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Rising Tides Lift All Boats: Advancing Oncology Pharmacy

Rising Tides Lift All Boats: Advancing Oncology Pharmacy

By Alina R Rashid, Clinical Director of Pharmacy, Member Success at HealthPRO Canada 


As a Clinical Director of Pharmacy at HealthPRO Canada with a background in oncology, I recently attended the Canadian Association of Pharmacists in Oncology (CAPhO) conference. The conference theme, “Rising Tides Lift All Boats: Partnering to Advance Oncology Pharmacy” highlighted the importance of collaboration across Canada to help propel oncology pharmacy practice forward.

The poster presentations offered a captivating glimpse into the latest research and projects spanning the breadth of oncology practice across our country. Among the many topics covered, here are some notable highlights:

Empowering Future Leaders: The Contribution of Pharmacy Students to Oncology Practice

Christine Peragine and her team at Sunnybrook Odette Cancer Centre have incorporated a co-op pharmacy student into their oral-anticancer therapy (OAT) program [1]. This co-op program allows students to gain specialized knowledge while contributing to the overall satisfaction of their clinic patients. Average patient satisfaction score was reported at a 9.6/10 and having a pharmacy co-op student on the team increased capacity in their clinic allowing pharmacists to perform other clinical duties.

May Nguyen and colleagues evaluated the competence, confidence, and perceived barriers related to providing oncology pharmacy care for pharmacy students in Canada [2]. This was assessed through a timed, 6-item questionnaire. Students completing their clinical rotation at Extend Pharmacy completed this questionnaire at the beginning, midpoint (4 weeks), and end (8 weeks) of their rotation. The results showed that students began their rotation with low levels of confidence when it comes to oncology focused medication dispensing, clinical knowledge, and providing compassionate care. These measures improved over the rotation and served as discussion points at student-preceptor check-ins. The preceptors could tailor training and education based on any gaps identified during these check-ins.

Mentorship was also a hot topic with Thomas Cho and Colleagues evaluating the first nationwide Canadian oncology mentorship program offered through the University of Toronto’s National Community Oncology Dispensing Association (NCODA) chapter [3]. This is a mentorship program that I have personally been participating in as a mentor as well. The authors collected feedback from the mentees at the midpoint, and both mentees and mentors at the endpoint. Mentees expressed the need for a more diverse group of oncology mentors (industry and hospital). Starting the program earlier in the school year with a more structured, guided timeline could enhance the experience. Mentors highlighted the diversity in the level of engagement from the mentees. One suggestion to overcome the low level of engagement from some mentees included hosting more group sessions.

Streamlining Treatment: Dose Banding for Enhanced Efficiency and Cost-Effectiveness

Dose banding or dose rounding is used in clinical practice as a cost avoidance strategy. This is particularly important for novel and patented anti-cancer medications which account for some of the highest medication expenditures in the hospital budget. Loreena Pang and colleagues at BC Cancer presented their strategy on  creating a dose rounding policy [4]. The dose rounding strategies they assessed had a maximum down-rounding to -10% and a maximum up-rounding to +5%. They found that dose rounding down to a maximum variance of -10% has the potential to achieve maximal cost avoidance in the context of available vial sizes for IV daratumumab. Looking at retrospective data, the -10% strategy would have saved an estimated $4.5 million over the past 4 years (n = 8420 doses eligible for dose rounding) for BC Cancer.

Dose banding in combination with outsourcing of the sterile compounding of trastuzumab was assessed by Jonathan Shloush and colleagues at Sunnybrook Odette Cancer Centre [5]. Trastuzumab doses were rounded to the nearest 42 mg which resulted in 7 dosebands capturing 90% of all doses. Turnaround times for same-day trastuzumab containing treatments reduced from 44 minutes to 33 minutes with the most significant reduction in turnaround times for trastuzumab monotherapy (47 minutes to 28 minutes). Overall satisfaction or improvement was reported post-implementation by front-line staff for impact on workload, subjective perception of improvements in turnaround time, chair turnover, hood traffic, and phone calls to physicians for dose changes. This success with dose banding at Sunnybrook highlights the efficiencies and cost-savings that can be utilized with other highuse anti-cancer agents as well.

