's not always the case. So I think our pharmacists get really frustrated when they start down that rabbit hole of trying to get something covered from a payer, finding patient assistance, those kinds of things.

As we build care teams that have more financial navigators and financial counselors, and those support services that get through these administrative burdens, I think our pharmacists are more free to do that drug management that they want to do and that we are trained to do much better than some of the financial counseling and some of the other things.

Pharmacy Times: What is the greatest challenge impacting oncology pharmacists’ level of involvement on patient care teams?

Soefje: Our biggest challenge right now is overcoming the habits and the inertia, and the “That's the way we've always done it” kind of thing as you send pharmacists into new clinics. A lot of times we'll get, “Well, we don't know what to do with you here.” And so, we've taught our pharmacists how to just move through, just keep pushing, we tell them, “Sometimes you got to take 2 steps forward and 1 step back, or 2 steps forward and 1 step back.” But as long as you're moving forward. And every time we've done that, what we've seen is that it's almost like a light bulb goes off, some situation happens, something happens, the provider uses of the pharmacists in a way they didn't think about, and then it's like the floodgate opens, and all of a sudden, the pharmacy and the pharmacist is doing more and more and more and more, and their role evolves, evolves, evolves.

So, my challenge is how do we speed that process up? How do we get from here's a pharmacist for your clinic, to the pharmacist doing that high level top of practice type work without having to go some of those steps that we've had to go through in the past.

Then the other big challenge is every time we send the pharmacist to a clinic, we have to re-justify their value. I keep wondering at what point in time can I say, “We've done that, it worked, we've shown it worked. So just let us put somebody in there because it's needed.” I think that's something that we're still going to have to fight with over the next several years as we demonstrate value and show that it's worthwhile putting pharmacists in these different areas.

Pharmacy Times: Any closing thoughts?

Soefje: I just think that the role of the oncology pharmacist is on the cusp of beginning to evolve and change. We're starting to see the blurring of inpatient and outpatient, and we're going to see the blurring of outpatient and home infusions. Then the role of artificial intelligence taking over some of these administrative mundane tasks.

I think we have to be, as oncology pharmacist, ready to embrace these opportunities to say, “This is going to help me do my job better, and it's going to make me help my patient get better.” And if we do that, we can be ahead of the curve a lot of times, and not get bogged down in some of the things that will cause other professions to get bogged down because they're afraid to make that change. So, I would encourage pharmacists to be ready to make that change and be ready to step forward and say, “Here I am, I can do that work.”