Board-certified Oncology Pharmacists Research Articles

Pharmacist's role in the management of drug-drug interactions caused by nirmatrelvir/ritonavir in COVID-19 oncohematology patients.

New drugs developed for SARS-CoV-2 infection, such as nirmatrelvir/ritonavir (NMV/r), represent a potential for oncohematology patients, but also pose a challenge in managing the potential clinically relevant drug-drug interactions (pDDIs) that may arise. The aim of this study is to assess the frequency, severity, and pharmacist detection of pDDIs. This prospective, observational, study spanned 8 months, involving 42 oncohematology patients prescribed NMV/r in a tertiary-level hospital. A Board Certified oncology pharmacist assessed pDDIs using three databases and made recommendations to prescribing physicians. Linear and logistic regression analyses were employed to explore the relationship between prescribed drugs and pDDIs. Clinically relevant pDDIs were detected in 76.2% of patients, with 18.1% of all medications involved in drug-drug interactions (DDIs). The most common drugs implicated were atorvastatin and imatinib. Micromedex® identified 63.3% of interactions as major severity, while Lexicomp® and University of Liverpool classifications were less restrictive. Pharmacists prevented most DDIs from reaching patients through different interventions, including treatment monitoring (44.2%), discontinuation (36.5%), and dose reduction (17.3%). This study highlights the high prevalence of clinically significant pDDIs in oncohematology patients receiving NMV/r for COVID-19. Pharmacists, as integral members of the healthcare team, played a crucial role in detecting, categorizing, and mitigating these interactions. The results underscore the need for comprehensive studies to evaluate the impact of pharmacist-led interventions in optimizing drug therapy and enhancing patient safety in this vulnerable population.

Clinical and economic impact of oncology-trained pharmacist integration in an ambulatory cancer clinic.

Outpatient oncology practice is a growing area of opportunity for pharmacists to provide clinical services and evidence-based care. This single-center, retrospective chart review analyzed the clinical and economic benefits of a board-certified oncology pharmacist after integration into the ambulatory oncology clinic setting. Primary outcomes were total cost avoidance for pharmacist interventions and impact on Centers for Medicare and Medicaid Services (CMS) OP-35 measures. Pharmacist interventions were characterized into distinct types which were then assigned a cost avoidance value. Cost avoidance was calculated per hour and then extrapolated to a yearly estimate based on a 40-h work week for one year for one full-time equivalent pharmacist. Data collection for the primary clinical outcome was performed by compiling provider-specific emergency department (ED) and inpatient admission rates for diagnoses specified in CMS OP-35 measures within 30 days after receiving outpatient chemotherapy. The rates for the data collection period were compared to the rates six months prior to pharmacist integration to assess pharmacist impact. In six months, 516 total interventions were made by the oncology pharmacist. The incidence of ED visits was 3.34% and 1.72% during the pre- and post-pharmacist intervention periods, respectively. The incidence of inpatient admissions was 2.43% and 0.34% pre- and post-pharmacist intervention, respectively. Total cost avoidance was estimated to be US$375,795 and when accounted for the median pharmacist salary at our institution, total cost savings was US$204,437. The presence of an oncology pharmacist specialist in the ambulatory cancer clinic provided clinical and economic benefits to the cancer clinic.

Oncology pharmacy practice in the United States: Results of a comprehensive, nationwide survey.