Unlocking Access: Pharmacist-Led Clinics as Key Players in Healthcare Delivery

Out of the east coast we saw an example of a pharmacist-led Prostate Cancer Shared Care Clinic [6]. Hayley Underhill and colleagues developed, implemented, and
evaluated this clinic which focused on patients taking oral anticancer therapy for prostate cancer, melanoma, or renal cell carcinoma. The pharmacists were physically located in the same vicinity as the oncologists and the nursing teams. Interventions completed by the pharmacists included best possible medication histories (BPMH), drug therapy problem (DTP) identification and resolution, patient education, toxicity management, adherence assessment and support, and deprescribing.

Another great example of a pharmacist-led clinic, also from the east coast, was presented by Laura Minard and colleagues – this time for a pharmacist-led gynecology oncology PARP inhibitor clinic [7]. Patients receiving Olaparib or niraparib received education, Best Possible Medication History (BPMH) services, a drug interaction review, blood work review, and toxicity management. Patients had set meeting points with the clinical pharmacists. Over the course of one year, the pharmacists completed 223 encounters – 152 of these encounters replaced visits with the oncologist or the nurse. The top three Drug therapy problems (DTPs) identified (n=98) included adverse drug events (n=46), requirement for blood work (n = 11), and need for additional therapy (n = 8). Our colleagues on the east coast have shown us the enhanced patient services oncology clinic pharmacists are able to perform.

Our final example comes out of Ottawa where a PharmD-student led clinic within a specialized community pharmacy helps patients on potentially hypertension inducing take home anti-cancer therapy [8]. This research was completed by Alicia Davis and colleagues. PharmD students complete a hypertension assessment and provide a care plan for patients newly started on axitinib, cabozantinib, Lenvatinib, pazopanib, sunitinib, abiraterone, apalutamide, darolutamide, or enzalutamide. The student followed up with the patients at week 1, 2, 3, and 7 to assess medication adherence, tolerance, and review blood pressure readings. The student completed 22 interventions for 24 patients. The top three interventions included non-pharmacological interventions (n=14), discontinuation of hypertension inducing medication (n=9), and addressing drug interactions (n=6).

These initiatives across Canada highlight the evolving role of the oncology pharmacist, showcasing enhanced patient care, cost savings, and educational advancements through collaboration. I look forward to seeing what CAPhO 2025 has in store!

References
[1] Peragine C, Ng G, Lo S, et al. Conception and impact of the oral anticancer medication clinical pharmacy co-op program at the Sunnybrook Odette Cancer Centre. Poster presented at CAPhO 2024, Moncton, New Brunswick.
[2] Nguyen M, Wentzell J, Hutton L. Evaluating pharmacy student competence, confidence, and perceived barriers during specialized community oncology clinical rotations improves students learning outcomes and experiences. Poster presented at CAPhO 2024, Moncton, New Brunswick.
[3] Cho T, Huynh V, Vu K, et al. Evaluating the first nationwide Canadian oncology mentorship program (2022-2023) by the University of Toronto NCODA Chapter. Poster presented at CAPhO 2024, Moncton, New Brunswick.
[4] Pang L, de Lemos J, Venner C, Schaff K. Cost avoidance opportunity of dose rounding strategies at product launch: using I.V. daratumumab for multiple myeloma as a case example. Poster presented at CAPhO 2024, Moncton, New Brunswick.
[5] Shloush J, Hopkins S, Tyono I, Charbonneau LF. Trastuzumab dose banding & outsourcing of sterile compounding improves efficiency in the Sunnybrook Odette Cancer Systemic Therapy Program. Poster presented at CAPhO 2024, Moncton, New Brunswick.
[6] Underhill H, Leblanc M, Macfarlane R, et al. A descriptive example using quality improvement frameworks to develop, implement, and evaluate a novel ambulatory oncology pharmacy practice model. Poster presented at CAPhO 2024, Moncton, New Brunswick.
[7] Minard LV, Phonchaeron N, Scott SN, et al. Development and implementation of a pharmacist-led gynecology oncology PARP inhibitor clinic in Nova Scotia Health, Central Zone.
[8] Davis A, Choukeir Z, Andriescu I, Sadiq R, Wentzell J. Implementation of a PharmD student-facilitated digital hypertension clinic for patients prescribed potentially hypertension inducing take-home cancer drugs at a specialty oncology pharmacy. Poster presented at CAPhO 2024, Moncton, New Brunswick.