The Pharmacist and Cancer

This month we focus on cancer. Pharmacists have many opportunities to engage in cancer-related activities. To demonstrate this, I decided to use some recent headlines to illustrate the breadth of roles that pharmacists can play as well as challenges they face or will be facing as they engage in providing services.

“I think everyone’s been touched by cancer.”

I read this statement in an interview in which a pharmacist graduate told why he contributed to his university’s scholarship fund to support students taking courses in nuclear pharmacy. He mentioned that his grandmother died from cancer, as did his girlfriend’s mother. “I think everyone’s been touched by cancer,” he said. My point is to remind us that this disease seems ubiquitous in our society, affecting many families.

Pharmacists are often privileged to be able to interact with these families, offering a shoulder to cry on, medicine that may cure the cancer or alleviate symptoms, as well as be a source of encouragement. What a privilege we have to be able to serve such an important humanitarian as well as professional role. Regardless of where you practice, your professional role gives you an opportunity to be of help to cancer patients and their families. As difficult as this can be, it does help us appreciate why we became pharmacists and the unique opportunities this profession gives us.

“Innovation: Cancer Vaccine”

This headline appeared in a major weekly news magazine in the technology section. Included in the article was the fact that “cancer-treating drugs likely topped $75 billion last year.” Although some oncology products are far from market, I want to make several points. As pharmacists, we have an obligation to keep up-to-date with current pharmacotherapy developments. In some cases, our role may be to put someone’s newfound hope in perspective so that patients have reasonable expectations for treatment options or outcomes.

We also have an opportunity to encourage people, especially those with cancer, to endure the side effects that are being experienced in light of the potential outcomes later. Occasionally, the opportunity may be to help a patient, or more likely a family, to accept that recovery may not be likely and palliative care is the best thing to do. These can be difficult opportunities.

“The percentage of oncology drugs available in oral form is projected to reach 25% by 2013.”

This quote came from Adam Fein’s blog Drug Channels a few years ago. Cancer medications continue to be a growth area for the pharmaceutical industry. The fact that an increasing number of these agents are administered orally means that pharmacists in community settings may have an opportunity to play a role in both distribution and the management of outcomes. But there is a possible problem. Often these types of drugs are being handled in restricted distribution networks because of cost as well as a need to better manage drug therapy outcomes.

How are you changing your practice model to be able to work directly with patients in helping them manage their drug therapy? Payers are only going to give us the opportunity to handle these types of agents if we can deliver results.

“Move promptly to ensure that a high level of expertise in pharmacogenomics resides within the pharmacy department.”

This quote was one of the many strategic recommendations that appeared in the American Society of Health-System Pharmacists publication, “Pharmacy Forecasts 2013- 2017: Strategic Planning Advice.” One new role that has been projected for pharmacists has been in targeted drug therapy because of the genomic revolution. Cancer drug therapy is likely to experience this opportunity most broadly because advances in understanding molecular events of carcinogenesis have led to the development of genetically targeted therapies.

That is why the strategic recommendation is to develop expertise in pharmacogenomics. Maybe you can learn what you need to know, but what this observation may suggest is that all pharmacists cannot do everything the profession requires. Not only is our profession often divided by practice settings, we are also becoming divided by specialist knowledge. How are you going to prepare yourself for this future? Do you need to become a specialist yourself or can you develop skills to manage a variety of specialists to provide patient-centered care? The future role for the pharmacist in cancer may require such a choice.

These problems—or opportunities—are just the tip of the many that pharmacists might experience as they assume a greater role in the care of patients with cancer. With opportunity often comes risk, but without risk there is no reward. What are you willing to risk to better serve your patients with cancer?

Mr. Eckel is a professor emeritus at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He is interim executive director of the North Carolina Association of Pharmacists.