Introduction: This study was designed to describe the landscape of oncology pharmacy practice at patient facing institutional healthcare organizations throughout the United States. Methods: The Hematology/Oncology Pharmacy Association (HOPA) Practice Outcomes and Professional Benchmarking Committee conducted a multi-organization, voluntary survey of HOPA members between March 2021 and January 2022. Four overarching domains were targeted: institutional description, job function, staffing, and training/certification. Data were evaluated using descriptive statistics. Results: A total of 68 responses were analyzed including 59% and 41% who self-identified their organization as academic and community centers, respectively. The median number of infusion chairs and annual infusion visits were 49 (interquartile range (IQR): 32-92) and 23,500 (IQR: 8300-300,000), respectively. Pharmacy departments reported to a business leader, physician leader, and nursing leader 57%, 24%, and 10% of the time, respectively. The median oncology pharmacy full-time equivalents was 16 (IQR: 5-60). At academic centers, 50% (IQR: 26-60) of inpatient and 30% (IQR: 21-38) of ambulatory pharmacist FTEs were dedicated to clinical activities. At community centers, 45% (IQR: 26-65) of inpatient and 50% (IQR: 42-58) of ambulatory pharmacist FTEs were dedicated to clinical activities. As many as 18% and 65% of organizations required or encouraged certification for oncology pharmacists, respectively. The median number of Board-Certified Oncology Pharmacists was 4 (IQR: 2-15). Conclusion: As the number of patients with cancer rises, the oncology workforce must grow to support this expanding population. These results describe the practice landscape of oncology pharmacy at US healthcare institutions to serve as a foundation for future research evaluating metrics and benchmarks.

Abstract 723: Who reconstitutes my chemotherapy? Examining the educational needs of oncology pharmacy practitioners in Nigeria

Abstract BackgroundNigeria has the highest cancer burden in Africa with 124,815 cancer cases and 78,899 cancer deaths in 2020. The limited number of oncology specialists, inaccessibility of essential cancer medicines like chemotherapies, and suboptimal delivery of cancer care lead to poor treatment outcomes. Oncology pharmacy (OP) practitioners are critical oncology professionals in the multidisciplinary team (MDT) for cancer treatment globally. In Nigeria, there is a limited number of OP practitioners providing services like reconstitution of chemotherapy, clinical research, safe use of biosafety cabinets, and monitoring of adverse drug reactions. Although the interest in oncology pharmacy is increasing, the educational needs, available skill sets, and directed training in oncology pharmacy across the nation are unknown. In this study, we examined the educational needs of OP practitioners and worked with the West African College of Pharmacy West African Postgraduate College of Pharmacists (WAPCP), Oncology Pharmacy Practitioners Association of Nigeria (OPPAN), and the International Society of Oncology Pharmacy Practitioners to upgrade the oncology pharmacy practice in Nigeria. MethodA cross-sectional study with a semi-structured questionnaire was done in 2021 with 39 pharmacists working in oncology centers across Nigeria. General descriptive statistics and qualitative analysis was performed. ResultsThere is no board-certified oncology pharmacist in Nigeria. More than 50% of the general pharmacists working in oncology centers are responsible for chemotherapy reconstitution. Understanding chemotherapy reconstitution (automation of chemotherapeutic mixing, use of radiopharmaceuticals, etc), use of biosafety cabinets, knowledge of pharmacology, designing treatment protocols, data management, immunotherapy delivery, and oncology clinical trials were some of the most significant educational needs of the OP practitioners in Nigeria. OP practitioners are lacking in most cancer centers and MDTs. ConclusionThere is an urgent need for a specialty postgraduate training programme in oncology pharmacy in Nigeria. This would help increase oncology clinical trials, improve delivery of cancer medicines, quality of care, and management of toxicities. The West African Postgraduate College of Pharmacists and OPPAN need appropriate training resources to develop an oncology pharmacy curriculum, promote the specialty and collaborate with global institutions for board certifications. Citation Format: Runcie C. Chidebe, Ramatu M. Alabelewe, Darlingtina K. Esiaka, Gloria C. Okwu, Tochukwu C. Orjiakor, Nwamaka Lasebikan, Jacinta Emejulu, Adamu A. Umar, Ndifreke Okwuegbunam, Funsho David, Toyosi Adepoju, Krishna Prasad Sapkota, Candidus C. Nwakasi, Agha A. Agha, Simeon C. Aruah, Katy Graef, Richard Mshelia, Rob Duncombe, Matthew O. Nwaneri, Noel Wannang, Cindy O’Bryant, R. Donald Harvey, Peace C. Babalola, Folakemi T. Odedina. Who reconstitutes my chemotherapy? Examining the educational needs of oncology pharmacy practitioners in Nigeria [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 723.

