Spotlight On: Oncology Pharmacists – Part I, a Q&A

R. Donald Harvey, PharmD, FCCP, BCOP (top) and John Valgus, PharmD, BCOP, CPP (bottom)
June 10, 2014
· Amber Bauer, ASCO staff

If you’ve been diagnosed with cancer, you will interact with a number of different members of the health care team at various times during treatment. When you walk into a doctor’s office, hospital, or cancer center, you may encounter nurses, physician assistants, social workers, doctors—the list goes on. In this series, we talk with some of these health care professionals to learn more about their jobs and the role they play in providing high-quality cancer care.

With the important role medications play in the treatment of cancer, the oncology pharmacist has become an integral part of the cancer care team. Oncology pharmacists are actively engaged in all aspects of cancer care—from chemotherapy dose preparation and safety checks, to educating patients about side effects, to drug development research. In addition, if a patient or caregiver has any questions about a cancer medication, the oncology pharmacist is a helpful resource.

To learn more about the evolving role pharmacists play in providing high-quality cancer care, we gathered a group of oncology pharmacy experts:

  • Beth Chen, PharmD, BCOP, an oncology clinical specialist at Biologics where she is primarily involved with caring for patients who are receiving oral medications for the treatment of cancer
  • R. Donald Harvey, PharmD, FCCP, BCOP, Director of the Phase I Clinical Trials Section at the Winship Cancer Institute of Emory University, Assistant Professor in the Department of Hematology/Medical Oncology, and past President of the Hematology/Oncology Pharmacy Association
  • Susanne Liewer, PharmD, BCOP, Clinical Pharmacy Coordinator for the Blood and Marrow Transplant Service at the University of Nebraska Medical Center and a clinical assistant professor for the university’s College of Pharmacy
  • John Valgus, PharmD, BCOP, CPP, a Hematology/Oncology Clinical Pharmacist Practitioner at the University of North Carolina Hospitals and Clinics and a clinical assistant professor at the UNC Eshelman School of Pharmacy

Here’s what they had to say…

Q: How would you describe the role of the oncology pharmacist?

Susanne Liewer (SL): Oncology pharmacists have a vital role in the health care team. Pharmacists possess specialized knowledge about medications and how they work to fight cancer. They work with the medical and nursing staff to maximize the benefits of drug therapy while trying to minimize toxicities. Pharmacists also help coordinate the complete medication plan, from inpatient chemotherapy infusions to what medications need to be taken at home. Additionally, oncology pharmacists work with the health care team to educate patients about what to expect during treatment and ensure that each medication is given at the right time and dosed correctly.

Beth Chen (BC):  No matter the setting, oncology pharmacists are true experts in the medications used to treat cancer, as well as the medications used to manage complications of cancer and side effects from its treatment. They can explain to patients exactly how their medications should be taken. They can look at a patient’s current list of medications to identify any worrisome drug interactions and then provide guidance on managing these interactions. Oncology pharmacists also explain what side effects may occur and assist in managing these side effects. Finally, oncology pharmacists work closely with a patient’s oncologist in order to achieve the best possible outcome.

Q: What are some of the most important jobs or tasks you do as an oncology pharmacist?

SL: Pharmacists perform daily evaluations of medication profiles to ensure each drug is dosed appropriately. Pharmacists are also active in educating patients and family members about what to expect during chemotherapy and following up with the health care team to adjust medications if the patient is experiencing side effects from chemotherapy.

R. Donald Harvey (RDH): My role as a clinician-researcher means I am a primary and co-investigator on research studies for patients. I direct our phase I clinical trials unit at Emory, and see 10 to 20 patients every day who are receiving novel treatments for a variety of cancers. Through this, I am helping them manage side effects and ensuring the information we collect through patient discussions, blood sampling, and tumor biopsies is as complete as possible in order to help them and to identify drugs that are candidates for the next stages of evaluation (testing).

John Valgus (JV): In my role as a Clinical Pharmacist Practitioner (CPP) for our Oncology Supportive Care Service in North Carolina, I am able to manage a patient’s supportive care plan, which often focuses on pain, neuropathy, nausea, or vomiting. The unique skill I bring to this role is utilizing the in-depth medication knowledge that an oncology pharmacist has in order to best serve our patients.

