Supporting Complex Breast Cancer Care Through Pharmacist Expertise and CDK4/6 Inhibitors

In this interview, Julia Ziegengeist, PharmD, BCOP, clinical pharmacist coordinator, breast medical oncology, Atrium Health Levine Cancer Institute, highlights the essential responsibilities of pharmacists when managing treatment for high-risk patients with breast cancer, particularly those undergoing complex chemotherapy regimens. Effective care requires evaluating a patient’s comorbidities, prior treatment tolerance, and potential drug interactions to determine the most appropriate treatment regimen.

The pharmacy team plays a multifaceted role in patient care, acting as a critical link in coordinating treatment and managing clinical risks. One of their key responsibilities is treatment personalization and safety. Pharmacists evaluate a patient’s comorbidities and prior treatment history to determine how well they might tolerate new therapies. They are also responsible for identifying potential drug interactions, particularly with treatments that carry higher interaction risks.

In addition, the pharmacy team plays an important role in care coordination and communication. They help ensure that all members of the care team are aligned on treatment start dates, which is essential for coordinating necessary labs and electrocardiogram appointments. Pharmacists also manage communication around treatment holds, such as those required for conditions like neutropenia. In these situations, they help ensure follow-up labs are scheduled and inform patients when it is safe to restart their medication.

Additionally, pharmacists provide critical clinical oversight. Because providers and nurses often manage many patients simultaneously, pharmacists act as an additional safeguard to ensure that important nuances of care do not fall through the cracks. They provide reminders to other members of the care team about required actions and help both providers and patients feel more confident managing high-risk scenarios.

Further, pharmacists contribute to financial and risk assessment in patient care. They consider the cost perspective of treatment and assist patients in accessing and navigating assistance programs when needed. They identify and define factors that indicate patients are high risk (eg, tumor grade, number of positive lymph nodes), which can help determine which patients may require more intensive intervention.