How Health-System Pharmacists Help Oncology Patients

Specialty pharmacists aren't the only pharmacists who care for oncology patients.

Specialty pharmacists aren’t the only pharmacists who care for oncology patients, as health-system and community pharmacists also play a role in helping this at-risk population.

Oncology patients may be in contact with several pharmacists from different practice settings because they need to be on multiple therapies. Sandra Cuellar, PharmD, BCOP, a clinical pharmacist and professor from the University of Illinois at Chicago, told Pharmacy Times that oncology patients may be taking 10 medications at a time.

In addition, patients with cancer tend to be older and face more comorbidities. The American Cancer Society estimates that by 2030, about 70% of patients receiving cancer care will be seniors.

Health-system pharmacists can help this patient population by performing medication reconciliation at hospital admission. Dr. Cuellar noted that this process isn’t simply compiling a list of the medications that the patient is currently taking. Instead, health-system pharmacists should ask patients why they’re on each drug, how they’re taking it, and when they last had it filled.

Health-system pharmacists can also help the health care team figure out the reason for an oncology patient’s admission, such as a drug-related adverse event, chemotherapy, or other medication issues.

Discharge is yet another area where health-system pharmacists play a major role.

“As soon as a patient gets admitted, we’re almost always working on their discharge plan,” Dr. Cuellar said.

That’s because a lot of coordination is needed to determine which medications patients will go home with, whether they’ll require prior authorization, who will be able to fill them, and whether the patient can afford them.

Dr. Cuellar pointed out that if there’s a problem with access, it’s better to reconcile the issue sooner than later.

In addition to solving any medication issues, health-system pharmacists can get involved in discharge counseling at bedside. At this time, the pharmacist can go over the new medication list, make family or caregivers aware of new or adjusted medications, and set up follow-up appointments with providers to address other issues, such as comorbid diabetes or hypertension. The pharmacist can also work with social workers to make sure that the patient won’t have any transportation issues in accessing a pharmacy, for example.

Pharmacists’ bedside counseling also provides patients with a good opportunity to ask questions about their medications. Dr. Cuellar said that many oncology patients have fears about adverse events, so pharmacists can provide additional information about what they might expect while taking their medications.

After discharge, the focus turns to follow up and smooth transitions of care, which Dr. Cuellar said is a hot topic in oncology pharmacy right now.

At post-discharge meetings, the health care team discusses what treatment changes need to be made, and follow-up phone calls can confirm that medications were picked up and initiated. These proactive efforts can help decrease readmission rates, Dr. Cuellar pointed out.

In addition, health-system pharmacists should be in communication with community pharmacists to make sure that prior authorizations are going through and to address polypharmacy issues. Specialty pharmacists should also be contacted to coordinate access to medication.

Even if they don’t identify as oncology pharmacists, pharmacists are still involved in oncology care because many cancer patients have comorbidities and anticoagulation issues. It may be intimidating for some pharmacists because oncology patients tend to have complicated regimens, but that doesn’t mean pharmacists should see oncology patients differently when treating them for conditions like diabetes.

“At the end of the day, a diabetic patient is a diabetic patient,” Dr. Cuellar said. “The goals would be the similar for a noncancer patient.”

Oncology patients also benefit from medication therapy management, which is another area where all pharmacists can play a role.

Pharmacists who aren’t too familiar with oncology care can access resources online and in print about how to care for this patient population, or they can call up a colleague who identifies as an oncology pharmacist, Dr. Cuellar said.