A Positive Outlook for Oncology Pharmacists

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Edward Li, PharmD, MPH, BCOP
Associate Professor
Department of Pharmacy Practice
University of New England College of Pharmacy
Portland, ME

There were a number of areas where we asked the forecast panelists questions specifically regarding oncology, and how the changing environment might relate to oncology pharmacists.

I think the largest chapter that discusses clinical significance for a practicing oncology pharmacist is the drug development and therapeutics chapter, which was written by Pamela K.  Phelps, PharmD, FASHP, Director, Clinical Pharmacy Services, Fairview Health Services, Minneapolis, MN, and James M. Hoffman, PharmD, MS, BCPS, FASHP, Associate Member, Pharmaceutical Sciences, and Chief Patient Safety Officer, St. Jude Children’s Research Hospital, Memphis, TN. Within that particular chapter, there are a few questions that could be related to oncology pharmacy practice.

One question is about how likely it would be that cancer chemotherapy treatment pathways would be used within pharmacy practice. Overwhelmingly, close to 60% of forecast panelists said that it was “very likely” that these cancer treatment pathways would be pretty prevalent. This has a lot of implications, because as oncology pharmacists who practice in the outpatient setting, we’re concerned about reimbursements with chemotherapy regimens.

We’ve lived in an era where, if we felt that it was clinically appropriate to give this particular regimen to a patient, and there was adequate reimbursement, we have a lot of autonomy in terms of using that particular regimen.
With cancer chemotherapy treatment pathways, having that autonomy may not be the case; patients might be prescribed based on who’s actually developing the pathways, and whether there’s a third-party payer, or some other stakeholder involved.

We’re going to be the ones who are simply following the pathways and picking the regimen based off of a limited menu of choices for our patients. That’s going to be a big paradigm change for oncology pharmacists.

Another question topic that’s a little bit less doom and gloom and more optimistic for pharmacists is that, because we have an expansion of oral antineoplastic medications available now, we’ve seen a large number of oral anticancer drugs receive approvals over the past few years.

The forecast panelists were pretty optimistic that health systems and institutions would actually lead the charge in terms of implementing a pharmacist-managed oral antineoplastic service, so that we could see better medication adherence in our patients, mitigate drug toxicities, and control treatment costs.

Our autonomy with infused chemotherapy may go down a little bit in terms of selecting the regimens, but in terms of having pharmacists manage these concerns with oral antineoplastic agents, autonomy will go up.

From a clinical standpoint, I think that pharmacists will be much more heavily involved in the oral aspect over the next couple of years.

The other aspects within this particular chapter have to do with biosimilar agents and new and specialty products. We definitely anticipate the approval of more biosimilars over the next few years, which would impact the oncology space.

In this particular item, approximately 96% of forecast panelists said that most health systems out there will have reviewed ≥1 biosimilars for their formulary. Biosimilars are coming, and oncology pharmacists have to be prepared to have discussions about specific biosimilars with their pharmacy and therapeutics committee, and recognize that we, as oncology pharmacists, are seen as experts in biologic and specialty medications. These are drugs that have unique mechanisms of action, are very expensive, and have unique toxicity profiles. We’ve been the experts in terms of managing those particular products.

The forecast panelists are saying they believe that it’s pretty likely new biologic and specialty medications will start to become more prevalent, not just for oncologic diseases, but for other common chronic disorders such as hyperlipidemia and diabetes.

We’re going to start seeing a lot more of these biologic and specialty products. We see some of this with the newer agents for hyperlipidemia that have been approved in the past year.

I think the relevance to oncology pharmacists is that perhaps we’ll be helping our colleagues in the other disciplines and in the other therapeutic areas to help them develop the same sort of skills that we learned as oncology pharmacists to manage these unique specialty products.

Last modified: April 6, 2016