Collaborative Physician-Pharmacist Multiple Myeloma Clinic Improves Guideline Adherence and Prevents Treatment Delays

Although survival of patients with multiple myeloma (MM) has improved in the last decade, achieving optimal outcomes requires timely delivery of anti-myeloma therapy as well as adherence to supportive care guidelines and patient education. We hypothesized that a multidisciplinary approach of a collaborative physician-pharmacist MM clinic would have a positive impact on clinical measures such as guideline adherence as well as improve the workflow process and prevent treatment delays.From March 2014 to February 2015, we initiated a collaborative MM clinic at our institution, whereby in addition to normal physician care, a dedicated board-certified oncology pharmacist provided consultation on all new and continuing patients. The pharmacist provided education and medication lists, completed medication reconciliation, monitored for adherence and side effects, recommended management of toxicity and supportive care, and navigated issues involving enrollment and access to oral specialty medications. All consultations were documented in the patient's medical chart using a template addressing these key components. Outcomes were compared to those of patients being treated by the same physician during the previous year, when ad-hoc pharmacist consultation was available (traditional model). We compared clinical measures related to guideline adherence and analyzed delays in obtaining immunomodulator drugs (IMiDs) using available dispensing records.Patient characteristics were similar between the collaborative and traditional models including age, sex, race, ISS stage, protein subtype, treatment type, and prior number of therapies. During the 12-month study period when a collaborative model was implemented, 399 pharmacist consultations occurred during 551 physician visits (n=57 patients). During the prior year when a traditional model existed, there were 26 pharmacist consultations on 355 physician encounters (n=44 patients) (7.3% versus 72.4%, p<0.0001).We observed improved adherence to bisphosphonates (BP) in the collaborative clinic (55 (96%) versus 30 (68%) patients, p=0.0002). Among patients receiving BP, the time to initiation from diagnosis and re-initiation after autologous stem cell transplant (ASCT) was 5.5 versus 97.5 days (p<0.001) and 12.5 versus 135 days (p<0.001) among the collaborative and traditional clinic, respectively. One hundred percent of patients in the collaborative clinic versus 41% of patients in the traditional clinic received concomitant calcium and vitamin D (p<0.001). In patients receiving IMID-based regimens, appropriate VTE prophylaxis was prescribed in 52 (100%) versus 29 (76%) patients in the collaborative and traditional clinic, respectively (p<0.0002). Appropriate use of acyclovir prophylaxis in patients receiving proteasome inhibitor-based treatment was observed more frequently in the collaborative clinic (98% versus 56%, p=0.004). Although the number of patients receiving Pneumocystis Jirovecii pneumonia prophylaxis post-ASCT was similar (93 versus 100 percent, p=0.4), the time to initiation of prophylaxis was shorter in the collaborative clinic (11 versus 40.5 days, p<0.0001). Finally, influenza vaccination administration was higher in the collaborative clinic (76 versus 24 percent, p<0.001). When analyzing delays in obtaining IMiD therapy, we found that the median time from when the treatment plan was noted in the medical chart to when the IMiD was first filled was 7 (range: 0-32) vs. 15 (range: 3-62) days in the collaborative and traditional clinic, respectively (p=0.002). Finally, there was a significant reduction in treatment delays observed in the collaborative compared to the traditional clinic (21% vs. 85% of patients undergoing a delay, p<0.0001).Here we pilot a multidisciplinary approach that leads to increased guideline adherence and prevents delay in anti-myeloma treatment. The collaborative clinic model could be applied to several different practice sites in order to establish an improved and more systematic approach in the management of MM patients. Prospective studies analyzing clinical outcomes, patient satisfaction and cost effectiveness of this approach are warranted. DisclosuresWirth:Celgene: Consultancy, Honoraria. Patel:Celgene: Consultancy, Honoraria.

Sensitivity and specificity of drug interaction databases to detect interactions with recently approved oral antineoplastics.

