Part 2: Navigating Oncology Pharmacy Practice During the COVID-19 Pandemic

April 23, 2020

In part 2 of our video interview, Doug Hackenyos, oncology pharmacy clinical coordinator at the University of Connecticut, discusses the effects of COVID-19 on cancer care pharmacy.

In part 2 of our video interview, Doug Hackenyos, oncology pharmacy clinical coordinator at the University of Connecticut, discusses the effects of COVID-19 on cancer care pharmacy.

Drug Topics®: Hi, my name is Gabrielle Ientile with Drug Topics® and today we’re speaking with Dr Doug Hackenyos, Oncology Pharmacy Clinical Coordinator at the University of Connecticut, and we’re talking about the current COVID-19 pandemic. Dr Hackenyos, thank you so much for joining us today.

Hackenyos: Of course. Thanks for having me.

Drug Topics®: Can you kind of give us an idea on your current day-to-day?

Hackenyos: Yeah, so my day-to-day right now, it’s probably anything but usual. There are at least, probably a few phone calls about meetings on a daily basis related to this current crisis, so there’s a lot of planning that’s being done on the pharmacy department, I could speak a little bit towards what we’re seeing here: A lot of [Personal Protective Equipment] (PPE) conservation is what we’re looking to put in place, so very tightly monitoring what our inventory is, what our daily utilization is, and trying to really minimize any sort of waste. A lot of those products are on back quarter right now, the supplies are in high demand so we’re really trying to make our way through, protect our employees, and then make sure those supplies are available elsewhere where they may be needed in the hospital. We’re doing a lot of planning related to drugs and drug shortages that have come up with this scenario as well so, albuterol, multidose inhalers, things that are coming up that are having to manage. For our infusion patient population, Actemra, or tocilizumab, is a drug that has some evidence for having preliminary use for cytokine release syndrome and these patients, our COVID Positive patients, so it’s working with our rheumatologists here discussing a prioritization of their outpatient treatment for rheumatoid arthritis versus our inpatient needs for cytokine release syndrome it’s really managing a lot of different aspects of this and it could be pretty time consuming, and again different from what we’ve seen in a typical day-to-day.

Drug Topics®: So, you mentioned changes in treatment, how has the dramatic influx of COVID-19 patients into hospitals and other health care facilities affected cancer patients? Are they able to receive other treatments? Radiation, surgeries that they require? And do they expect more disruptions in the coming weeks?

Hackenyos: Yeah, so, I could probably again speak partially to this, but it’s much more focused in on the operations and the pharmacy at this point in time. I know the MCC guidelines and those mission statements that they have nicely outlined and certain disease states, such as breast cancer, those patients that really have to have their surgeries prioritized and handled immediately versus those that may be able to have them differed for a number of weeks and they’ve also outlined the same with patient oncology as well. I think it is impactful. We have as much as possible tried to eliminate any sort of elective surgery, obviously those with cancer aren’t necessarily falling into that bucket. There are a number of situations where we’ve just had to cut down our volume on any sort of outpatient activities, really focusing on our inpatient care and our preparation for the surge that we’re anticipating in the couple of weeks. Cancer patients have to be treated, I don’t think anyone is thinking we can’t treat them so we’re really just trying to prioritize those things that have to be dealt with urgently or those things that have to be dealt with in person. We’re doing a lot of telephonic screening whenever we can, prior to patients coming in, temperature checks at all entrances as well. Our patients are all wearing masks, we’re trying to really make any of those actual in person visits as safe as possible as well.

Drug Topics®: Then you also mentioned potential drug shortages, and the FDA has been closely monitoring those shortages, and there was also a letter to Vice President Pence from the American Society of Hospital Pharmacists requesting an increase in manufacturing of medications that work in conjunction with ventilators so such as opioids, sedatives, paralytics. Are any of those medications vital to cancer patients in treatment and how would that supply disruption affect their health?

