The Path to Oncology Pharmacy

Eric Urnoski, 2015 PharmD Candidate

 

My philosophy has always been to cherish each educational opportunity or experience not only for professional development but also for personal growth. Adhering to this principle, I took advantage of every available chance to learn and grow as a pharmacy student. While in high school, I had the opportunity to transition from a grocery store cashier to a pharmacy technician after waiting for a position within the company to become available. In addition, I was briefly employed at a specialty mail order pharmacy to help diversify my work experiences and explore the many work settings pharmacy has to offer. Over the next several years, I was able to use these experiences to develop my direct patient communication skills as I learned how to have a genuine rapport with patients. Also, being exposed to patients on many different therapeutic regimens helped prepare me for the challenges of pharmacy school.

I attended undergraduate school with a future career in pharmacy as my goal. During this time, I became involved with research—new drug development in a medical chemistry lab. Under the direction of a pharmaceutical sciences professor, I worked in a basic sciences laboratory on synthesizing a microtubule-stabilizing analog similar to paclitaxel. I began to realize how research and drug development of new chemotherapeutic agents were on the rise and how innovation was propelling the pharmacy profession into becoming an integral part of the cancer care team—that these new agents require the vigilant monitoring that a pharmacist can provide.

When I started pharmacy school at the Jefferson School of Pharmacy, I was eager to get involved in clinical research. Remarkably, one of my professors, Dr Ginah Nightingale, was seeking students to assist with an ambitious longitudinal research opportunity. Dr Nightingale was collecting data about the role of a pharmacist in a multidisciplinary care team for patients of the recently established Senior Adult Oncology Team at Thomas Jefferson University Hospital. Specifically, pharmacists performed a medication review (prescription, over-the-counter, and herbal medications) at the patient’s first visit. The focus was to evaluate polypharmacy and potentially inappropriate medication use before complex chemotherapy regimens were started for this at-risk senior adult population. Despite having had limited interaction with Dr Nightingale previously, I inquired about assisting in the data collection. Afterward, I was able to assist with her senior adult oncology research study for nearly 2 years. Initially, I performed literature searches for background information about inappropriate medication use in senior adult oncology patients. I obtained Institutional Review Board (IRB) certification through the Collaborative Institutional Training Initiative (CITI), and collected pertinent information from patient charts about cancer diagnosis and staging, comorbidities, Eastern Cooperative Oncology Group (ECOG) functional status, and medication use.

In addition to my coursework and pharmacy school experiences, I applied for an internship in the Department of Pharmacy at Thomas Jefferson University Hospital and was accepted. Although I was not working in the oncology pharmacy, I compounded and delivered medications to patients’ rooms and was able to see firsthand the complexity of the medications prescribed for hospitalized cancer patients. Most striking to me were the patients who were being cared for in the bone marrow transplant unit who were sometimes receiving dozens of supportive medications, including anti-infection prophylaxis, immunosuppressants, and colony-stimulating factors. In addition, these patients were receiving total parenteral nutrition and palliative care. This complexity truly underscored the importance of having an oncology pharmacist assisting in the care of patients with cancer.

I view pharmacists as integral to the multidisciplinary team. Oncology pharmacists are particularly valuable members of this interdisciplinary care team, with the responsibility of managing complex therapies, medication-related toxicities, and comorbidities experienced by many cancer patients. Oncology pharmacists also must ensure that chemotherapy and supportive medications are delivered at the appropriate intervals. It is no secret that oncology is one of the most heavily researched and progressive specialties of pharmacy. As such, the role of oncology pharmacists will become more important.

Another area I am interested in is infectious diseases, and the fact that oncology pharmacists constantly need to manage immunocompromised patients makes the field even more appealing to me. As immunocompromised patients have limited ability to fight bacterial, viral, or fungal pathogens, a pharmacist must carefully monitor these patients and ensure they receive sufficient anti-infective prophylaxis and treatment while simultaneously minimizing the toxicities of each agent. Dr Nightingale is a pharmacist I have developed a profound respect for over these past several years. Since I have been able to observe her ability to balance didactic teaching, precepting students, working collaboratively with other health disciplines, and conducting practice-based research, I have become inspired to pursue a similar path in my professional career. I am looking forward to this fall when I will be one of her advanced pharmacy practice experience (APPE) students within a medical oncology team at Thomas Jefferson University Hospital.

The advanced training and certification oncology pharmacists pursue reinforces the dedication of many pharmacists to stay current on breakthroughs in oncology research. I foresee pharmacists—especially oncology-trained pharmacists—providing even more services in the upcoming years. Oncology pharmacists will increase their involvement in the management of both inpatients and outpatients. Not only will oncology pharmacists continue to help improve patient outcomes and overall care by providing insight to new targeted biologic therapies, but they will also have the opportunity to work in a variety of settings. Oncology pharmacists can practice in more diverse settings, such as ambulatory care/outpatient centers, specialty pharmacies, or even in-home infusion. Because of the widespread improvements in cancer therapy, patients are living longer. Pharmacists can fill a necessary role in the healthcare system by providing optimal medication-related education to patients as well as their families before, during, and after chemotherapy. Pharmacists will present information about any potential adverse events that patients may experience as well as discuss any drug-food and/or drug-drug interactions that may be possible with oral chemotherapy. I find this aspect of direct patient interaction to be particularly appealing and rewarding. A pharmacist’s ability to quell the anxiety of a newly diagnosed cancer patient and to coach the patient and family throughout the entire treatment process is something that is truly rewarding.

Naturally, there is no telling where these next few years will take me. I would venture to guess that many readers of The Oncology Pharmacist never envisioned a career as an oncology or hematology pharmacy specialist when they were in high school or even when they were starting their pharmacy education. I am confident that oncology pharmacists will continue to advance the profession by establishing a major role as part of the multidisciplinary team. Oncology pharmacists will expand their role by providing medication education to the team, ultimately leading to improvements in cancer care and patient outcomes and in the healthcare system overall.

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Last modified: July 28, 2015