Drug-drug interactions (DDIs) with oral antineoplastics (OAs) are of increasing concern given the rapid increase in OA approvals and use in cancer patients. A small pilot study of 20 DDIs with OAs showed significant variability in commonly used DDI screening databases in sensitivity of detecting potentially clinically relevant DDIs. This study builds upon that work by expanding the number of potential DDIs analyzed and including a specificity analysis. Newly approved OAs from 2016 to May 2019 (n = 22) were included in this analysis. Prescribing information for each drug was reviewed. A list of explicit and theoretical drug interactions was created for each OA by the two investigators. A board-certified oncology pharmacist adjudicated all DDI pairs for potential clinical significance. In total, 229 DDI pairs were used to analyze sensitivity of 5 DDI databases (Lexicomp®, Micromedex®, Medscape, Eporactes®, & Drugs.com). Additionally, 64 "dummy" or false DDI pairs were created to analyze specificity. Sensitivity and specific were analyzed using Cochran's Qtest, while accuracy was analyzed using chi-square test. There was significant variability among the databases with regards to sensitivity (p < 0.0001), specificity (p < 0.0001), and accuracy (p < 0.0001). In terms of accuracy (max score = 400), Lexicomp®(355), Epocrates® (344), and Drugs.com (352) scored higher than MicroMedex® (270) and Medscape (280). Considerable variability exists among DDI screening databases with regards to OAs and potential drug interactions. Clinicians should be vigilant in both screening for DDIs with OAs and describing DDIs encountered in clinical practice.

Oncology Pharmacists Can Reduce the Projected Shortfall in Cancer Patient Visits: Projections for Years 2020 to 2025.

Based on the projected need for a larger oncology care workforce, we estimated the patient care visits and care activities that Board Certified oncology pharmacists (BCOPs) could contribute to oncology care from 2020–2025. Using projected counts for BCOPs through 2025, we estimated that 2.9–4.1 million 30-min BCOP patient visits were possible at 50% workforce capacity. BCOPs’ clinical activities overlapped strongly with those of nurse practitioners (NPs) and physician assistants (PAs) in patient education and treatment management. BCOPs could help reduce provider stress and burnout concerns by spreading these activities across a broader set of providers. BCOPs were more active than NPs and PAs in clinical trials research. Recent advances in immunotherapy, pharmacogenetics, pharmacogenomics, and oral oncolytic agents make the medication-focused training of OPs particularly useful to care teams. Comparison also showed that BCOPs were less active in providing follow-up visits and prescribing. Fulfilling the projected BCOP numbers through 2025 will require continued growth in Postgraduate Year 2 (PGY2) oncology pharmacy resident programs and on-the-job training programs. Our review of the trends in cancer incidence, mortality, and survivorship suggest a sustained need for the activities of BCOPs and other oncology care providers.

Evaluation of pharmacist interventions in a head and neck medical oncology clinic.

Head and neck cancers (HNC) are a complex and heterogeneous group of cancers, often necessitating a multidisciplinary approach across the care continuum. Oncology pharmacists are uniquely qualified to play a vital role on a multidisciplinary team and provide specialized care to optimize medication therapy. This was a retrospective chart review evaluating the role of a board-certified oncology pharmacist in the head and neck oncology clinic at an academic, comprehensive cancer center from April 2017 through March 2018. The primary objective of the study was to describe the types of interventions made by the oncology pharmacists. Secondary objectives included quantifying time spent on patient education and number of prescriptions sent to pharmacies. The pharmacist had 873 encounters with 151 patients, resulting in 2080 interventions. Approximately 57% of the interventions were performed in the clinic. Patient education (58%), facilitation of new prescriptions or refill requests (49.9%), and supportive care management (32.6%) were the most frequent interventions. The oncology pharmacist spent 154.1 h on patient education and sent 811 prescriptions to pharmacies, with 63.6% of prescriptions sent to the institution's cancer center pharmacy. The incorporation of an oncology pharmacist in the HNC team optimized patient care through comprehensive and timely interventions across the care continuum. Our study is the first to highlight the vital role oncology pharmacists have in improving the overall quality of care of HNC patients. Future directions include exploring the impact of oncology pharmacist interventions on select Quality Oncology Practice Initiative measures by the American Society of Clinical Oncology.

