Sara Karlovitch Assistant Editor

 is getting to know oncology pharmacy professionals through a series of interviews. In this issue, we talk to Gordon Vanscoy, PharmD, MBA, CACP, recently named a national Entrepreneur of the Year for 2020 by Ernst & Young. 

Title: Chairman and CEO of PANTHERx Rare Pharmacy and chairman and CEO of RareMed Solutions

What motivated you to become a pharmacist and to practice in the oncology space? 

When I was a kid, my family were blue-collar individuals from western Pennsylvania. I was [the] fourth child of 4 and the first to go to college. I only knew of the University of Pittsburgh (PITT) back then. Being a person who was very proud for the [PITT] Panthers, I chose that route. 

My mom and dad always wanted a doctor in the family but, locally, the person who provided [me with] the most primary care was a pharmacist. It’s just a fact. It was a different time, and he was a pretty well-respected individual. So, I decided, instead of just going for a 4-year degree, [I’d] also apply to pharmacy school. I started college when I was 16 and pursued a bachelor in science for pharmacy degree. It was a difficult decision, to complete pharmacy school or to go into medical school, but I loved all aspects of pharmacy. 

When I went for my PharmD, there were only 4 other people in my class at Duquesne University. I finished a residency, did a fellowship, went back to PITT for my MBA, and then I started my career. The anchor in my career was always pharmacy, but I was an entrepreneur. I eventually started 8 companies, including PANTHERx and RareMed. 

I’ve kind of been a fish out of water. I was the one who walked in the different realms of entrepreneurship and academics, and I loved both realms. [That] is how I met my business partners, who were my former students. Because of them and my team, we are where we are today. It’s pretty incredible. 

We got into the oncology side of things, primarily for 2 reasons. One, in 2011, a pediatric voucher act was proposed to the federal government that would accelerate orphan drug development, both financially and politically. That went through to the Orphan Drug Act. What we saw in 2014 and 2015 was the FDA pipeline loaded with orphan drugs. We have these products that target very, very small populations where you see significant benefit with limited risk. That’s why [I chose] oncology. 

The other side of it is that everybody has a personal experience with cancer. My wife is a cancer survivor, and my mother-in-law [had cancer and] was not a survivor. 

Putting together a business opportunity and a passion for making a difference on the cancer side is why PANTHERx Rare ended up smack dab in the middle of being a leading provider in oncology and oncology care. 

 Can you talk a bit about the Entrepreneur of the Year award and what it means to you? 

 Honestly, I was surprised [by the win]. I was taken aback. We had won in the region, and then we were competing nationally. I didn’t even tell many people that we were a part of it with the anticipation that nothing would come, and we were grateful to Ernst & Young for our involvement in the event, as well as their support. It’s a very, very rigorous process. It’s a number of essays and financial analyses, interviews that go on, and there are a number of things that happen in different ways. So for us, to think when we started this process that we would actually have an opportunity to be a national winner was pretty remote. 

When it was announced, I was almost speechless. For our region, the last time somebody had even made it to the finals was in 2002, so it was an 18-year period between anyone ever making it to being a finalist in the nationals and [then winning.] And quite honestly, the thing I’m really proud of is that pharmacy was represented on a national level. In an industry dominated by giants where you have corporate entities that are just consuming companies left and right, we represented an independent company. Seeing pharmacists with business acuity win, and seeing it on a national level where there are few others, was pretty daunting. I’m really proud to be representing pharmacy on that national level, and that pharmacy has that degree of talent. It’s not [just] my talent. I’m a representative of my team, and my team is absolutely phenomenal. 

What do you think is the biggest challenge currently facing oncology pharmacy? 

It’s interesting. We have this forefront of gene therapy and there is so much promise with it. However, I think the biggest challenge is going to be how we afford it. These products, as we go for smaller and smaller populations—and remember, it still takes a lot of money to develop and design these drugs&mdash;what we’re ending up with is extremely expensive therapies. Now we have gene therapies and cell therapies, where you may be talking [about] millions of dollars to treat a single patient. We have yet to get to the point where we’ve had enough gene therapies in order to understand the bell curve because we just have a few. I think that’s the future, quite frankly. 

