Oncology pharmacists come into their own

February 19, 2007

There was a time when the diagnosis of cancer was ominous, but not anymore. Cancer has evolved into a chronic disease, with 95% of cancer patients treated in outpatient settings. Novel drug therapies and advances in radiation treatment have made many cancers survivable. That's good news for patients, and so is the fact that pharmacists are playing a more pivotal role in managing not only the clinical but also financial aspects of patient care.

As stand-alone, community-based cancer centers and physician-office-based treatment facilities proliferate and chemotherapy agents become more complex, the demand for board-certified oncology pharmacists is growing. A recent study estimated that 70% to 80% of large oncology practices employ pharmacists and pharmacy technicians. Pharmacists have proven a valuable asset for several reasons. Not only are R.Ph.s familiar with drug protocols and experts when it comes to dealing with drug interactions, but oncologists also frequently rely on them for recommending dosage adjustments in patients whose disease is complex. At some comprehensive cancer centers, pharmacists preside over the preparation of injectable agents by pharmacy technicians.

Increasingly, the pharmacist's role is expanding beyond clinical duties. For example, in many facilities pharmacists oversee drug purchases. Recently, a Congressional Medicare Payment Advisory Commission recommended that community-based oncology practices, in order to reduce costs and improve efficiency, hire pharmacists to buy and prepare medications and recommend drug products based on price and clinical effectiveness.

The rise of oncology pharmacy as a board-certified specialty has been steady, and the demand for such specialists is expected to increase over the next decade. Oncology was the fifth specialty to be created by the Board of Pharmaceutical Specialties (BPS) in 1996.

The first crop of BPS-certified oncology pharmacists numbered 118. Now, just a little more than 10 years later, that number has climbed to 655, making it the second-largest specialty after pharmacotherapy, which boasts 3,688 pharmacists.

At the Cancer Center of New Jersey in New Brunswick, oncology pharmacists are playing a pivotal role in the management of patients. Pharmacists there recommend and monitor drug therapy for anemia, anticoagulation, and pain management issues. "There has been a push to have knowledgeable individuals in those roles to determine appropriate therapy along with concerns about the medication safety process," said Susan Goodin, Pharm.D., director of pharmaceutical sciences. At the center, five clinical pharmacists, four for adult patients and one for pediatric patients, see everyone who walks through the door for treatment.

Oncology pharmacy as a specialty is particularly alluring because it provides unique opportunities for pharmacists to focus on subspecialties such as acute care, bone marrow transplant, and pediatric and geriatric oncology. "It's exciting to be on the cutting edge," said Rowena Schwartz, Pharm.D., director of oncology and Weinberg Pharmacy at the Johns Hopkins Hospital in Baltimore. "The science is constantly evolving, and that changes practice constantly. We, as pharmacists, realize how much drug therapy management is essential for a good quality of life for cancer patients."

While subspecialties are luring many younger oncology pharmacists, geriatric oncology is also attracting a lot of attention. At Johns Hopkins, pharmacists are engaged in an evolving geriatric oncology pharmacy program. "Geriatric oncology is fascinating because you're managing comorbidities, chronic disease, and issues of the elderly and other patients who have cancer," said Schwartz.