Impact of a student pharmacist-directed pilot intervention on influenza vaccination documentation and administration rates in older adults receiving parenteral anticancer therapy.

71 Background: Annual influenza vaccination is recommended for individuals 6 months and older. Older adults are at high-risk of developing influenza and complications associated with the virus. However, &lt; 50% of patients with cancer receive the influenza vaccine annually. In previous work at our institution, a quality improvement project identified that only 40% of adult patients initiating parenteral anticancer therapy between September and December 2017 were documented to have received the influenza vaccine. Therefore, a multidisciplinary student pharmacist-directed pilot intervention was developed to improve influenza vaccine documentation and administration rates, and we sought to investigate the impact of this intervention. Methods: All adult patients (≥65 years old) scheduled for parenteral anticancer therapy during November 2018 were screened for influenza vaccination documentation. Patients were identified by reviewing infusion center schedule. Under supervision of board-certified oncology pharmacists, two student pharmacists evaluated influenza vaccination documentation in the institution/network electronic medical record (EMR) and outside records. Patients with unknown vaccination history were identified for interview by pharmacy students. The student pharmacists collaborated with oncology nurses and clinicians to order and administer influenza vaccine to patients who agreed to vaccination. Influenza vaccination status was updated in the EMR following record reviews/interviews. Results: Student pharmacists screened 617 patient EMRs and interviewed 124 patients to verify vaccination status. Furthermore, 33 patients received influenza vaccination as a direct result of student pharmacist intervention. Overall, rate of influenza vaccination status documentation was 60.5%. Conclusions: Compared with historic data, we found promising results for a student pharmacist-directed pilot intervention, which demonstrated the potential to improve influenza vaccination status documentation and administration among older adults receiving parenteral anticancer therapy.

Demonstrating the value of the oncology pharmacist within the healthcare team.

Although many oncology pharmacists are embedded members within the healthcare team, data documenting their contributions to optimal patient outcomes are growing. The purpose of this paper is to demonstrate the value of the oncology pharmacist within the healthcare team and describe the knowledge, skills, and functions of the oncology pharmacist. A systematic literature review of articles that were published on PubMed between January 1951 and October 2018 was completed. Identified abstracts were reviewed and included if they focused on measuring the value or impact of the oncology pharmacist on provider/patient satisfaction, improvement of medication safety, improvement of quality/clinical care outcomes, economics, and intervention acceptance. Review articles, meta-analysis, and studies not evaluating oncology pharmacist activities were excluded. Studies were thematically coded into four themes (clinical care, patient education, informatics, and cost savings) by 10 oncology pharmacists. Four-hundred twenty-two articles were identified, in which 66 articles met inclusion criteria for this review. The selected literature included 27 interventional and 38 descriptive studies. The value of the oncology pharmacist was demonstrated by published articles in four key themes: clinical care, patient education, informatics, and cost savings. With an expected shortage of oncology physicians and the ongoing development of complex oncology therapies, the board-certified oncology pharmacist is well suited to serve as a physician extender alongside nurse practitioners and/or physician assistants as the medication expert on the oncology care team. The demonstrated value of the oncology pharmacist supports their role as frontline providers of patient care.

Promotion of Pharmaceutical Care and Sciences: Focus of the Japanese Society of Pharmaceutical Health Care and Sciences

