The Pandemic Compelled Oncology Pharmacy to Shift the Paradigm of Oncology Care

The COVID-19 pandemic remains a monumental challenge and a devastating tragedy around the globe. Millions have been infected and the mortality rate has far exceeded initial projections. Many had hoped that with the introduction and widespread use of COVID-19 vaccines, we would see the pandemic end much sooner, but mutations of the virus have been able to circumvent our best solutions. In short, the pandemic may be with us for years.

It is generally recognized that to get the pandemic under control, 70% to 80% of the population must be immunized or, alternatively, be infected and recover. Unfortunately, we have fallen short of this immunization level in the United States. With the spread of variants and high levels of vaccine hesitancy among the public, we have not been able to meet our immunity goals.

As drug experts, oncology pharmacists have a critical role in educating patients, caregivers, and health care teams within their communities. Their role can affect not only the efficacy of advancements in our health care system but also the scope of health care progress in our country.

On the Front Lines of Care

With pharmacists on the front lines of community and institutional health care, they remain trusted sources of information, whether or not they are called out as such by media and lawmakers. Pharmacists have been and will be a strong presence in communities, providing crucial expertise during this crisis. Pharmacists can be found in hospitals, clinics, community pharmacies, long-term care, physician offices, and national and public health offices; all these settings have strong oncology components.

Although the human tragedy of COVID-19 has been vast, so have the efforts by oncology pharmacists to meet new challenges. The pandemic has forced us to adapt, and these adaptations have created a positive evolution of professional practice that, in most cases, will remain the new standard of care. Let’s explore a few of these adaptations in the oncology pharmacy space.

Virtual Health Care

Over the past year and a half, we have worked while using personal protective equipment, masks, plexiglass, computer monitors, and other measures to prevent the spread of COVID-19. This has required sacrificing the personal touch of patient care.

This necessary detachment has also forced us to adapt our methods of communicating with patients, serving as a catalyst for virtual technology adoption across the health care system. Virtual health— including telehealth, digital therapeutics, navigation of care, meeting platforms, and educational resources—is here to stay in one form or another.

Fortunately, oncology pharmacy had much of the technology already in place to allow for a shift to virtual communication. Oncology pharmacists were able to quickly move from the clinic to the home office or another remote location; likewise, patients have received care from oncology pharmacists within their homes or other relatively isolated environments.

With telehealth at their disposal, oncology pharmacists can provide initial drug education, work with patients and caregivers on establishing strong medication adherence, and make any other necessary treatment adjustments. The focus now is on scalability, sustainability, appropriate reimbursement, and optimizing the balance between in-person and remote health care. It is likely that shifts in these areas will not revert once the “new normal” standard of practice has been established.

Studies have indicated that the use of telehealth has exponentially expanded over the course of the pandemic. Patients and providers have become comfortable with consulting over the phone or over Zoom, Teams, or Skype.

Boards of pharmacy, payers, and other policy makers have seen the value of this shift toward virtual care and have supported these changes through new regulations and financing options. With the challenges imposed by the new COVID-19 variants, we have seen these policies kept in place, and they may become permanent.

Why Not Oncology Pharmacy?

Outside of health care, we see that the traditional Monday-through-Friday office commute has shifted to telecommuting or hybrid models, leading to the question: Why not oncology pharmacy? Given the risk profile of a typical immunocompromised oncology patient, it makes sense to implement this shift in the oncology pharmacy space as well.

Many of our oncology pharmacist colleagues have estimated that nearly half of oncology pharmacists are working remotely because of the pandemic. By using various platforms, oncology clinical pharmacists can be found doing their rounds remotely from an office location or their home. This requires working closely with colleagues and the entire medical team.

As we entered lockdowns, work elements such as order verification and chart reviews in the clinic and ambula tory settings shifted almost instantaneously. Rather than limit access to care, we have potentially expanded care through adapted use of technology. As a result, oncology pharmacists were able to take on greater responsibilities when interacting with patients and other medical disciplines on issues such as patient safety, satisfaction, and cohesiveness to overall oncology care.

Additionally, remote oncology pharmacists have been able to successfully shift their medication therapy management and medication reconciliation efforts to a virtual environment. Even the oncology infusion pharmacists have been able to shift to performing their order verifications and completing their validation processes remotely, as well as checking the final administration of oncology infusions remotely via a photographic safety checking system.

Health care has historically been viewed as a locally managed process; through technology, many elements of patient care have been proven to be accessible remotely on a national scale. Post pandemic, we may see the emergence of a hybrid approach to patient care in oncology pharmacy. We will need the oncology pharmacist to be embedded with the overall oncology team to facilitate this, supporting oncologists and nurses directly.

Oncology pharmacists have demonstrated that follow-up and support can take place through technology, saving time and resources by expanding the scope of patient care. I see this as a reimbursable process through collaborative practice agreements made with providers and payers.

Leveling the Quality of Care

Although standardization and accreditation strive to provide relatively equivalent oncology care, no 2 settings can be totally alike. Additionally, it has been predicted that we will see a general decline in the number of oncologists and other oncology support personnel. With virtual health, we have an opportunity to expand care across traditional borders and institutions within the health care system.

Driven by the continued increase in the costs of cancer care, we have seen disparities in oncology care based on population groups and subgroups, income level, access to insurance and care settings, and proximity to clinical trials assessing novel treatments. Individuals affected by these disparities may experience decreased access to higher levels of oncology treatment, potentially leading to greater risk of financial challenges or poorer treatment outcomes.

These disparities have had greater attention and focus during the pandemic. Often, patients with less access to higher-quality cancer care are also at greater risk of acquiring SARS-CoV-2 due to their work or living environments. This exposure can also lead to a greater likelihood of hospitalization from COVID-19, resulting in a negative impact on cancer treatment outcomes.

Through the expanded use of virtual care, our profession can level patient access to higher-quality cancer care by closing disparities, improving access, and optimizing cancer care for all populations. With the recent move to expand access to broadband across the nation, more standardized oncology care is possible. A system in which patients would have broader access to their oncology pharmacist regardless of their location is foreseeable.

To make this future a reality, we must continue to make advancements in data sharing and set new standards in integrated health systems through electronic medical records. The pandemic has accelerated access to virtual care, but innovation coupled with adaptations to current methods of reimbursement and care access will need to rise to the occasion as well.

Triumph Through Adversity

The pandemic forced oncology pharmacy to make great shifts in practice, resulting in the need to further optimize the quality, care, and costs of oncology treatment. By bringing technology and innovative thinking to the fore, we have been able to significantly shift the paradigm of oncology care.

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 organizations. 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.