OPC 2025: Adapting Oncology Pharmacy to the Age of AI and Drug Shortages

At the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting, several studies were presented that have direct implications for the role of oncology pharmacists in the cancer care team. To better understand the practice implications of these ASCO abstracts for pharmacists, Melody Chang, RPh, MBA, BCOP, vice president of pharmacy operations at American Oncology Network at Fort Myers, Florida, moderated a session with Eugene Przespolewski, PharmD, BCOP, DPLA, a clinical pharmacist specialist lymphoma and myeloma and PGY-2 oncology pharmacy residency program director at Roswell Park Comprehensive Cancer Center in Buffalo, New York, and Scott Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, director of pharmacy, cancer care and associate professor of pharmacy at Mayo Clinic in Rochester, Minnesota, at the 2025 Oncology Pharmacists Connect (OPC) meeting in Austin, Texas.

During the OPC session, Przespolewski presented 6 ASCO abstracts of note: 1500, 1501, 11003, 1564, 1574, and 11088. This presentation was then followed by a panel discussion that dived into the implications from these studies for how oncology pharmacists can contribute to improving patient care, optimizing treatment protocols, reducing health care costs, and navigating the challenges presented by new technologies and drug shortages.

Medication Reconciliation in Phase 1 Trials

The first abstract (1500) Przespolewski presented was focused on a pharmacist-led medication reconciliation project in phase 1 clinical trials. The study, conducted between December 2022 and January 2025, spanned over 82 clinical trials involving 525 patients. The abstract highlighted the essential role pharmacists play in conducting thorough medication reviews post-consent, specifically in the assessment of prescribed medications, OTC drugs, herbal supplements, cannabis use, and allergy adjustments.

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In this study, the medication reconciliation process was intensive and required significant time, with an average of 45 minutes per patient and 18 minutes dedicated to phone consultations. The results indicated that, on average, patients reported 12 medications, with a range of 2 to 42 medications per patient. During the reconciliation process, pharmacists added an average of 3 medications, made 2 medication changes, and discontinued 3 medications per patient. Notably, cannabis and OTC herbals were often underreported by patients, but the pharmacist-led reconciliation successfully identified and corrected these discrepancies.

The key takeaway from this abstract was the critical role of pharmacists in conducting comprehensive medication reviews in clinical trials, especially in the context of phase 1 trials where patient medication histories are often complex and incomplete, Przespolewski explained. The panel also emphasized that while the medication reconciliation process is time-consuming and resource-heavy, it is vital for preventing protocol violations and ensuring the integrity of clinical trial data. Soefje and Przespolewski discussed the challenges associated with this process, noting that pharmacists’ involvement is necessary to identify unreported medications, especially in high-risk treatments such as CAR T-cell therapies.

Remote Clinical Pharmacy

The second abstract (1501) demonstrated the impact of remote clinical pharmacy services in reducing health care costs. In this study, 7 remote clinical specialists evaluated 5600 patients from July 2023 to December 2024, implementing various medical initiatives such as dose adjustments, therapeutic interchanges, and drug selection. The main end point of the study was to assess the total cost of care reduction, comparing the costs of original prescribed regimens with those adjusted by pharmacists.

The study demonstrated a significant reduction in health care costs, with a total cost savings of $8.9 million. The interventions that contributed most to these savings included dose banding for pembrolizumab (Keytruda; Merck & Co) and adjustments in the use of zoledronic acid. Notably, the acceptance rate for these remote pharmacy interventions was high at 93%, indicating the effectiveness and value of pharmacists’ involvement in remote care settings, according to Przespolewski.

However, the panel raised questions about whether these cost savings would be sustainable in the long term and whether such interventions could be easily replicated using smart electronic medical records (EMRs). Przespolewski expressed excitement about the initial findings but noted that many of these interventions, such as dose rounding and selecting biosimilars, could already be managed effectively through EMRs or other clinical staff. Soefje agreed, stating that while remote pharmacist interventions are beneficial, their cost-effectiveness might be limited unless they result in tangible improvements in patient outcomes, such as overall survival or progression-free survival.

Remote Supportive Care Management

The third abstract (11003) was a randomized clinical trial that evaluated remote supportive care management for patients undergoing curative-intent cancer therapies, including chemotherapy. The study randomized 196 patients to either the usual in-clinic care or a remote care model. Remote care involved daily reporting of symptoms, vital signs, body weight, and structured communication with the oncology team. The study aimed to measure the impact of remote care on urgent care visits, hospitalizations, quality of life, and symptom management.