The 6-year education system for pharmacists was introduced in Japanese schools of pharmacy in 2006, after which a 4-year doctoral course system was established for advancing clinical pharmaceutical research. The roles of hospital pharmacists and community pharmacists have been expanded from drug dispensing to patient care. Clinical pharmacists practice patient care daily using evidence-based medicine and shared decision making. Clinical pharmacists also carry out research proactively for resolving clinical questions encountered in practice. The Japanese Society of Pharmaceutical Health Care and Sciences (JSPHCS) was established in June 1990, and its membership has expanded significantly. The society has over 12000 members including clinical pharmacists and those in pharmacies who participate in practice, research, and education. The JSPHCS functions as the main platform for pharmacy professionals. It holds annual meetings, publishes an academic journal, supports overseas study, and confers awards on exceptional individuals. It also authorizes JSPHCS-Certified Clinical Pharmacists, Board-Certified Oncology Pharmacists, and Board-Certified Pharmacotherapy Specialists. Recently, clinical pharmacy educational seminars and conferences for newly qualified pharmacists have been held to improve the quality of clinical research performed. Several subcommittees under the JSPHCS were newly established for promoting clinical pharmacy research. The mission of the JSPHCS is to promote clinical pharmacy research and systematize the evidence and information, thereby contributing to the healthcare of all.

PCN5 - Evaluation of Pharmacists' Impact on Hematology Oncology Chemotherapy Orders

This study aims to evaluate the impact of the pharmacist interventions on hematology/oncology chemotherapy orders at a hematology pharmacist clinic using the Hatoum scale. It also aims to ascertain the patient experience after attending the hematology pharmacist clinic. The study was carried out at the Princess Margaret Hospital, a local tertiary public hospital in Hong Kong. Pharmacist interventions from hematology pharmacist clinic were collected over a 17-months period. Interventions were analyzed for intervention type, cause of drug-related problems, and acceptance rate. Each intervention was evaluated for its clinical significance by an independent hematologist and a board certified oncology pharmacist using the Hatoum scale. A patient experience survey on the hematology pharmacist clinic was conducted from September 2016 to February 2017 and subsequently analyzed. A total of 241 interventions were recorded. The most commonly identified drug-related problems were "no drug prescribed but clear indication" (23%), "necessary information missing on prescription" (21%), "inappropriate dilution concentration of chemotherapy drugs" (11%), and "inappropriate dosage" (10%). Acceptance rate of interventions was 99%. Respectively, 88% and 100% of the interventions were rated as significant using Hatoum scale by the hematologist and the board-certified oncology pharmacist. Twenty-eight completed patient experience surveys were obtained. Ninety-six percent of the patients were satisfied with the hematology pharmacist clinic and reported improved knowledge on chemotherapy, improved competency in handling side effect and better understanding on goals of therapy. The pharmacist interventions made in the hematology pharmacist clinic enhanced medication safety and delivery by performing clinical screening and making appropriate recommendations to care providers. This service model should be sustained to continuously benefit patient care.

Oncology Pharmacist Opportunities: Closing the Gap in Quality Care.

ASCO has worked to facilitate the improvement in quality oncology care via the development of the Quality Oncology Practice Initiative (QOPI). The extent to which the ASCO QOPI identifies areas in which pharmacists may enhance care is not known. These findings are important, as pharmacists are an integral part of the care team, providing direct clinical care in addition to medication use guidelines and practice-based policies. In addition, high-performing practices may receive reimbursement from the Centers for Medicare and Medicaid Services. Three pharmacists reviewed 200 QOPI measures for potential pharmacist involvement. We used the Hematology/Oncology Pharmacy Association Scope of Practice document and a validated summary of services provided by board-certified oncology pharmacists to identify which practice domains and pharmacy services would best fit the care provided by the selected QOPI measures. A total of 177 QOPI measures were analyzed. Potential areas of pharmacist impact were identified in 67 (38%) of the included metrics. Measures largely related to optimizing drug therapy through the development and implementation of pharmacy guidelines. Patient counseling and symptom management are services that best described the majority of QOPI measures deemed actionable by a pharmacist. We also found that several QOPI measures pharmacists can intervene upon overlap with metrics currently assessed for reimbursement via the Centers for Medicare and Medicaid Services Merit-Based Incentive Payment System. Oncology pharmacists are uniquely positioned to improve the quality of care provided to patients with cancer within the team-based setting.

Oncology pharmacist opportunities: Closing the gap in quality care.

