Jeannette Wick , RPH, MBA, FASCP

Driven by the graying of America, more than 75% of all newly diagnosed cancers occur in people aged 55 or older. Oncology—and oncology pharmacists&mdash;are changing hats swiftly.

Traditionally, inpatient or outpatient oncology pharmacists checked and dispensed medication.

 This pivotal responsibility has since evolved. Pharmacists are progressively swapping their dispensing hats for clinical caps, thanks to technician assistance, technology advancements, and practice progression.

Jon Jankun, RPh, of Hallmark Health, indicates that his institution uses a 3-tiered review process. Pharmacists review chemotherapy orders, monitor pertinent tests, and send recommendations to prescribers if necessary. These functions exploit oncology pharmacists’ specialized knowledge of antineoplastics and supportive care for comorbidities as some begin to work in remarkably progressive roles.

Jay Patel, PharmD, of Banner MD Anderson Cancer Center in Gilbert, Arizona, reports, “I work with oncologists to decide what chemother- apy regimens and supportive care are required for patients based on specific factors—organ function, age, cancer stage, etc&mdash;and the evidence in the literature.”

With more than 800 drugs, biologics, and vaccines in development for cancer, the “drug expert” label keeps oncology pharmacists learning constantly.

 In 2016 alone, the FDA approved or modified indications for 18 agents (online table 1

), with some being subject to multiple actions. These ongoing developments create considerable formulary management responsibilities. For example, at Hallmark Health, oncology phar- macists are integral to the Oncology Pharmacy and Therapeutics (P&T) Committee. Like general P&T committees, this committee develops policies and procedures, periodically reassessing them. Pharmacists also present comprehensive information about new drugs proposed for possible formulary addition and evaluate ongoing uses of approved drugs.

The unprecedented numbers of oncology agents approved in the past few years translate to complex, targeted therapy. Qualified oncology pharmacists who practice in this field have become a treatment team’s critical drug information source. Because drug interactions are a serious concern,

 Dr. Patel indicates that he often collaborates with providers. For example, prescribers will typically ask the oncology pharmacist if antibiotics will cover infections without precipitating interactions in these heavily medicated patients.

Only 65% of patients nationally reported receiving education about their medications, according to the 2015 Hospital Consumer Assessment of Healthcare Providers and Systems survey.

 This large void can lead to poor outcomes. Lisa Holle, PharmD, of the University of Connecticut’s Neag Comprehensive Cancer Center, works directly with oncologists to promote patient care involvement. A quick review of online table 1 shows that new agents have novel mechanisms and narrow indications and that these agents are often approved with companion diagnostic or monitoring kits.

 Many also have boxed warnings. Oncology pharmacists need to be prepared to deal with cancer treatment’s increased complexity and to help patients as they receive more combination therapies and progressive lines of therapy.

Because cancer treatment increasingly relies on oral agents, Dr. Holle reminds us that patients sometimes carry their chemotherapy home, taking it without supervision. Therefore, Dr. Patel and Dr. Holle conduct medication therapy management (MTM) in the clinic and by phone. The intensive education delivered through MTM addresses drug interactions, food interactions, and adherence. This last item is especially important because missed doses could cause cancer recurrence or resistance. The results of a retrospective cohort study indicate that pharmacist monitoring contributes to suc- cessful treatment.

) have produced similarly positive results.

Dr. Holle reports that lacking prescriptive authority, oncology pharmacists cannot bill for services independently as midlevel providers do. Currently, only pharmacists who execute collaborative practice agreements can see patients independently. Legislature is the only alternative solution to this challenge.

 Ongoing role expansion will rely on the accumulation of data that show that pharmacists improve individual systemic outcomes.

Mr. De Lena is a 2017 PharmD candidate at the University of Connecticut. Ms. Wick is a visiting professor at the University of Connecticut.

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What is cancer? American Cancer Society website. cancer.org/treatment/understandingyourdiagnosis/afterdiagnosis/after-diagnosis-who-gets-cancer. Updated February 20, 2015. Accessed December 20, 2016.

Pharmaceutical Research and Manufacturers of America. Medicines in development for cancer 2015 report. PhRMA website. phrma.org/report/medicines-in-development-for-cancer-2015-report. Published September 11, 2015. Accessed December 20, 2016.

Hospital Consumer Assessment of Healthcare Providers and Systems. Summary of HCAHPS survey results, January 2015 to December 2015 discharges. HCAHPS website. hcahpsonline.org. Accessed December 20, 2016.

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Articles

Driven by the graying of America, more than 75% of all newly diagnosed cancers occur in people aged 55 or older. Oncology&mdash;and oncology pharmacists&mdash;are changing hats swiftly.

The Oncology Pharmacist: Taking the Helm in Medication Management

Taxis may not only be a reliable mode of transportation for urbanites—they may also be frequent transmitters of the flu virus.

Around 12% of New York City taxi riders are older than 70, sedentary, and at high risk for chronic disease and influenza. With 233,000 of these US taxi drivers having close contact with riders, taxis may be breeding grounds for communicable diseases.

Thus, immunizing taxi drivers could protect the drivers and their riders.

Researchers have not conducted intervention-based studies targeting influenza vaccination among taxi drivers—until now. A team from the University of Chicago published the results of their vaccination efforts of taxi drivers in the 

The researchers targeted taxi drivers at Chicago-area airport taxi holding lots. They were assisted by Spanish translators and had materials in English, Spanish, and Arabic.

The study used volunteer clinicians, and clinic support staff included nursing staff, physicians, physician residents, marketing personnel, and administrative support from the University of Chicago.

The researchers held 1-day mass immunization clinics at O’Hare International and Midway Airports, and clinicians immunized 545 taxi drivers (11% of approached taxis) in October 2012 and 354 taxi drivers (7%) in October 2013.

Immunization rates were lower in 2013 because the 1-day event occurred on a cold, rainy day, and the researchers suspected that the weather discouraged vaccination.

It is also probable that the researchers immunized more than the 11% and 7% reported, since drivers make multiple trips to the airport daily.

Between 2% and 8% of vaccinated drivers were over 65 years old—a high risk population for the flu.

Reasons for vaccination refusal included vaccine safety concerns, lack of perceived individual risk for acquiring influenza, and concerns of acquiring the flu from immunization.

“While a number of commercial drivers declined vaccination, the feedback was overwhelmingly positive, with drivers frequently expressing appreciation for offering preventive medical services at a convenient location to a population self-characterized as overlooked,” the researchers noted.

The study authors called for vaccination education directed at taxi drivers to encourage higher coverage rates.

“Next steps to improving immunization coverage among this population should incorporate robust education initiatives to overcome misconceptions and vaccine hesitancy in order to protect taxi drivers and their passengers from vaccine-preventable illness,” the researchers concluded. 

Taxis may not only be a reliable mode of transportation for urbanites-they may also be frequent transmitters of the flu virus.
