The hematology/oncology pharmacist is in the best position to assist patients and caregivers in understanding how to safely take cancer medications.
We often hear that practicing medicine is an art. But developing a treatment plan for hematological cancer turns that art into a science, and trained oncology pharmacists are its ultimate weapon. Patients with cancers of the blood can have various and complex medication needs. Each patient tends to have a unique disorder, and an experienced oncology pharmacy team with knowledgeable experts is essential. Patients often present with hematologic malignancies such as leukemia, myeloma, and lymphoma. Providing pharmacological support for patients with blood cancer is critical, especially, during bone marrow transplantation. It is not unusual for 30 or more different drugs to be required. The hematology oncology (HemOnc) pharmacist is responsible for performing a variety of duties for the patient’s care team, as well as the patient and family directly. These duties often include the following:
A Day in the Life of a HemOnc Pharmacist
Pharmacists are members of a team who work with medical and nursing staff to maximize the benefits of drug therapy while trying to minimize its toxicities. It is the job of the HemOnc pharmacist to coordinate the complete medication plan. This often begins with inpatient chemotherapy infusions transitioning to cancer medications that must be taken at home, which are often dispensed by specialty pharmacy. The HemOnc pharmacist role includes recommending medications to manage the complications of cancer and managing any adverse effects from treatment. Given the complexity of the treatment regimens, the HemOnc pharmacist must review the patient’s current list of medications, identify any potential drug interactions, and adjust the therapy to manage those interactions. No drug is without its challenges, and oncology pharmacists explain to patients which adverse effects may occur and assist them in managing these effects. Additionally, oncology pharmacists work closely with a patient’s oncologist to achieve the best possible outcome.
The process does not stop there. The oncology pharmacist performs daily evaluations by reviewing medication profiles to ensure each drug is dosed appropriately. This is a fluid process because a cancer patient’s physiology is in a dynamic state. The pharmacist must constantly assess the integration of laboratory results, radiology reports, and other concurrent testing, and make adjustments.
Patient and Caregiver Education
So that patients can make informed decisions, HemOnc pharmacists actively educate them and their family members about what to expect during chemotherapy. Pharmacists also follow up with the health care team to adjust medications if the patient is experiencing adverse effects from chemotherapy. Several variables come into play when making decisions about treatment to ensure both patients and caregivers are informed about the expected outcomes, adverse effects, costs of therapy, administration, and monitoring of the hematological drugs. The process begins before these drugs are administered, with the oncology pharmacists meeting face to face (virtually or in person), independently of the oncologist, and must be continually reinforced throughout treatment. The HemOnc pharmacist is the medication expert on the team and should be the primary educator when it comes to drug therapy, to guarantee a consistent and informed process.
The coronavirus disease 2019 (COVID-19) pandemic has shifted much of this discipline to the telephone or to platforms such as Zoom or Microsoft Teams. If a meeting is to take place in person, the HemOnc pharmacist should have a designated and private space, and the timing should be supported by appropriate scheduling with other interactions concerning the patient’s treatment. Sessions should cover diagnosis; treatment goals and the duration; scheduling of treatment administration; drug-drug and drug-food interactions; adverse effects, including frequently reported and rare ones; and self-management strategies.
With the advent of limited-distribution products, patients and caregivers must have information on how to obtain products, and it should include specialty pharmacy’s role when necessary. Given the high cost of HemOnc therapies, pharmacists should provide patients with tools and options regarding financial assistance and alternatives, such as patient assistance programs, foundations, and vouchers.
As this is a stressful time for patients and families, the education process must be supported by written materials they can take home with them and review away from the clinic or hospital. The HemOnc pharmacist should validate of appropriate patient educational materials. The design of the materials should accommodate the variability in patients’ and caregivers’ health literacy and, when appropriate, must be translated into the patient’s primary language. Given our digital age, the materials should be a blend of written and audiovisual elements.
