The Cleveland Clinic was founded in 1921 in Cleveland, Ohio, by 4 physicians. At that time, it was one of only a few group practices in the United States. This group practice model was very familiar to 3 of the founders—George Crile Sr, Frank Bunts, William Lower—as they served together in military hospitals near the front lines of World War I. These 3 colleagues were determined to establish a not-for-profit clinic that combined the best of military and civilian medical practices. Joined by a fourth physician—John Phillips—they set about building a practice where medical specialists worked together to achieve the best outcomes in patient care while furthering the goals of research and education.
From the very beginning, the mission of the Cleveland Clinic has been to provide “better care of the sick, investigation into their problems, and further education of those who serve.” To help ensure the success of their mission, the founders decided to commit 25% of their net income to an endowment that supported medical research, education, and care of the indigent. Today, the Cleveland Clinic has facilities throughout Ohio, as well as in Florida, Nevada, Canada, and Abu Dhabi.
In the field of oncology, the Cleveland Clinic has a distinguished history. George Crile Jr, MD, the son of one of the founders, was a pioneer in establishing alternatives to radical mastectomy to treat breast cancer. His book, Cancer and Common Sense, was written for the public and endorsed conservative treatment for cancer while railing against what Dr Crile called “the unnecessarily mutilating results of the surgery being done at some of the socalled cancer centers.” These were controversial ideas in 1955, and Life magazine published excerpts from his book. Today, the Cleveland Clinic Taussig Cancer Institute is internationally recognized for its clinical, translational, and basic cancer research and is a National Cancer Institute–designated cancer center, as part of the Case Comp rehensive Cancer Center.
The Cleveland Clinic’s Department of Pharmacy is at the forefront of using technology and automation to let pharmacists focus on patient care and physician support—ensuring that all members of the oncology team are able to offer high-level care to their patients. Marc Earl, PharmD, BCOP, a hematology/ oncology clinical specialist, answered our questions about the Cleveland Clinic and how oncology pharmacists are working with patients to educate and counsel them about their medication therapy.
What is your hospital doing that is different from other cancer centers?
Marc Earl (ME): We are using technology to increase the amount of time pharmacists spend with patients. We have recently instituted physician order entry for chemotherapy as well as robotic technology for chemotherapy compounding. Over time, these things will allow our pharmacists to interact with more of our oncology patients.
How does that translate to better outcomes for your patients?
ME: It helps us meet our goal in that every cancer patient at the Cleveland Clinic has his or her own pharmacist. This technology will be safer and more efficient, allowing our pharmacists to interact with patients in a one-on-one manner. We will be able to work through issues in supportive care and medication discharge counseling that will translate to improved care for our patients.
The Cleveland Clinic believes in educating the patient and his/her family about cancer as a means of increasing the chance for a better outcome of therapy. Can you share a patient success story illustrating this belief?
ME: My biggest impact has been with adult patients who have recently been diagnosed with acute myeloid leukemia. It is an overwhelming time for the entire family. I am able to work with these patients and their families on a daily basis to answer any medicationrelated questions while they are in the hospital. I also look for a variety of medication- related problems during their 4- to 6-week stay in the hospital. I meet with them before they are discharged to go through any new medications. Many of these patients are not on any medications when diagnosed but must go home on 5 to 10 new medications. This is overwhelming for the patient and his/her family and provides an opportunity to answer questions and improve patient safety.
How has the oncology pharmacist’s role changed in the past 5 years?
ME: The majority of the changes have been related to patient safety. We are actively involved in developing preprinted and electronic chemotherapy orders, which help decrease errors. It helps standardize the treatment approach for many malignancies. This ensures that every cancer patient receives a similar treatment with the exact same supportive care management. What is in the future for the Cleveland Clinic? ME: I am excited about the future of pharmacy at the Cleveland Clinic. We have grown significantly in the past few years, and this will allow us to become more involved with our patients. We are also going to be incorporating more pharmacy students and residents into these programs so that we can reach more patients. I think there are opportunities in supportive care and discharge education our pharmacists can assist with. Our goal is that one day every patient will personally interact with a pharmacist on each visit to the Cleveland Clinic.
