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The role of clinical pharmacists in multidisciplinary oncology teams has evolved over the years, particularly in non-small cell lung cancer (NSCLC), according to Whitney Lewis, PharmD, clinical pharmacy specialist at The University of Texas MD Anderson Cancer Center. Pharmacists collaborate with oncologists, nurses, and other healthcare professionals to provide comprehensive care plans for patients.1
Physician’s Weekly (PW) spoke with Dr. Lewis to better understand the role of pharmacists in
oncology care and how they are a proactive source of advocacy for patients with NSCLC.
PW: How has the role of clinical pharmacists in multidisciplinary oncology teams evolved over the past few years, particularly in NSCLC?
Dr. Lewis: The roles of clinical pharmacists have evolved; we continue to do a lot, which is exciting and rewarding.1
The role of clinical pharmacists in oncology, especially in NSCLC, has evolved significantly over the past few years.1 When I first started, the landscape was very different. Today, we have a wide array of new drug approvals and targeted therapies that have transformed patient care.2 I often tell pharmacist students that nothing is treated the same way now as when I was in residency a decade ago. It’s been incredible to watch these advancements improve treatment options.
As a clinical pharmacist, keeping up with research advancements is essential. I work closely with two to three medical oncologists five days a week. This puts pharmacists in a unique position to provide counsel to patients on unexpected adverse effects and how to help manage them.1,3
Beyond direct patient care, we’re deeply involved in educating both providers and patients, helping ensure patient safety by reviewing anticancer orders and monitoring for drug interactions.1 We often assist with non-oncologic issues, like pain management for NSCLC, and do a lot with the Electronic Health Record system in terms of developing and ordering tools.4
Additionally, we can support the development of institutional guidelines and policies to help explore cost-saving measures from both an institutional and patient standpoint.1
PW: What roles do pharmacists play in the management and coordination of care for NSCLC patients in a community setting, and how does their involvement integrate with the work of other healthcare professionals?
Dr. Lewis: I think everything is a little less siloed and more integrated now. In a community setting, multiple pharmacists are often involved in a patient’s care at different stages. There may or may not be a clinical pharmacist working directly with the physician when decisions are made but the pharmacist’s role in providing broader coverage across various disease states remains vital.3 These pharmacists are still heavily involved in patient education, toxicity management, and discussions on how to handle side effects with the care team.1,3 They also often play a larger role in assisting with medication acquisition in the community setting.1
Many of my colleagues in the community spend a lot of time on prior authorizations—writing letters of medical necessity to secure these drugs for patients. While we’re fortunate to have dedicated resources for this in larger settings, that’s not always the case in the community. For example, we have an on-site specialty pharmacy but in many community settings, patients rely on mail-order pharmacies. This means different providers might be involved in the patient’s care at various points, including retail pharmacists who help with education and prior authorizations, particularly for supportive care medications.
Pharmacists and specialty pharmacies are often very proactive in coordinating care.3 They might initiate medication requests as soon as molecular profiling results are available and start working on prior authorizations right away. They also provide extensive patient counseling, follow up after therapy begins, and ensure refills are on time and screen for drug interactions when filling concomitant medications.1 While it can be more challenging with so many moving pieces, there’s still a significant opportunity in the community for pharmacists to be deeply involved in patient care and collaborate closely with the multidisciplinary team.3
PW: What specific responsibilities do pharmacists have in managing NSCLC-targeted therapy treatment options and how do they contribute to patient care?
Dr. Lewis: Our role as clinical pharmacists is focused on educating patients about potential adverse effects and helping them manage these challenges.1 While we don’t own these responsibilities, we are deeply involved in guiding patients through the complexities of their treatment.3 We work closely with physicians to discuss the best treatment options, considering factors in data like response rate duration, intracranial response, and the unique side effect profiles of each drug.3
It can also be frustrating for patients to feel like everything is happening to them, with little control over their situation. I work with patients to manage their adverse effects and, by doing so, help them feel more empowered and allow them to regain a bit of control over their disease. For example, while I may not be able to prevent nausea entirely, I can try to help patients stay ahead of it. This proactive approach can allow the patient to feel better sooner and is more effective than waiting for the medical team to respond to their concerns.
Additionally, I have found that I and other pharmacists can have crucial responsibilities in an NSCLC treatment plan. For instance, chemotherapy orders require two signatures and I often provide one of them before sending it to the physician for co-signing. I mentioned before that we’re lucky to have an onsite specialty pharmacy; this helps assist with prior authorizations and proactively screens patients for assistance programs in conjunction with our apps. The clinical pharmacy team connects various teams, ensuring all the necessary paperwork is completed and helps coordinate these efforts.
PW: How do pharmacists provide emotional and practical support to patients and their families throughout this treatment journey?
Dr. Lewis: One of the most obvious ways pharmacists provide support is during patient education counseling sessions.1 I always find this to be one of the most rewarding parts of the job. You can see people start to relax and feel more comfortable once they have a better understanding of how to help manage some of the side effects they might experience. During follow-ups, I often see the same patients for toxicity management, helping them adjust their plans to better manage their symptoms or pain. In my experience, pharmacists also play a key role when patients have questions about complementary or alternative medications, which is becoming more common.5 My teammates and I come prepared with literature to support or advise against certain therapies, using these discussions as another touchpoint to support the patient.
We understand that we’re not their only provider and patients may already be on other medications. By being that consistent touchpoint, especially in oral chemotherapy clinics, we can provide more continuity in their care. These relationships grow over time and while it can be heartbreaking to see a patient progress through their illness, it’s meaningful to be there for them. If they’ve met you before, it’s easier to approach them with the next treatment option, saying, ‘I know how you did with your previous treatment; let’s talk about this new one.’ We then tailor our advice based on how they tolerated their previous therapy.
Patients generally respond well to this approach.1,6 Even though it’s not always their favorite thing to see the pharmacist, especially when starting a new therapy or dealing with toxicity, it’s comforting for them to talk to someone they already know and trust—a familiar face, who is a reliable source of medication information.
PW: In what ways do pharmacists advocate for the needs and preferences of patients in treatment decisions in the community setting?
Dr. Lewis: A lot of this advocacy happens behind the scenes, often before the pharmacist even sees the patient. In an academic medical setting, for example, the provider usually sees the patient first, and then we discuss the best plan, considering the patient’s needs and preferences—whether that’s choosing between oral versus IV treatments, managing the frequency of visits or addressing toxicity profiles and side effects that the patient might be anxious about.
We also play a key role in understanding why patients might not be adhering to their treatment.1 Is it due to cost, leading them to stretch their medication? Are they reducing doses on their own because they’re experiencing side effects? There are many ways we can advocate for patients; help manage their toxicities and work closely with the team to help ensure the best possible outcomes.3
PW: In your opinion, how can the advocacy efforts of pharmacists be further supported and integrated into the broader healthcare system for these patients?
Dr. Lewis: Although pharmacy organizations have been advocating for this, I feel we could have been more proactive in pursuing provider status for pharmacists sooner. One of the challenges we face is the limited scope of services we can offer under the current framework. Expanding our role to include direct patient education could enhance our integration into oncology care and better support patient needs.1
When looking at NSCLC, patients are, on average, in their seventies, so they already have a complicated medical history or are on multiple medications.7 That said, when we are in the disease state, it’s crucial to manage the unique side effects.3 So, if pharmacists could bill for more of these services, it would allow us to expand our role—ideally involving a clinical pharmacist in the care of every patient. I think that’s a goal we should all be working towards.
Read on to learn more about biomarker testing for ROS1+ NSCLC patients.