I think in oncology, you have traditional oncology, and you have what’s in the future. PANTHERx Rare is focused on those future products. How do we look at these advanced entities that are targeted for small populations where we need real-time data, and very close relationships with the patient? In oncology pharmacy, we’re going to have to address [this and] how we do it. Because it’s not just the financial side of it, it’s the delivery side of it. These entities, some of them [must remain at negative] hundreds of degrees in order to get distributed, some have a shelf life of 12 hours, [and] some of them are coming from centers. If they are manufactured in Boston, and the patient is in California, how do you get it from the manufacturer to the pharmacy, to the patient within a period of time where it’s still conducive to a positive outcome? So, right now, that’s my focus. 

 What is a recent advancement or success you think is really going to impact the oncology pharmacy space or that you are personally excited about? 

 We have a cold chain product, and we’re seeing more and more cold chain and unique distribution model products. We were able to adopt a 5G-enabled refrigerator that has an iPad on the front of it. And each dose of the drug is tagged with radio frequency identification. When we ship out the drug, we also ship these refrigerators to the patient’s house, and we know when the patient takes the drug out of the refrigerator. We can communicate with the patient via this technology. 

We send a nurse to the patient’s house in order to train them, not only on injecting the product but also on the refrigerator. It’s fascinating to see adherence get to that level. We know when a patient misses a dose, whether the power went out, and whether there was a temperature dispersion. And we are able to plan for patient’s vacations. We had a circumstance where this product had to go to China. We had to make sure the product [and] a cold chain were able to get through TSA, that there was enough of it, and that all the supplies got to the patient. 

I think that even though this is an example of technology at its best, you [have] to make sure that the technology marries with the understanding of the patient because it’s not for everybody. Not everybody understands the level of how to use that type of system. Some patients like to be communicated [with] via the telephone. Some patients like to be texted. What we try to do is tailor technology around patient preferences to make it a better experience. 

 What do you think will be permanently changed in pharmacy by the coronavirus disease 2019 (COVID-19) pandemic? 

 There are a couple of things. Interestingly, I think pharmacy was recognized as a life-sustaining profession. You remember when pharmacy was the most respected profession; then we got away from that for a variety of reasons. But I think now [that] pharmacy has been involved in ordering some of the COVID-19 tests, it is going to be instrumental in [the] vaccine delivery process. And pharmacy [has] frontline workers. You didn’t see your pharmacies close. So, what I think we’ve seen COVID-19 do is bring pharmacy back to the forefront as a health care provider that is there for patients, regardless of the circumstance. 

I think that [perception] was magnified at PANTHERx Rare and RareMed because we have dozens of exclusive or semiexclusive situations where the only place you can get a product in the country is from us. We have absolutely, positively, no option to close. None. We close, and patients’ lives suffer. So, we have to have not only have plans in place to manage through that crisis, [but] we also have to have redundancy plans, [and] we have to have backups to the redundancy plans. 

What has also changed is work from home. Yes, we have to have a distribution component that has to be onsite, but at PANTHERx Rare, we suggest that 80% of our workforce is now decentralized or virtual. And at RareMed, 95% is [remote]. I think pharmacy, and in particular direct delivery pharmacy, has gone virtual. 

What hasn’t changed is our focus on patients by teams. [For] every disease state, [for] every drug that we have, there is a multidisciplinary team that is purely dedicated to it. These folks are on Zoom all the time. These teams still exist, but it’s virtual. And they can do it from their homes. But again, you still have to have the distribution component available… and you [have] to have practices in place to ensure that COVID-19 never penetrates and shuts that down. 

 What do you enjoy most about practicing in oncology pharmacy? 

 It centers on the patient. In my organization, I lead people, and what I enjoy the most from my perspective is supporting, developing, and understanding what my frontline providers are doing on behalf of our patients. We create systems, we create education, and we create processes to support these individuals. And they are the front lines that do it. That’s the reward. 

One of our organizations is now approaching a $2 billion organization just with 300 associates. It’s amazing how so few people on the grand scale can have such an impact on so many lives. They do it 1 patient at a time. We’re not rushing them, we’re not pushing them, and if they can take those few extra moments with the patient, we encourage that. The most important thing for me is getting feedback from our patients about how my pharmacists, pharmacy techs, insurance resolution specialists, or nurses have made a difference in their life. 

 What is 1 fact about you that may be unexpected to your customers or clients? 

