Five Ways Cancer Care Teams Can Best Utilize the Expertise of Pharmacists

Providing guidance is as central to the pharmacist’s role as filling prescriptions. But in this era of multidisciplinary cancer care teams and multi-drug treatment regimens, pharmacists practicing in community-based cancer centers have more people looking to them for more answers than ever before. According to Tom Ollis, MS, RPh, director of pharmacy for Regional Cancer Care Associates (RCCA), that is a good thing for pharmacy.

“The increased demand for a pharmacist’s knowledge and skills reflects 3 positive trends. First, it is driven by the rapid expansion of treatment options. The American Association for Cancer Research reports that 17 new agents were approved to treat various solid tumors and hematologic malignancies last year, while another 28 already-approved therapies received expanded indications,” said Ollis. “The ability to use agents with varied mechanisms of action in combination or sequentially gives oncologists a much bigger therapeutic toolbox, but it increases the complexity of decision-making and patient management, making close consultation with pharmacy essential.”

Second, Ollis explained people with cancer are, overall, living far longer than they did 10 or 20 years ago because of the efficacy of newer therapies. Although this is great news, living longer lives means these patients may experience additional diagnoses and need medicines to treat those comorbidities. Pharmacists’ knowledge of drug metabolism and the dosing adjustments needed to accommodate renal or hepatic impairment, potential drug-drug interactions, and related topics is critical to managing patients with multiple conditions who are on complex medication regimens.

“Here at RCCA and at other cancer care organizations, multidisciplinary teams have been organized to provide the patient with truly comprehensive care,” said Ollis. “Again, this is a great development, but it means that in addition to the oncologist or hematologist consulting with pharmacy services, we’re also hearing from and working with nurse practitioners and physician assistants, nutritionists, nurse navigators, patient financial coordinators, and others.”

Ollis added that he and other members of the RCCA leadership team are responding to those trends by ensuring that pharmacy plays an integral role in decisions regarding everything from corporate policy and clinical protocols to individual patient’s care. With 22 community-based care centers throughout New Jersey, Connecticut, Maryland, and the Washington, DC area, RCCA has more than 90 physicians and 50 advanced practice providers, who see more than 26,000 new patients and 245,000 established patients annually. Further, the NJ-based organization has additional centers slated to join the network in the second half of 2024, with Ollis focused on helping RCCA offices, clinicians, and patients to benefit to the greatest extent possible from the expertise the pharmacy team has to offer.

Ollis suggests that cancer care professionals who are seeking to optimize the role of the pharmacist should start by looking at how effectively they are utilizing pharmacy services as a resource in 5 areas:

1. Navigating drug shortages. The recent shortages of various chemotherapies and other oncology agents have physicians and pharmacists alike scrambling to find appropriate alternatives to preferred therapies.
   “Our hematologists and oncologists have really relied heavily on pharmacy services throughout this period to help identify and secure the best available agents,” Ollis said, noting that this often requires detailed assessment of how various agents compare in terms of mechanism of action, pharmacokinetics, pharmacodynamics, safety profile, and other features.

1. Evaluating new agents and integrating them into formularies and care plans. The Pharmacy and Therapeutics Committee long has been the domain of the pharmacist, and close collaboration with revenue cycle analysts and other financial personnel is also the norm in many cancer care organizations. Similarly, pharmacists increasingly play a role in shaping an organization’s treatment protocols.
   If a cancer care organization already is taking those steps, Ollis explained that the organization may want to consider 2 further ways of enhancing the value pharmacists offer. The first is providing other clinicians with concise education on newly available agents, covering areas such as the indication and patient-eligibility criteria, efficacy and safety data, and factors to consider when deciding whether to prescribe the new agent or an established alternative. The second involves assessing the myriad biosimilars available today and identifying the financial implications their use holds in specific cases.
   “The promise of biosimilars is that they offer efficacy and safety comparable to that of the original agent but at greatly reduced cost. However, reimbursement for a particular biosimilar can vary dramatically from one insurer to another, sometimes on the order of thousands of dollars. In order to provide outstanding care to patients, we have to be here to provide that care—we have to pay the bills that keep the lights on and the doors open. One way to make that happen is for pharmacy to work closely with the rest of the clinical team and the administrative team to ensure that if the patient is receiving a biosimilar, that agent is the appropriate choice medically and, based on his or her insurance, makes sense in terms of the patient’s financial situation and our own finances.”
2. Facilitating ‘whole patient’ care. The National Cancer Institute reports that the median age at cancer diagnosis in the US is age 66 years, according to Ollis. While that age obviously varies by cancer type, it underscores the fact that, by the time people are found to have cancer, they are likely to also have other conditions, such as hypertension, type 2 diabetes, or impaired renal function. In many cases, Ollis added, a comorbid condition or a drug used to treat it does not constitute an absolute contraindication to a cancer therapy, but rather requires enhanced monitoring or dosage adjustments. By advising physicians on the potential for drug-drug interactions, how those interactions might affect the bioavailability and efficacy of the agents involved, and strategies for avoiding or addressing issues, pharmacists can help oncologists and other clinicians meet a patient’s overall health needs, Ollis explained. Additionally, cancer care organizations should encourage prescribers to consult pharmacists when they encounter an electronic medical record (EMR) flag or other indication noting that a comorbidity or drug-drug interaction may preclude them from implementing their preferred treatment plan.
3. Mitigating the impact of adverse events on patients – and on adherence rates. The ability to avoid or manage the adverse effects (AEs) of many cancer treatments has improved dramatically in recent years, to the point that there is no reason for most people to be miserable because of issues such as diarrhea, Ollis explained. He added that RCCA pharmacists work with other care team members to devise plans for preventing or minimizing AEs and are available to help those patients who experience more significant AEs.
   “We don’t want patients to be deprived of a treatment’s benefits because they discontinued therapy due to a side effect that can be managed effectively, and we’re often able to get patients through mild or moderate transient issues by providing them with practical strategies for obtaining relief,” Ollis said.
   RCCA pharmacists’ interactions with patients aren’t limited to responding to problems, however. Ollis explained that a pharmacist talks with a patient when a new drug is dispensed and via a phone call made 30 days after the patient starts the medication. Beyond helping to avoid outright discontinuations, he adds, this communication can provide patients with the reassurance and motivation needed to maintain a high level of adherence to dosing schedules.
4. Gathering – and sharing – information to help in dealing with pharma companies and payers. “I talk with everybody,” Ollis said of his approach to interacting with representatives from pharmaceutical companies. Noting that some pharmacists are averse to such discussions, he added that his meetings almost always yield valuable insights about a drug or the patient-assistance programs designed to increase access to the medication. He relays the information obtained at those meetings to others within RCCA.
   Similarly, Ollis said pharmacists can be a helpful resource for clinicians preparing for peer-to-peer calls with payer medical personnel. In some cases, the pharmacist can provide a compelling fact or datapoint that can carry the argument with an insurer who has been unwilling to authorize a particular therapy, according to Ollis.

Additionally, Ollis noted that a major trend in medicine over the last decade or more has been ensuring that all team members are practicing ‘at the top of their license.’

“In the case of pharmacists, this means going beyond fulfilling our core dispensing role to providing knowledge, insights, and recommendations to the other members of the cancer care team so that our patients achieve the best outcomes and quality of life possible,” Ollis said.