Advanced Practice Perspectives
As the treatment of hematologic conditions and cancer has evolved to include more personalized , targeted agents , the demand for comprehensive pharmacist services has risen . Oncology pharmacists engage in all aspects of cancer care , from preparing chemotherapy and related medications to answering patient and caregiver questions .
This month , three members of Emory University ’ s oncology pharmacy team describe the expanding role of the oncology pharmacist and the importance of ongoing patient education and communication .
UP FRONT
The Evolving Role of the Hematology / Oncology Pharmacist
Danielle Schlafer , PharmD , and Elyse Hall Panjic , PharmD , are hematology / oncology clinical pharmacy specialists at Emory University Hospital in Atlanta , Georgia . R . Donald Harvey , PharmD , is associate professor of hematology / medical oncology and pharmacology at Emory University School of Medicine and director of the Phase I Clinical Trials Section and Unit at the Winship Cancer Institute of Emory University .
What are the typical responsibilities of the hematology / oncology pharmacist ? Oncology pharmacists play a critical role in the provision of safe , effective treatment for patients in both ambulatory and inpatient environments . We work alongside the physician and other clinicians to provide optimal medication management .
An average day involves preparing chemotherapy orders and medications , as well as assessing patients for dose adjustments for organ dysfunction or toxicities . We also work with other members of a patient ’ s health-care team to ensure the patient is receiving comprehensive therapies for managing or mitigating any treatment-related adverse events ( AEs ; e . g ., infection prophylaxis , venous thromboembolism prophylaxis , anti-emetic agents , and prevention of skeletal-related events ).
We see many patients enrolled in clinical trials because many treatments are administered in the context of a blended clinical and research environment . To optimize patient care while maintaining protocol requirements , we assess patients for eligibility , assist with preparing clinical trial orders , evaluate patients ’ organ function , and monitor other lab parameters .
Education and training ( for ourselves , health-care providers , and patients ) also fall under our purview .
What types of education efforts do hematology / oncology pharmacists engage in ? Our mandate is to ensure we are fully educated on new medications and their associated AEs , overall clinical use , and monitoring . With the relative flood of new anti-cancer agents in recent years , including targeted therapies and immune checkpoint inhibitors , it is challenging to stay current . We do so by reading primary literature , reviewing summaries from the U . S . Food and Drug Administration approval process , and attending professional conferences for hematology / oncology pharmacists to gather information relevant to new agents ’ clinical use .
“ Our numbers continue to grow , and , as more pharmacists graduate from specialty residency programs , we expect to see even higher numbers of us in clinics in disease-specific practices .”
We provide education in clinics and hospitals and through formal mechanisms , such as lectures , Pharmacy and Therapeutics Committee meetings , journal clubs , and e-newsletters .
Patient education is a critical component of our day-to-day responsibilities , reflected by the amount of time we spend on it prior to new treatment initiation .
In a typical day , how much time is spent interacting with patients ? Hematology / oncology pharmacists provide continuity of care for patients transitioning between inpatient and outpatient environments . This means we are often the main points of contact for patients – and caregivers – when they have questions about medications .
A member of our pharmacy team meets with every patient before he or she starts a new chemotherapy regimen to provide medication counseling . While patients are on treatment , we check in periodically during a clinic visit ( or hospitalization for inpatient chemotherapy ) to answer any new medication-related questions or provide recommendations for symptom management .
The conversation does not end after prescriptions are filled . We educate and counsel patients on chemotherapy and supportive-care medications both during their visit to the clinic or infusion center and after they head home . This entails reviewing home medications for potential drug-drug interactions , providing written materials detailing treatment regimens , and recommending options for nausea and pain management . We call patients to address questions or concerns that occur between appointments , and relay information to other health-care providers as necessary .
As one might expect , the most common questions concern side effects : How will I feel while I ’ m on this treatment ? Are there any restrictions to my diet or activities ? What should I do if a given side effect occurs ? It is our goal to inform patients and their caregivers about treatment and how to manage potential side effects , while also conveying the importance of adhering to medications .
Myeloma regimens , as an example of one condition for which multiple drugs are given on differing schedules , can be particularly complex . To ensure that patients are prepared to follow these regimens , we work with our nursing colleagues to create treatment calendars as visual aids . We then discuss potential common and serious AEs , along with our game plan for managing them .
How has the introduction of newer , targeted therapies affected the oncology pharmacists ’ responsibilities ? We know more information about cancer biology now than ever before , and we are finding more opportunities to specialize within cancer subtypes .
The new agents available in the clinic have more specificity . As a result , our training in specialties such as multiple myeloma is no longer relegated to specializing in hematopoietic cell transplantation . We have dedicated pharmacists in the areas of myeloma , lymphoma , and leukemia , and each is frequently called on by other clinicians . Because of the recent advances in novel agents and combination therapies in myeloma ( including the introduction of pomalidomide , elotuzumab , ixazomib , and daratumumab ), along with an active clinical trial portfolio , we established a dedicated pharmacist who has updated treatment and education protocols , expanded patient counseling activities , and ensured all supportive care for agents and regimens are up-to-date .
We have also witnessed a greater acceptance of pharmacist input and independence . Our numbers continue to grow , and , as more pharmacists graduate from specialty residency programs , we expect to see even higher numbers of us in clinics in disease-specific practices . ●
30 ASH Clinical News December 2017