 I’m a private pilot. I do crazy things that drive my partners and sometimes my family crazy. We all enjoy scuba diving, and I captain my own boat. I like doing things that are somewhat on the edge, but not that much, quite frankly. It’s that thrill-seeking that I think we brought to business and the risk-taking that is necessary in order to propel it. 

The other thing, which isn’t a surprise, is I’m probably the most family-oriented person you’ll ever find. I just had a granddaughter! She is now 6 months old, and I watch her eat. She went from a bottle to now eating solid foods, pureed foods, and that was the joy of my day. Being a grandfather is a really great place to be. 

Articles

Directions in Oncology Pharmacy® talks to Gordon Vanscoy, PharmD, MBA, CACP, recently named a national Entrepreneur of the Year for 2020 by Ernst & Young. 

Combining a Passion for Making a Difference With Entrepreneurship

Technology can help drastically improve disease monitoring, management, and diagnoses, according to clinical pharmacists. Wearable technology and apps for monitoring health and wellness have increased in popularity, and virtual health services are demonstrating that telehealth can be just as effective as in-person visits with pharmacists.

Experts on digital health care at the virtual 2020 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting and Exhibition presented data and information on evolving health technology in 2 sessions. They illustrated how pharmacists could use this technology in oncology.

According to presenter Betsy Cernero, PharmD, an ambulatory care clinical pharmacist at NewYork- Presbyterian Hospital in New York, New York, wearable technology and apps that monitor health and wellness have exploded in popularity and sophistication in recent years. 

“Digital medicine and its regulation are constantly evolving, which is a great thing,” said Cernero.

She said the 21st Century Cures Act helps accelerate the development, approval, and review of such products and the Health Insurance Portability and Accountability Act regulates the information that is transmitted or stored on apps and devices.

Although wearable devices that monitor our health, such as self-blood pressure monitors for cardiology conditions and continuous glucose monitors for individuals with diabetes, are making massive strides in digital health technology, wearable devices that administer medication are also gaining traction. Patients adhere to 50% of the drugs prescribed for chronic disease in developed nations, according to the presentation by Cernero and Carolyn J. Oxencis, PharmD, BCOP, BCPS, a clinical oncology pharmacist and clinical assistant professor at Froedtert & the Medical College of Wisconsin in Milwaukee. Wearable drug delivery devices, sometimes called bolus injectors or on-body infusers, can help increase medication adherence, Cernero said.

The technology has proved especially beneficial for those living with cancer. For example, in 2015, the FDA approved a device for pegfilgrastim that decreased the incidence of infection in patients with nonmyeloid malignancies who received myelosuppressive anticancer drugs associated with a clinically significant incidence of febrile neutropenia. The device is a single-use-on-body infuser with a prefilled cartridge. The provider loads the device, which delivers a 45-minute at-home self-injection approximately 27 hours after application.

In another ASHP session, a panel of experts moderated by John Beyer, PharmD, MS, MBA, BCPS, a pharmacy informatics manager at the University of Iowa Health Care in Iowa City, and LaTasha Riddick, PharmD, a clinical coordinator at Johns Hopkins Home Care Group in Baltimore, Maryland, opined that telehealth offers patients an interactive, cost-effective way of seeing a health care provider remotely using video and audio technology.

Prior to the coronavirus disease 2019 pandemic, telehealth was largely seen as optional and was primarily used during particular circumstances. However, the pandemic has made telehealth an invaluable service, as it offers patients a safe way to speak to their health care providers.

“Traditionally, these [telemedicine services] have been focused on inpatient pharmacy services, such as order verification for hospitals that are either located in rural communities or are extensions of a larger health system,” said Beyer. “And many times, pharmacists would provide cognitive services such as being a resource to nursing staff, or provider staff…or other types of clinical monitoring. We’ve now seen a much larger expansion into the outpatient space.” 

Despite the benefits of health technology, barriers still exist. One barrier may include patient confusion on how the technology works. According to Oxencis, a lack of integration into electronic health records also exists. Low-income patients or patients with low health literacy may also not have access to needed technological devices.

Additionally, all of the factors relating to medication adherence are not fully addressed in most digital applications. A reliance on self-reporting may also impact results.

“So, barriers to using any of these apps, of course, are…ease of use and cost,” Oxencis said. “What do these apps look like, and are they actually helpful?” 

According to Cernero and Oxencis, technology and medicine have continued to merge in recent years. Pharmacists should be integrating health technology in their routine clinical practice for maximum optimization.

