Study Evaluates Oncology Pharmacist Prescribing Tendencies in Ambulatory Care in Canada


In the ambulatory setting, oncology pharmacists independently prescribe medications to support and manage therapy toxicities for cancer patients.

In the United States, statewide protocols govern pharmacists’ autonomous prescribing rights based on state board or agency regulations. Licensed pharmacists must meet state protocol requirements to be authorized to prescribe specific medications granted by state laws and regulations. Other nations, such as the United Kingdom and Canada, allow pharmacists to engage in independent prescribing without requiring supervision from another health care professional. Specifically, in Canada, all pharmacists are required to obtain their additional prescribing authorization (APA) prior to having independent prescriptive authority.

A group of researchers from Canada conducted a retrospective chart review of oncology pharmacists’ prescribing in a proprietary electronic health record. They analyzed prescriptions over 6 months in adult, ambulatory cancer centers in Alberta, Canada. Prescription volume and prescribed medication class were quantified using descriptive statistics. A cross-sectional analysis on a random sample established the type of prescription intervention and evaluated pharmacist documentation.

Image credit: goodmanphoto |

Image credit: goodmanphoto |

The findings noted that 33 clinical pharmacists ordered 3474 prescriptions with a median number of 7 medications prescribed per month. The median was 21.67 prescriptions per month per full-time equivalent when prescribing was normalized by pharmacists’ employment time. Antiemetic medications were most prescribed (24.1%). A cross-sectional analysis of 346 prescriptions noted pharmacists initiated 172 (50%) new medications, continued 160 (46%) existing prescriptions, and adjusted 14 (4%) for prescription dosage. There was a 47% adherence to specified documentation standards.

In their discussion, the investigators drew attention to the study’s limitations and strengths.

Limitations included over-reporting of new medication initiation due to inaccurate past medication histories updated in the electronic medical record, not capturing pharmacist deprescribing, and omitting prescriptions authorized outside of electronic medical record. Strengths included providing objective data on oncology pharmacist prescribing practices and bolstering previous data for pharmacists’ important contributions in managing cancer patients and their prescribing value in patient care.

This study adds to past surveys with objective data highlighting how oncology pharmacists use their APA. In the ambulatory setting, oncology pharmacists independently prescribe medications to support and manage therapy toxicities for cancer patients. Furthermore, these investigators observed variability among pharmacists with regard to prescribing frequency and class of medication prescribed. This study also demonstrated the impact clinical oncology pharmacists can have in cancer care with an opportunity to expand their role even further.

About the Author

Bragadeesh (Bijju) R. Iyer BS, Pharm D, BCGP, CSP, is a Clinical Pharmacist in Naperville, IL and a student in the UConn Medical Writing Program.


Hynes K, Folkman F, Dersch-Mills D, Marin H, Ghosh S, Chambers C. Prescribing practices of oncology pharmacists working in ambulatory cancer centers in Alberta. J Oncol Pharm Pract. 2023;29(8):1965-1973.

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