The results showed no significant difference in emergency department visits or hospitalizations between the 2 groups, but remote monitoring significantly reduced urgent clinic visits. Additionally, remote care improved quality of life in some patients, especially in terms of activities of daily living and symptom assessments. Although the data on quality of life and symptom metrics were not fully reported, the study suggested that remote care could reduce the need for in-person visits while still ensuring patients received appropriate care, Przespolewski explained.

During the panel discussion, the potential for remote care to improve patient outcomes was debated. Soefje emphasized that remote care models could be highly effective in certain settings, but the challenge remains in balancing the benefits of remote monitoring with the need for face-to-face interactions. He suggested that a hybrid model, where both pharmacists and other health care providers, such as nurses and social workers, collaborate, would be ideal for providing comprehensive care to patients with cancer.

Artificial Intelligence in Oncology: Enhancing Decision-Making

A central theme of the OPC session was the integration of artificial intelligence (AI) in oncology practice. Przespolewski discussed the implications of the fourth abstract (1564), which compared the performance of ChatGPT and expert oncologists in answering questions about hematologic malignancies. The study revealed that expert oncologists’ responses were preferred over AI’s responses in 75% of cases, though AI was able to identify correct answers 90% of the time. Despite these promising results, the panelists agreed that AI is not yet capable of replacing the expertise of human oncologists, particularly when it comes to nuanced decision-making and the application of clinical judgment.

During the panel discussion, Przespolewski and Soefje noted that while AI could assist in data analysis and operational tasks, AI still lacks the intuition and contextual understanding that experienced clinicians bring to patient care. They also noted the ethical concerns surrounding AI-guided treatment decisions and the accountability for errors made by AI systems. The conversation also touched on the importance of educating patients about the benefits and limitations of AI, as some patients remain distrustful of AI technologies, especially when it comes to making critical decisions about cancer treatment.

Patient Trust and AI

The fifth abstract (1574) addressed patient trust in AI and its acceptance in oncology care. In this study, investigators surveyed 330 patients at an urban academic medical center, finding that patients under 65 and those with higher levels of distrust in health care systems were more likely to express skepticism about AI in health care. The study also found that patients were more comfortable with AI when it came to low-risk aspects of care, such as cancer screening or lifestyle recommendations, but were less comfortable with AI’s involvement in diagnosing and determining treatment plans.

During the panel discussion, Przespolewski emphasized the role for pharmacists in educating patients about the use of AI in health care, while helping patients understand its limitations. Przespolewski argued that while AI has the potential to streamline certain aspects of care, it is crucial that patients still feel supported by human experts who can apply clinical judgment and provide empathetic care.

Drug Shortages: Impact on Treatment Decisions

The sixth abstract (1506) focused on the impact of drug shortages on treatment pathways in lung cancer. The study examined the effects of cisplatin and carboplatin shortages on treatment regimens, finding that these shortages led to a shift towards the use of immunotherapies, particularly in metastatic cancer cases.

The panel members discussed how drug shortages can disrupt treatment plans and force oncologists to make difficult decisions about prioritizing patients and adjusting therapies. Soefje explained that his institution’s approach to drug shortages supports collaboration between pharmacists and clinicians to develop contingency plans. According to Soefje, while current practices are reactive, there is potential for predictive inventory management systems to help organizations anticipate and prepare for shortages. Przespolewski agreed, sharing that his institution also has a robust system in place to handle shortages, but acknowledged that prioritizing patients during shortages is always a challenge.

The Future of Oncology Pharmacy

The panel discussion highlighted several key issues in oncology pharmacy practice, including the role of remote care, the integration of AI, and the challenges posed by drug shortages. Although the panelists agreed that oncology pharmacists are essential to improving patient care, they also noted that the profession will need to continue to evolve to meet the demands of a changing health care landscape. Further, they discussed the importance of standardizing metrics for pharmacist interventions, ensuring that pharmacists’ contributions to patient care are accurately documented and valued by administrators.

Przespolewski concluded by emphasizing that the future of oncology pharmacy will require greater collaboration across health care teams, the integration of new technologies, and a focus on improving patient outcomes. As oncology care continues to become more complex and personalized, pharmacists will play a critical role in optimizing treatments, managing complex medication regimens, and supporting patients through their cancer journeys.

REFERENCE

Chang M, Przespolewski ER, Soefje SA. Pharmacists at the Forefront: Enhancing Delivery and Quality of Oncology Care. Presented at: Oncology Pharmacists Connect; Austin, Texas; June 19-20, 2025.