BC: Our patients are administering their cancer medications at home. Because they are not receiving intravenous chemotherapy in a clinic or hospital, they may not have as many opportunities to interact directly with the health care team. A very important service we provide to our patients is in-depth education regarding their treatment. We also call patients during their treatment to make sure they are continuing to take their medication correctly and are managing side effects effectively. Finally, we are able to report any issues we discover back to the patient’s oncology team so it can be addressed.

Q: How has the role of the oncology pharmacist changed over the past few decades?

JV: Cancer care is rapidly evolving, and as the needs of the patient and health care team change, so does the role of the oncology pharmacist. I have seen the role of the oncology pharmacist expand from the more traditional operational role of preparing chemotherapy into being integrated into the medical team within hospitals and involved in the care of patients in the clinic, in addition to leading the business side of oncology as administrators. With medications having such a central role in the treatment of cancer, the role of the oncology pharmacist continues to expand as the in-depth pharmaceutical knowledge that pharmacists have is sought after by all members of the medical team, as well as our patients.

RDH: Since I began practicing in 1998, the role of the oncology pharmacist has changed dramatically.  Conventional tasks of chemotherapy mixing and dispensing are still vital to safe patient care, but emerging roles have developed that place pharmacists more in front of patients. For example, we go on rounds with medical teams in hospitals, run clinics, and participate in specialty practices, which all have increased our profession’s role and visibility. We are now actively sought after members of the cancer community for issues of drug policy, access to medications, and ensuring safe, effective treatments are in use and in development. 

Q: What is the most rewarding part of your job?

BC: Beginning a new therapy for cancer can be frightening, especially when the patient will be responsible for administering the medication at home. Often, these oral cancer therapies have complicated schedules, strict administration guidelines, and troublesome side effects. Helping patients understand how to safely take their oral cancer medication and educating them on what to expect is extremely rewarding. By checking in with patients periodically during treatment, we may be able to identify a problem before it becomes severe and communicate this to the patient’s oncology care team.

RDH: The most rewarding part of my job is direct interaction with patients on clinical trials of first-in-human compounds. Patients on these phase I trials are among the most courageous in our cancer center and are helping us to understand how effective new drugs are today and for future patients.

SL:  I find identifying medication changes that can help patients feel their best while receiving their chemotherapy the most rewarding.

JV: The most rewarding part of my job is when I can see I have made a difference in a patient’s life. As an oncology pharmacist, I am in a position to do this every day.

Q: Do you have any tips to help patients and their caregivers better communicate with their pharmacist(s)?

RDH: Ask, ask, ask! Patients who are curious and talk about their experiences while taking cancer drugs are those who have the best outcomes. Let your pharmacist(s) know about all medicines you are taking, and any new or worsening side effects you may be having. Often, it is something easy to fix, but it may also require discussions with physicians or other health care providers. As we use more and more oral medications for cancer treatment, the role of the pharmacist and exchanging information will become more critical. 

BC: Having a list of current medications a patient is taking is extremely helpful. Since oral cancer medications can have serious interactions with other drugs, we need to know all other medications a patient is taking. Also, oral cancer medications may be given as part of a treatment plan that could include radiation therapy or additional medications. Providing the oncology pharmacist with the entire treatment plan, including start dates, is very helpful to ensure we send the oral cancer medication at the right time. Finally, keeping a journal of side effects can help facilitate discussions with the oncology pharmacist, as well as other members of the health care team. 

JV: I think it is important that patients share with their oncology pharmacist all the medications they are taking or plan to take. It is often easy to overlook over-the-counter medications or supplements that may be part of the patient’s daily routine. These medications and supplements can carry their own possible side effects and drug interactions, which could impact the patient or the other medications a patient is taking.

SL: Patients shouldn’t be afraid to ask questions. Pharmacists truly want to help the patient and family understand why they are taking each medication and how often each medication is supposed to be taken.

If you are interested in learning more about the role of oncology pharmacists, check back later this week for a podcast with R. Donald Harvey and John Valgus.