Oncology Pharmacists: Medication Specialists in Cancer Care
By: Clara Elchebly
Originally seen in Hospital News
When you or a loved one is facing cancer, a dedicated team of healthcare professionals works tirelessly to provide patients with the best care. Among these crucial individuals are oncology pharmacists. These are specialized pharmacists who play an essential role in your treatment journey. Most people think pharmacists only count pills or mix drugs, and when I present myself as an oncology pharmacist, the reaction is often one of surprise, as most people are unaware pharmacists play pivotal roles within hospitals and other healthcare-systems settings. So, what does an oncology pharmacist do? Oncology pharmacists specialize in oncology and are involved in many aspects of patient care. This includes ensuring medications are safe and effective, managing potential side effects, taking part in research to develop new treatments, and working to improve overall healthcare-systems pharmacy services.
Whether patients receive their treatment in the outpatient clinic or require a hospital stay, oncology pharmacists are there to support the patient, the oncologist, and nurses. In the outpatient clinic, before patients receive their medication, pharmacists meticulously review their blood tests and prescriptions to ensure proper dosing and administration of antineoplastics drugs. The treating team will often consult pharmacists for medication review and drug interaction management, dose adjustments and management of side effects.
When patients begin a new treatment, they will always meet with an oncology pharmacist for a detailed consultation and will have the time and the opportunity to ask all their questions regarding the treatment. Pharmacists also play a crucial role in communication. If needed, they will get in touch with community pharmacists to share important information about treatments, especially with newer therapies like immunotherapy. Because of its mechanism of action and potential grave side effects, it's vital that all healthcare providers are aware of patients receiving these medications to avoid interacting medications like corticosteroids, which could reduce its effectiveness, in order to promptly recognize and manage any potential immune-related side effects.
On the hospital wards, oncology pharmacists continue to be essential members of the care team. Beyond the typical tasks of a hospital pharmacist, they help coordinate the administration of medications, especially when patients have limited intravenous access or are receiving drugs that are not stable over long periods of time. They ensure that medications are compatible and that patients receive the necessary hydration, which can be significant for some treatments (sometimes three or four litres of fluid per day) or require specific measures like urine alkalinization to help the body eliminate the drug effectively. To further personalize treatments, oncology pharmacists may also plan therapeutic drug monitoring to ensure drug efficacy, assess risks of toxicity, or monitor drug elimination, and by adjusting doses based on these results.
As drug specialists, oncology pharmacists are constantly learning about new cancer treatments and new ways to use existing medications. Once a new drug is approved in Canada, it still needs to go through a review process for public funding. During this time, the pharmaceutical companies often have patient support programs to help patients access new therapies sooner. Oncology pharmacists work closely with oncologists and drug access navigators to enroll patients in these programs, to ensure they receive their medication promptly, while monitoring for any side effects, and providing necessary counseling.
Hospitals, including my own workplace, the McGill University Health Centre, are also actively involved in clinical trials, which are crucial for developing the next generation of cancer treatments. Oncology pharmacists play a key role in this field by reviewing protocols with the hospital ethics committee, ensuring proper drug preparation and administration, managing side effects, and taking part in audits by pharmaceutical companies and Health Canada to ensure the research is conducted properly.
Beyond direct patient care and research, oncology pharmacists often take on leadership roles within their hospital, outpatient clinics, their province, nationwide, or even internationally. Locally, they work to create a safe environment by ensuring that hazardous drugs are handled and stored correctly. With hospital directives and governments, they contribute to the development of practice guidelines and make recommendations on healthcare-systems pharmacy practice.
Excitingly, the role of oncology pharmacists is continuing to evolve. In recent years, more jurisdictions have expanded the scope of practice for pharmacists, including oncology pharmacists. Advanced practice agreements have also become more common. Those legislative changes and agreements now allow oncology pharmacists to autonomously prescribe and adjust support medication for patients, ensuring the best care is provided and side effects are managed in a timely fashion. Pharmacy colleges and oncology pharmacy associations are actively working to further advance this field, promising an even greater role for these dedicated healthcare-systems pharmacy professionals in the fight against cancer and the future of cancer care.
Clara Elchebly is a Clinical oncology pharmacist at McGill University Health Centre in Montréal, QC.