Annette Hood, PharmD, BCACP, leads a discussion on the role of oncology pharmacists in supporting oncologists to determine the appropriate treatment plan for individuals with ovarian cancer.
Maurie Markman, MD: This is a wonderful opportunity right now. We’ve had this discussion of both the management of ovarian cancer, where it was, where it’s going, and the complexity of it. And now to bring in the conversation about the critical role, increasing role of the pharmacist, clinical pharmacist in helping physicians. Annette, what is the impact of a pharmacist in helping physicians choose a specific agent for the patient? And I would add to that, how can one bring awareness to the clinicians who are not aware of the role of oncology pharmacist and what she or he can bring to this critically important and complex conversation.
Annette Hood, PharmD, BCACP: Well, pharmacists play a key role in really understanding how the drugs are metabolized, so we can look specifically for drug interactions. If we’re talking about the PARP inhibitors, all three PARP inhibitors are metabolized via different pathways, so we have different interactions that we’re concerned about. So that could be some way the pharmacist can kind of help decide which PARP to put a patient on or maybe manage some of the other medications that they’re on in terms of dose reductions and things like that.
A pharmacist can help with formulary. So obviously cost is an issue with these medications. So we can work with drug companies to maybe try and get a lower cost for any of these drugs, or figure out which drug the insurance company will cover for the patient, and maybe that will help choose which therapy we might want to choose for the patient.
If we’re talking about compliance, niraparib is dosed only once a day, whereas the other 2 PARPs are dosed twice a day, so something to kind of keep in mind when we’re making a selection for our patients. Pharmacists play a big role in helping manage side effects. So fatigue is a big side effect of some of the PARP inhibitors, so we can do a lot of nonpharmacologic and pharmacologic counseling on how to manage the fatigue that patients are experiencing. Some of those type of side effects, or diarrhea that they may experience, as well as some of the nausea. So the PARP inhibitors are considered moderate intensity for risk of nausea, so we should make sure that the patients have some type of antiemetic at home and be taking that before they take their PARP inhibitor, so another key role that pharmacists can play there.
And then again, just patient counseling in general, how to take these medications, ways to help the patient encourage compliance and how to help patients remember to take their medications since it is, for the PARP inhibitors they take them at home, that they’re not coming to the clinic for that. Obviously, we’re giving that to the patients, so we have to make sure that patients are compliant with their medications, so using compliance aids for these patients as well.