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Specialization in Oncology From the Beginning

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I would like to welcome everyone to the inaugural edition of “Koeller’s Corner.” The intent is for this to be a regular column for The Oncology Pharmacist. For this introductory edition, I would like to introduce myself to the readers and describe the intent of my column as we move forward.

First, my name is Jim Koeller, and I am currently a full professor at the University of Texas at Austin College of Pharmacy and an adjoint professor of medicine and oncology at the University of Texas Health Science Center in San Antonio.

Some have affectionately referred to me as one of the old-timers in oncology pharmacy. And my 32-year career as an oncology pharmacy specialist has been an interesting journey so far. I hope to share some of that perspective, reflection, commentary, and, hopefully, thought-provoking discussion with you. I may not always have the answers, but for those who know me, I always have something to say. I can tell you that I am not exactly sure what direction this column will take. I have not been given any marching orders or guidelines as to what to say or how to say it, so we will have to see where this goes.… I do read the Hematology/Oncology Pharmacy Association (HOPA) listserv religiously, and some topics will come from those discussions; other topics will just be things I think we need to talk about.

Our Past

Much of what exists today in oncology training, continuing education, and licensure have their roots from those early days when others like me were looking to create a forum for our specialty. Many of the formal oncology interest groups, residencies, and fellowships were created in the early 1980s.

Back when I started in this business, specialty pharmacy practice was in its infancy, so with little direction a group of us forged a path ahead for oncology pharmacy practice. Our specialty arose out of an American Society of Health- System Pharmacists’ (ASHP) special interest group. In 1986, I headed a group from across the country, sponsored by ASHP, who were responsible to create a petition for oncology as a specialty that would go to the Board of Pharmaceutical Specialties (BPS). This turned out to be a 7-year odyssey. That first submission was denied by BPS. This was quite a setback and almost doomed the recognition of our specialty. But a handful of us persevered and, 2 years later, submitted a proposal that was accepted. A group of us were asked to serve on the first BPS Special Council on Oncology Pharmacy, which created the inaugural specialty examination in 1995. A successful specialist now could be a Board Certified Oncology Pharmacist (BCOP).

With an identified specialty, the next issue was continuing education that focused on oncology pharmacy practice. Neither ASHP nor the American College of Clinical Pharmacy offered adequate oncology specialty content to satisfy annual BCOP requirements or the overall needs of specialists. The American Society of Clinical Oncology annual meeting was an option, but not all oncology pharmacists were able to attend. In addition, the only standalone oncology pharmacy program was the M. D. Anderson Cancer Conference, but that was primarily an M. D. Anderson –created event using M. D. Anderson staff.

During this same timeframe, a group of oncology specialists formed ONC, a subgroup of a medical education company that specifically created oncology pharmacy continuing education. From this group, the second stand-alone oncology pharmacy national conference was formed: Making a Difference. This meeting was a success, but following the sales of the medical education company, the Making a Difference conference was idled. Phil Johnson and a handful of others, however, resurrected the conference, ultimately becoming the HOPA annual meeting when the organization launched in 2005.

Our Future

I thought a little look backward to how our specialty came to be, would interest some of the younger oncology pharmacy specialists. Today, there are more than 1000 identified oncology specialty pharmacists. As the old Virginia Slims TV commercial once said, “we’ve come a long way baby.”

I was just looking through my desk drawer for a pen, and do you think I could find one? Not one, no druglabeled pens, nada. Where have all the pens and sticky pads gone? I remember when pens and sticky pads were as common as fire ants in a Texas yard. Now, because I’m not trusted to make an unbiased drug assessment, all those enticements have been revoked. No more trips or junkets. Believe me, things have not stopped there. Most health science centers and health system rules currently outlaw the taking of any item from a drug company—and I mean anything. And if that’s not bad enough, at a rescent drug company lecture I gave, pharmacists were not allowed to attend unless they paid for their own dinner. Now employers are telling you what you can do on your own time.

Are we really so sleazy that we can be bought with a pen, pad, or dinner? Maybe the answer is yes for some, but what heresy do these varmints speak (I am speaking about those of us who speak for pharmaceutical companies) that is so toxic? The industry is so regulated and monitored now that to clear the numerous legal internal hurdles that exist, a company-sponsored lecture is so cleansed and squeaky clean, it basically mirrors the package insert. Don’t get me wrong, I appreciate the continuing medical education (CME)-designated lectures I get a chance to hear from time to time, but the rules for CME have become quite tedious and not always reasonable for every lecture.

With all this being said, my question is still: How do we get good, up-to-date information on cancer drugs and treatment to us in practice in a reasonable and timely fashion, without having to spend thousands of dollars to go to a national meeting? I do realize there is web-based programming available. However, much us this is limited and many times does not deal with the disease or treatment of interest at the time. I’m not sure what the answer is, but I do understand the ethics surrounding receiving gifts for using a specific product and how that could taint the decision process. When I look back at how we made decisions and used drugs in the ‘80s and ‘90s and how we do things now, I really don’t see a big difference. Is it just me, or is my sight failing me in my old age? If you don’t agree, let me know where I’m off base or just wrong.