174 Background: The quality of care provided to oncology patients is beginning to be linked to hospital and practice payment models. Oncology pharmacy specialists are well trained to deliver high-quality oncology care, with a focus on the appropriate utilization and monitoring of medication therapy, patient education and collaboration with other healthcare team members. The extent to which the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) metrics identify specific areas in which pharmacists may enhance care is not known. These findings are important because Centers for Medicare and Medicaid Services designate QOPI as a Qualified Clinical Data Registry (QCDR) and over 1000 US-based oncology practices submit quality data to it. Methods: We reviewed all QOPI measures for potential oncology pharmacist involvement. We utilized a summary of services provided by board-certified oncology pharmacists to identify which services would best fit the care described by the selected QOPI measures. Three individuals identified the areas where pharmacists could contribute and consensus was reached. Metrics were only scored positively for pharmacist impact if they could be obtained via the pharmacist as the primary team member responsible for meeting the measure. Results: Two hundred QOPI quality measures from Fall 2016 were reviewed and 177 were analyzed. Potential areas of pharmacist impact were identified in 67 (38%) of the included metrics. These measures fell within 11 of the 13 possible categories of the service summary. A total of 147 services were identified for the 67 actionable metrics. Patient counseling and education (28%), symptom management and supportive care (23%), chemotherapy adjustment (10%), and participation in protocol-based care (10%) comprised services that most commonly contributed to the ASCO QOPI measure performance. Conclusions: Multiple opportunities exist for pharmacists to directly impact the quality metrics that are measured by the service summary. Focusing new services and patient care activities to address validated quality metrics is a natural next step in the care that oncology clinical pharmacists provide to patients.

Drug Interaction Database Sensitivity With Oral Antineoplastics: An Exploratory Analysis.

Drug interactions are a concern in oncology with the shift toward oral antineoplastics (OAs). Using electronic databases to screen for drug interactions with OAs is a common practice. There is little literature to guide clinicians on the reliability of these systems with OAs. The primary objective of this study was to explore the sensitivity of commonly available drug interaction databases in detecting drug interactions with OAs. A list of 20 drug interactions with OAs was developed by two Board-certified oncology pharmacists. The list included multiple types of drug interactions. The sensitivity in detecting these interactions by MicroMedex, Facts & Comparisons, Lexi-Interact, and Epocrates were evaluated. These databases were chosen based on their local availability and widespread use in practice. Drugs.com was evaluated as a surrogate for a patient-accessible drug interaction database. The Cochran Q test was used to assess the sensitivity distribution across the five groups. Lexi-Interact and Drugs.com had a sensitivity of 95% for the 20 tested drug interaction pairs. Epocrates had a sensitivity of 90%, and both Micromedex and Facts & Comparisons had a sensitivity of 70%. There was a statistically significant difference ( P = .016) in the distribution across the databases in detecting clinically significant drug interactions. Commonly used databases for identifying drug interactions with oral antineoplastics vary significantly in their sensitivity. Clinicians should not rely on a single database and should consider using multiple resources as well as sound clinical judgment. Further work is needed in this area.

Board-Certified Oncology Pharmacists: Their Potential Contribution to Reducing a Shortfall in Oncology Patient Visits.

With an aging US population, the number of patients who need cancer treatment will increase significantly by 2020. On the basis of a predicted shortage of oncology physicians, nonphysician health care practitioners will need to fill the shortfall in oncology patient visits, and nurse practitioners and physician assistants have already been identified for this purpose. This study proposes that appropriately trained oncology pharmacists can also contribute. The purpose of this study is to estimate the supply of Board of Pharmacy Specialties-certified oncology pharmacists (BCOPs) and their potential contribution to the care of patients with cancer through 2020. Data regarding accredited oncology pharmacy residencies, new BCOPs, and total BCOPs were used to estimate oncology residencies, new BCOPs, and total BCOPs through 2020. A Delphi panel process was used to estimate patient visits, identify patient care services that BCOPs could provide, and study limitations. By 2020, there will be an estimated 3,639 BCOPs, and approximately 62% of BCOPs will have completed accredited oncology pharmacy residencies. Delphi panelists came to consensus (at least 80% agreement) on eight patient care services that BCOPs could provide. Although the estimates given by our model indicate that BCOPs could provide 5 to 7 million 30-minute patient visits annually, sensitivity analysis, based on factors that could reduce potential visit availability resulted in 2.5 to 3.5 million visits by 2020 with the addition of BCOPs to the health care team. BCOPs can contribute to a projected shortfall in needed patient visits for cancer treatment. BCOPs, along with nurse practitioners and physician assistants could substantially reduce, but likely not eliminate, the shortfall of providers needed for oncology patient visits.

