ACCC Celebrates American Pharmacists Month

October is American Pharmacists Month—a time designated to recognize pharmacists and the contributions they make to healthcare and their communities. First celebrated in 1925 as National Pharmaceutical Week after a North Carolina pharmacist suggested the idea as a way to promote and teach about the profession, the celebration was expanded to a full month in 2004.

The American Society of Health-System Pharmacists (ASHP)—which represents pharmacists who serve as patient care providers in acute and ambulatory settings—has designated this week (Oct. 20-16) as “Pharmacy Week.” On Oct. 15, ASHP celebrates “Pharmacy Technician Day,” and on Oct. 12, the organization celebrates “National Women Pharmacist Day.”

Each year the American Pharmacists Association (APhA) selects a specific theme to draw attention to pharmacists’ roles and contributions to the medical community. This year’s campaign, Pharmacists: Easy to Reach, Ready to Help, aims to raise awareness among the public, patients, policymakers, and other stakeholders about the wide array of services pharmacists provide.

As cancer treatments have grown more complex, nuanced, and costly, the range of services provided by oncology pharmacists has continued to expand. Oncology pharmacists play a key role on the multidisciplinary cancer care team—from ensuring the right medication is reaching the right patient, to managing formularies, to participating in P&T committees, to providing patient education, and more. In response to the increasing number of oncolytic agents and treatment regimens, the associated economic burden on patients and providers, and the requirements of alternative payment models, today we need a scalable model of chemotherapy stewardship for oncology pharmacists.

One such model—antimicrobial stewardship—has  been adopted by infectious disease professionals. Antimicrobial stewardship is driven by defining appropriate antimicrobial agents for use in patients, decreasing patterns of emerging resistance, and reducing costs. I believe the foundational scope of chemotherapy stewardship should mirror that of antimicrobial stewardship, with the goal of improving patient outcomes and controlling costs by decreasing waste and improving resource utilization.  Specifically, oncology pharmacists can prospectively review treatment plans to:

• Determine if there are any clinical issues (dose reductions or modifications) that may lead to inappropriate therapy or augmented toxicity

   

• Identify safety issues with chemotherapy and under- or over-utilization of supportive care medications

   

• Review off-label use of oncology medications and appropriately referenced data to help improve the reimbursement process by reducing waste for hospital systems or practices and saving patients from possibly having treatment denied or delayed

   

• Confirm that the appropriate processes and infrastructure are in place to ensure select treatment regimens can be provided safely in the outpatient setting to facilitate cost reductions
  

The scope of stewardship

Chemotherapy stewardship can be designed as a process through which a pre-selected list of anticancer agents is restricted to approval for use by the stewardship team. The scope of any stewardship program should include:

• Clinical Assessment: Is the use of this agent within established evidence-based guidelines? Is there an established and recognized clinical benefit for use? If not, is there a published rationale supporting its use? Is supportive care maximized to prevent toxicity and potential need for healthcare resources to manage adverse events? Is the dose appropriate based on organ function to prevent toxicity and potential need for healthcare resources to manage sequelae?

   

• Cost Assessment: Is the agent the most cost-effective medication available to treat the patient’s indication (while maintaining prescriber authority and autonomy)? Can the therapy be given in an ambulatory setting? Can the dose be rounded to the nearest vial size increment? Is there documentation of insurance approval? If there is no insurance approval or if the patient has a burdensome co-pay, are there any patient assistance programs available to help alleviate the financial burden to the patient and/or the health system or practice?
  

Widespread adoption of oncology pharmacist–driven chemotherapy stewardship programs would help ensure safe and effective treatment of oncology patients while judiciously managing limited healthcare resources.

Ali McBride, PharmD, MS, BCOP, is the clinical coordinator of hematology/oncology at The University of Arizona Cancer Center, Department of Pharmacy. He is the president of the Association of Community Cancer Centers.

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