Hackenyos: Yeah, so on the outpatient side, certainly, opioids are things that we’re needing urgently for these patients. A lot of the shortages right now, fortunately have only been impacting intravenous therapy, so our ambulatory treatments aren’t being impacted quite so much, but any of these shortages for medications you mentioned, paralytics, sedatives, any of those things could be very impactful for our patient population given how vulnerable they are. If they are to get sick and be admitted, so we would expect some of our patients to unfortunately be some of the most critically ill if they were to become ill and need some of those therapies desperately if they were to be admitted. That’s something that we’re working closely to manage our supplies here. Our critical care specialists here are working very closely with our ICU attendings to discuss therapeutic approaches, we’re kind of broadcasting out what our pharmacy inventory is looking like, letting all of our providers know what we have on hand, just so there’s good communication between groups. We know exactly what we should be doing for management and we’re mindful of the supplies that we have, but yeah, it’s a real problem I know there are some other areas Boston, New York that are really struggling with some shortages with some of these paralytics and opioid medications, sedatives, it can be very difficult; I’ve heard some therapeutic strategies that are pretty eye opening where people are having to conserve and manage these shortages. 

Drug Topics®: There’s currently a lot of different avenues of research and clinical trials searching for potential COVID-19 treatments. FDA issued an emergency authorization of chloroquine or hydroxychloroquine, vaccines are being pursued, convalescent plasma is being considered as well. So from an oncological perspective what’s your opinion on the various avenues of treatment out there?

Hackenyos: Yeah, and I think it’s really encouraging and probably one of the silver lining coming from all of this is the great amount of collaboration and of the team effort that is being put towards the development of a lot of these treatments a lot of information sharing in very real time, which is great to see and something that I hope could continue beyond just this pandemic that we’re dealing with right now. I think from an oncology standpoint, we’re used to unfortunately seeing a lot of trials in rare diseases where there are very small ends, very few patients so we’re seeing that with some of these new emerging therapies but at the same time, I don’t think any of us are necessarily gonna hang our hang or be ready to accept wholeheartedly or promise these drugs as miracle cures by any means at this point based on the limited amount of information we have available. Again, I think that the collaboration is great, I know that Cancer Consortium are also working to busily develop a repository of information for cancer patients, basically a reporting system for community centers, for academic medical centers to identify and report in their experiments with cancer patients being diagnosed with COVID-19 and this will be real-time sharing of this information.  I think collaborative piece of all of this is something that’s really encouraging and hopefully with that we’ll know how to better manage these patients on day to day basis.

Drug Topics®: And then what are your biggest concerns regarding COVID-19 and the next coming weeks and what do you expect the next few weeks to look like more broadly?

Hackenyos: Yeah, so, I have to say that everyone probably has some of the examples in New York City on their mind in health care right now so we’re really concerned how our own health care providers will be impacted by this. Within the pharmacy, we’ve taken a lot of steps to make sure we’re protecting our own personnel, so proper hand hygiene, conservatively wearing personal protective equipment wherever possible. We’ve taken some steps with the way that we’re handling and receiving medication as well, from the cleanliness and sterility standpoint even beyond what we usually do, just to make sure there isn’t any sort of transmission that’s coming from objects that have been out on the floors and are coming back, or any shipments that we’re receiving in. I think we’re really, really trying to do our best to make sure our employees themselves are here and able to care for the patients that we’re expecting to have come as a part of the surge that we’ll see in the next couple of weeks. We’re doing as much as we can right now to test out some of our telecommuting both as an ability to make sure that we’re spacing employees out, practicing social distancing, but then also as an effort to make sure some of our employees are well rested and able to come in and respond when that demand is incredibly high within the hospital. We’ve done a lot here to in fact add additional beds for patients, additional ICU areas so that we’re able to really handle these patients when we see this increase in volume that we’re expecting. So those are the big things, there’s preparation right now for the coming weeks and making sure our staff are ready those are the main things we’re concerned about and obviously all of this is being done so that we can provide the care to the patients that we’ll have coming in.

Drug Topics®: Dr. Hackenyos, thank you so much for your time today and stay safe.

Hackenyos: Of course, thanks, you as well.

Editor’s note: This interview transcription has been lightly edited for style and clarity.

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