Cernero B, Oxencis, C. Don’t worry, be “appy”: when tech meets medicine. Presented at: 2020 ASHP Midyear Clinical Meeting and Exhibition; December 6-10, 2020; virtual. 

Beyer, J, Riddick, L. “Siri, get me my pharmacist”: the virtual health pharmacist role. Presented at: 2020 ASHP Midyear Clinical Meeting and Exhibition; December 6-10, 2020; virtual. 

“Digital medicine and its regulation are constantly evolving, which is a great thing.”&mdash;Betsy Cernero, PharmD

The Role of Telehealth in Oncology Pharmacy Is Increasingly Important

Computer algorithms can help patients with cancer better manage symptoms and improve overall wellbeing, according to a study published in the 

Patients with cancer often experience a range of symptoms caused by the disease itself or resulting from the adverse effects of chemotherapy or other treatments, which can be life threatening and require hospitalization. These symptoms can lower a patient’s quality of life significantly and better management is needed in order to reduce physical distress. 

The study included 508 patients between 18 and 86 years of age who were starting chemotherapy at Leeds Cancer Centre in the United Kingdom. Over the course of the 18-week study period, 256 of the participants diagnosed with early-stage breast or gynecological cancer answered specific questions through an online symptom, known as eRAPID, once a week or when a new symptom appeared. 

Questions addressed pain levels, nausea, spending time in bed, and not meeting family needs. An algorithm designed by investigators and clinicians scored the responses and determined what advice the patient received. In total, 3314 online reports were completed documenting 18,867 symptoms. 

According to the study, patients reported better symptom control and wellbeing in the early weeks of treatment. Additionally, the system prevented symptom deterioration in approximately 9% of patients after 12 weeks.

Patients also reported they were more confident in managing their health at the end of the 4-month trial period. Emergency alerts were sent under 29 times, whereas serious symptoms not requiring immediate medical attention were reported on 14% of occasions, according to the study. 

"Remote online monitoring options have the potential to be a patient-centered, safe and effective approach to support patients during cancer treatment and manage the growing clinical workload for cancer care," said Galina Velikova, PhD, program lead professor, in a press release. 

The system was also found to be cost-effective. According to the study, more than 80% of self-reported symptoms triggered self-management advice. Data showed no increase in hospital workload, differences in chemotherapy delivery, or compromised patient safety.  

New tech helping cancer patients manage symptoms [News Release] January 8, 2021; Leeds, United Kingdom. Accessed January 11, 2021. 

https://www.eurekalert.org/pub_releases/2021-01/uol-nth010821.php

Novel program found cost effective and safe for patients with cancer managing the adverse effects of treatment. 
 

Computer Algorithm Can Help Manage Cancer Symptoms

Patients with coronavirus disease 2019 (COVID-19) on immunosuppressive drugs have similar outcomes to patients with COVID-19 who are not on these therapies, according to a study published in 

The COVID-19 pandemic has caused more than 1.89 million deaths and there have been over 86.7 million confirmed cases worldwide, according to the World Health Organization. There is an estimated 10 million immunocompromised people in the United States alone and immune suppression has been considered a potentially major risk fact for severe or fatal COVID-19. This is mainly due to the belief that severe acute respiratory syndrome coronavirus 2, the virus that causes COVID-19, can spread unchecked in the body of immunosuppressed people. 

Investigators analyzed the records of 2121 hospitalized patients with COVID-19 at John Hopkins Medicine medical system in Baltimore, Maryland, and Washington, DC, between March 4 and August 29, 2020. According to the study, investigators found that patients with COVID-19 who were on immunosuppressants did not have worse outcomes on average when compared with patients who were not. 

According to investigators, approximately 5% of cases during the study period could be classified as patients who were immunosuppressed due to the use of either anti-inflammatory drugs or anti-rejection drugs. The study found that on average, hospital stays were not longer for patients on immunosuppressive drugs than those who were not. 

"There has been concern that immunosuppression might be an important risk factor for severe COVID-19, but reassuringly we found no sign of that," said study first author Kayte Andersen, a PhD candidate in the Bloomberg School's Department of Epidemiology, in a press release.

Investigators are currently undertaking a following-up analysis of a much larger data set, which will allow for more precise estimates. The results of the smaller study accounted for different factors between the groups, such as age, sex, and non-COVID-19 disease burden that may have skewed the analysis. 