Limitless, free options are available online that have been developed by various manufacturers, institutions, and quality publications such as our sister publication CURE® (curetoday.com). CURE® provides access to leading resources and information that serve as a guide to every stage of the cancer experience. CURE® also provides cancer updates, research, and patient and caregiver information to connect members of the cancer community and empower individual journeys. HemOnc pharmacists can find many articles to refer to and that will assist patients in their journey.
Role of the HemOnc Pharmacist in Drug Research
New products and therapies are being introduced to combat hematological cancers. HemOnc pharmacists are at the center of this process and frequently act as clinician-researchers in addition to carrying out their pharmacy duties. They work directly with patients and their broader oncology team to manage drug selection, monitor adverse effects, and adjust doses, gather information from patient discussions, various blood samplings, and tumor biopsies. Collecting information must be as thorough as possible to identify new compounds that may be candidates for the evolution of breakthrough therapies or enhance existing approved products.
Perpetual Education of the HemOnc Pharmacist
The role of the oncology pharmacist is strikingly broad and increasingly complex. Most pharmacy students starting their doctor of pharmacy education have already obtained 1 undergraduate degree. To become a board-certified oncology pharmacist (BCOP) or be recognized as an oncology pharmacist typically entails an additional, dedicated 2 to 4 years of education or training.
The BCOP certification is the most recognized program in the United States for oncology pharmacists. Ultimately, the standard is determined by the individual institution or practice setting, but designating someone “officially” as an oncology pharmacist can be a challenge; roles may vary locally, nationally, internationally, nationally, and even individually.
Each practice setting may define the scope of the position and any unique functions its ecosystem requires of the HemOnc pharmacist who works in it. Typically, accredited oncology programs include authentication that the pharmacist can function as the authoritative expert on the optimal use of medications. The pharmacist is the focal point in driving the optimization of oncology patient outcomes, providing evidence-based, patient-centered medication therapy and serving as an integral part of an interdisciplinary oncology team.
Our own Pharmacy Times® Continuing Education (PTCE) team develops dozens of programs focused on HemOnc training that are designed to give oncology pharmacists access to educational programs. Many of these training programs offer CE credits and stand on their own.
A good deal of ongoing oncology training and updates are offered live at conferences such as those held by the American Society of Health-System Pharmacists, American Society of Clinical Oncology, and Hematology/Oncology Pharmacy Association, and during the pandemic our PTCE team has done a sterling job of converting to virtual education. The programs replicate those that would be offered in person, but through a proprietary platform created by PTCE.
Stay tuned to Directions in Oncology Pharmacy® for multiple oncology pharmacy education opportunities in 2021. Simply register for the CE event, and you will receive a reminder with a direct link to the program, which is broadcast live complete with a video of the speaker and presentation slides simultaneously. You can even respond to real-time surveys, and listen to the speakers discuss the results.
Capping off the HemOnc Pharmacist’s Role
For patients and caregivers, the start of the HemOnc treatment journey can be fraught with anxiety. It is often compounded by the stress of having to administer medications at home or combine treatment in multiple settings. HemOnc therapies are among the most complex treatments and have problematic schedules, strict administration guidelines, and disruptive adverse effects.
The HemOnc pharmacist is in the best position to assist patients and caregivers in understanding how to safely take cancer medications. It is a huge responsibility, but for HemOnc pharmacists, it can be one of the most rewarding roles they undertake.
Dan Steiber, RPh, operates Genesis Pharma Consultants, a practice responsible for commercial operations and trade-supply chain strategy development. Steiber has served in senior positions in pharmacy, distribution, and industry over the course of his 40-year career, and is a licensed pharmacist in Texas, Washington, California, and Pennsylvania. He is affiliated with several professional associations and publications and is a frequent speaker on behalf of many professional organizations. Steiber graduated from Washington State University College of Pharmacy and Pharmaceutical Sciences in Spokane. He has participated in a variety of postgraduate programs in law and business development/marketing at Harvard University, and Northwestern University.