Role of the Pharmacist in AML Outpatient Treatment

Review of the pharmacist’s role in outpatient care for acute myeloid leukemia.

Katie Culos, PharmD, BCOP: I have a lot of experience in the outpatient setting with acutely ill patients. We do all our stem cell transplants as an outpatient. All our allogeneic patients will start outpatient and only come into the hospital for complications or closer monitoring, similar to your inpatient/outpatient [IPOP] use for patients receiving these therapies.

For my role as a pharmacist, I trained at an institution where everything was done inpatient. In an outpatient setting, I’ve seen a change caring for patients who are acutely ill, going through very intense chemotherapy in this setting. Amanda, can you speak about how your role differentiates inpatient versus outpatient, now that we have a new setting or intensive chemotherapy in an outpatient setting?

Amanda Brahim, PharmD, BCOP, BCPS, BCACP: Yes, there’s a definite paradigm shift that has occurred over the last couple of years. Some intensive chemotherapy regimens, such as conditioning regimens, are being moved to the outpatient side. It’s a great opportunity for a pharmacist to be involved and to shift the focus to practicing patient and family-centered care, where the patient and their caregivers are at the center of it all, and we help them, educate them, and do our best to support them from an outpatient perspective. Before it had been dictated. You were told “you’ll be here for many weeks, and this is what is happening to you,” rather than this approach, which is patient and family centered, and we’re here to support them.

We’ve added additional pharmacists to our outpatient malignant hematology team. They follow up with the patient on a daily or every-other-day basis, make sure that they’re adherent to their medications, identify barriers that they may have, and they’re able to clarify any confusion. There’s a lot happening to these patients in a really short period of time, so it’s important that we’re there to help support them and to reinforce certain educational points.

Yehuda Deutsch, MD: We take these things seriously, and it tells us that we do a lot of work as providers, pharmacists, and physicians to help these patients get this intensive type of care, even as an outpatient. But there are certain requirements that patients and their families need. Patients need to have someone, a loved one, a family member, a close friend, to be there for them and to come with them and help take care of them. That’s really important, especially in transplant, but even with this type of IPOP care.

It’s important for patients to live close by. They can’t get this type of care if they’re traveling 2 hours each way to come and see us. The patients also need to be relatively healthy enough, because we know that many of these patients will end up getting admitted to the hospital with febrile neutropenia. And we need to make sure they are not at high risk, that they do not develop life-threatening complications before being able to come to the hospital.

Katie Culos, PharmD, BCOP: Do you have a required radius that your patients stay within the medical center if they are going to be undergoing this as an outpatient?

Yehuda Deutsch, MD: We don’t have a definite radius in terms of miles or distance. It depends on how long it usually takes them. Some places have a lot more traffic than others. So, it’s a combination of how far and also if they have readily available transportation to get to us.