“Walking With Patients”: How Pharmacists Can Ease the Emotional and Financial Weight of Breast Cancer Care

Pharmacists are often the most accessible clinicians in a patient’s cancer journey, yet their influence can extend far beyond dispensing medications. In this conversation, Kelly Gable, PharmD, BCPP, FAAPP, reflects on the realities of financial toxicity, the overlooked burden of medically induced menopause, and the power of motivational interviewing in truly meeting patients where they are. She explains how pharmacists can help patients feel seen, supported, and less alone—especially when navigating systems that often feel overwhelming.

Q: Financial toxicity is a major stressor throughout treatment. What role can pharmacists play in both anticipating these pressures and helping patients navigate them without feeling ashamed or overwhelmed?
Kelly Gable, PharmD, BCPP, FAAPP: You're not always going to have fixes to the problem, especially with our health care system. Patients are going to be diverted to different pharmacies because of what's available and the intricacies of their medication therapy, and so some things are out of your control. Also recognize that patients may have labs and provider appointments that go throughout the day, and going to the pharmacy or seeing the clinical pharmacist is just one piece of that treatment plan.

And so I think approaching that with a level of understanding and appreciation of how hard it is—that it is not easy to navigate our health care system, and in particular as a breast cancer patient and survivor—is important. If we can approach it in that way, just knowing that in advance—I know this was not easy for you, I know it was not easy to get this medication, to take this, to start this, to talk to me about this—then the walls just start to come down for a patient, and they feel safer to be able to really welcome you into their care team.

That's really where motivational interviewing shines. We are here to walk with the patient—not ahead of them, not behind them. We walk with them side by side. Framing it in that motivational interviewing space allows you to approach patient care in that way.

Ultimately, you're not going to be able to change some of the issues in our system, in particular things that are insurance-driven that make it harder for patients. But at least have that understanding that it's not easy, and patients may feel exhausted at the end of the day. When they come see you, they may be physically and emotionally exhausted.

Q: Communication around side effects is often framed clinically, but patients often care most about impact: “Can I work? Can I care for my family? Will this derail my plans?” How can pharmacists shift their conversations to better reflect these real-world priorities?
Gable: Yes, we have to talk about quality of life. Quality of life is a key aspect of long-term cancer care, in particular breast cancer care, where, again, patients are going to be in medically induced menopause for upwards of 10 years, or they may be in long-term treatment for metastatic breast cancer.

We have to acknowledge that quality of life matters, and survival is not the same thing as quality of life. So what can we do to help this person live their life to the fullest potential despite having to take a medication that may have a pretty dramatic influence?

What we know in particular—and I think there's a big disconnect, unfortunately, between oncology, breast care oncology, and menopausal care—is that the impact of medical menopause is great on quality of life. There are significant impacts even without breast cancer care. But are we addressing them? Are we talking about them?

Those quality-of-life aspects are the sleep changes, the vasomotor symptoms of menopause that show up that are relentless, the joint pain, the chronic pain that influences whether you’re able to move and do the things that you used to do, the cognitive impairments, the brain fog, the mood lability—the list goes on. These are all pretty common aspects not just of menopause or the transition of menopause, but of medically induced menopause when it’s earlier for that patient.

So I think we need to talk about them. We need to talk about how that patient is experiencing the side effects and symptoms, how it is impacting their quality of life, and what we can do—if anything—to help improve their quality of life.

Q: Peer support, care partners, and social networks can deeply influence a patient’s ability to cope. How can pharmacists encourage or connect patients to these supports while respecting privacy and individual preference?
Gable: It really depends on what you do in your organization in terms of patient-facing care. But if you know the patient well enough to know that they are navigating breast cancer care, know that peer support would be valuable to them if they don't already have it, and that behavioral health services would be valuable to them if they don't already have it, that's all you really need to know at that point. You don't need to know what they've already tapped into.

Just know the resources in your community. There are a couple of resources in my community that I did not know about until I ran into someone else who’s a survivor, and she said, “Hey, have you checked out Pink Ribbon Good?” Okay, well, that's how we learn. So if you're a pharmacist working with folks in the cancer space, just know what's out there. Know what resources are there so you can at times say, “Hey, I wonder if you’ve checked this out. I wonder if this might be helpful to you.”

Ultimately, I ended up having to find a lot of them on my own, and I feel like that just shouldn't be the case. Whether it's coming from the pharmacist, the oncologist, the nurse—somebody needs to tell a patient, “Hey, this matters enough. Your mental health matters enough that I want you to know about these resources.” There are peer-driven supports in all communities. But where are they? How do I find them? And if I am so beat down from cancer care, I may not have the energy to start searching online for things. I need someone to help me navigate that.

The other piece that I think is so important is: Do you know who is providing behavioral health services in your community? Who is providing psychiatric care? Who is providing therapy for patients undergoing cancer care? I think it's important for pharmacists to know that because you may not be offering those services, but you can be the person who reinforces the importance of them and helps somebody figure out who they might be able to see in that system.

Q: When you think about the pharmacist’s role in the broader care team, where do you think we have the greatest ability to shape the patient’s emotional and practical experience — not just their medication plan?
Gable: I think that goes back to motivational interviewing. It's all about how you talk with patients, how you are present with them, and the compassion that you give in those sessions. I frequently talk to our students about compassion expression and how important it is. In fact, empathy expression may be one of the greatest gifts you can give to a patient in an interaction. But it also weighs on you as a clinician, as a pharmacist—to hear the stories, to live that with someone. So on top of giving that gift to people, a gift to patients that you serve, you need to give it to yourself as well. You need to be self-compassionate, and you need to take care of yourself.

That would be my message to pharmacists: embrace the spirit of motivational interviewing, connect with your patients, but also in that process take care of yourself and make sure you are okay.

Q: Is there anything you’d like to add?
Gable: If I didn't already say, I think it's really, really important—especially for pharmacists on treatment teams working with breast cancer survivors—that we acknowledge the implications of medical and medication-induced menopause. It is so frequent and so common to be a part of cancer care, and it has such strong implications for quality of life. As a pharmacist on that treatment team, be aware of what impact it has and what you can do, and what you can offer as resources to help that person improve their quality of life.

For me, the learning experience as a patient is that it's hard to see that disconnect. The disconnect between oncology, primary care, and behavioral health is great, and it doesn't need to be. It really can be better integrated, and we as pharmacists can really be a part of that integration.