COVID-19 outcomes for patients on immunosuppressive drugs on par with non- immunosuppressed patients [News Release] January 7, 2021; Baltimore, MD. Accessed January 11, 2021. 

https://www.eurekalert.org/pub_releases/2021-01/jhub-sb010721.php

New research suggests immunosuppressants do not increase the risk of worse COVID-19 outcomes. 

 

Immunosuppressants Do Not Increase Risk of Severe COVID-19

Caring for a partner or spouse with a new dementia diagnosis is associated with a 30% increase in depressive symptoms compared with older adults who don’t have a spouse or partner with dementia, according to a study published in the 

Previous research suggests that depression can spike after a traumatic event, such as a cancer diagnosis, accident, or death. Most people return to their previous emotional health over time; however, the new research suggests that this does not happen with dementia caregivers. 

Investigators looked at data from the Health and Retirement Study on 16,650 older adults, some of whom who had a partner diagnosed with dementia to compare them with those who did not.  

The average number of depressive symptoms reported by older adults with partners without dementia was 1.2, whereas those who have a partner living with dementia experienced a 27% increase in symptoms. According to the study, those with a partner diagnosed more than 2 years ago experienced an additional 33% increase.

Investigators adjusted for health, health behavior differences between partners, and sociodemographic factors. The study also found that changes in depressive symptoms was associated with a 30% increased risk of fall. 

"Whether it's carers protecting family members from injury, as we found in prior work, or a spouse's dementia status affecting the carer, as we found in this study, we have seen that family members deeply affect each other's health, so clinical and supportive care must orient more around the needs of the family," said Geoffrey Hoffman, PhD, a professor at the University of Michigan School of Nursing, in a press release. 

Partners are often caregivers for spouses with dementia, which  makes sustained understanding of depression over time especially important, according to the study. 

Depression worsens over time for older caregivers of newly diagnosed dementia patients [News Release] Ann Arbor, MI; September 2, 2020. Accessed January 11, 2021. 

https://www.eurekalert.org/pub_releases/2020-09/uom-dwo090220.php

The symptoms of depression in caregivers of patients with dementia exacerbates over time. 
 

Caring for a Spouse With Dementia Increases Risk of Depressive Symptoms

Smoking is associated with an increased risk of developing coronavirus disease 2019 (COVID-19) and a greater risk of hospitalization compared with non-smokers, according to a study published in 

The COVID-19 pandemic has caused more than 1.87 million deaths and there have been over 85.9 million confirmed cases worldwide, according to the World Health Organization. Certain factors, such as age and preexisting health conditions, put some populations at a greater risk of a severe case of the virus.   

Data were collected using the ZOE COVID Symptom Study App between March 24, 2020, and April 2020. Of the participants, 11% were smokers, which is lower than the proportion of smokers in the overall population of the United Kingdom at 14.7%. 

The study found that smokers were more than 14% more likely to develop the triad of symptoms that suggest a COVID-19 diagnosis: fever, persistent cough, and shortness of breath. Although more than one-third of smokers reported not feeling physically well during the study period, current smokers were also more likely to have a higher symptom burden than non-smokers. 

Additionally, smokers were 29% more likely to report more than 5 symptoms associated with COVID-19 and 50% more likely to report more than 10, according to the study. A greater number of symptoms suggest a more severe virus, according to the study. Smokers who tested positive for COVID-19 were also more than twice as likely to be hospitalized than patients who do not smoke. 

"As rates of COVID-19 continue to rise and the NHS edges towards capacity, it's important to do all we can to reduce its effects and find ways to reduce hospital admissions. Our analysis shows that smoking increases a person's likelihood to attend hospitals, so stopping smoking is one of the things we can do to reduce the health consequences of the disease," said lead researcher Claire Steves, PhD, consultant physician and Reader at King’s College London in a press release.

According to investigators, smoking cessation should be included as an element to address COVID-19. Reduction in smoking rates could also reduce health systems from other smoking-related conditions that lead to hospitalization.  

Smoking associated with increased risk of COVID-19 symptoms [News Release] January 6, 2021; London, UK. Accessed January 7, 2021. 

https://www.eurekalert.org/pub_releases/2021-01/kcl-saw010621.php

Smoking was associated with not only a greater risk of disease, but also an increased risk of severe COVID-19. 

 