Impact of an oncology pharmacy elective course on guiding Doctor of Pharmacy students toward specializing in oncology pharmacy

ObjectiveTo assess the impact an elective course in oncology pharmacy has on students’ career interests. MethodsA written survey was offered to Doctor of Pharmacy students taking part in an elective oncology pharmacy course. The first part of the survey was administered prior to the start of the course and the second part was given after completion of the final exam. ResultsOf the 54 students who took the course offered in two consecutive spring semesters, 45 and 53 students completed the first and second parts, respectively. Although most students had some pharmacy experience prior to the course, few of them were exposed to oncology pharmacy activities or were familiar with the medications used in oncology pharmacy. While taking part in the course greatly increased this familiarity, decreases were observed in the number of students who were definitely interested in becoming an oncology pharmacist, taking part in an oncology specialty residency, or becoming a Board-Certified oncology pharmacist. ConclusionProviding educational opportunities in areas of specialty pharmacy practice enables students to make informed decisions about their career plans, encouraging some to pursue their interests, while discouraging others.

Physician-pharmacist collaboration for oral chemotherapy monitoring: Insights from an academic genitourinary oncology practice.

Oral chemotherapy is being routinely used in metastatic castrate-resistant prostate and renal cell cancer. Although convenient, these drugs require monitoring for adherence, toxicity, and drug interactions to maximize outcomes. Oncology pharmacists have the training and expertise that place them in an optimal position to collaboratively provide medication therapy management. A board-certified oncology pharmacist, working in collaboration with a medical oncologist, initiated an oral chemotherapy-monitoring program. The pharmacist provided education, completed medication therapy management; monitored for adherence and toxicity; and recommended treatment of toxicity and supportive care issues. Patient encounters included one of the following: collaboration with medical oncologist visit, pharmacist visit, or telephone or email follow-up between visits. From December 2012 to May 2014, the pharmacist had 123 encounters with 20 patients with either metastatic prostate (n = 17) or renal cell cancer (n = 3). All patients were males (median age 80 years). Most encounters were clinic visits, in collaboration with physician visit or alone (52%); 36% were telephone encounters, and 11.3% were email follow-ups. Medication-related problems were identified in 25% of the 315 assessments made. Problems included: adverse drug reactions, 40%; inappropriate therapy, 20%; and noncompliance, 18%. Recommendations included: modification of laboratory monitoring, 25%; cancer or non-cancer therapy modification, 12%; drug discontinuation, 6.9%. Non-cancer therapy-related drug information and coordination of care accounted for 30% of recommendations. Our program led to identification of a number of potentially clinically significant issues for patients on oral chemotherapy and demonstrated the benefit of the pharmacist in the multidisciplinary team to assist in addressing them.

New milestone: More than 20,000 pharmacists hold BPS certification

The Board of Pharmacy Specialties (BPS) has reached new heights, with the total number of board-certified pharmacists now at 21,560 following administration of the fall 2014 examination—an increase of 12% from 2013. Exceeding 20,000 board-certified pharmacists is a very important milestone for BPS, demonstrating that BPS credentials are sought by an increasing number of pharmacists and recognized by employers around the globe.

BPS certifications continue to expand rapidly

The Board of Pharmacy Specialties (BPS) recently reported that a total of 3,247 pharmacists successfully passed the 2013BPS specialty certification and recertification examinations. There are now 19,109BPS board-certified pharmacists, representing an increase of almost 21% from 2012.