Immunotherapy in the frontline management of advanced and metastatic NSCLC.

The frontline treatment paradigm for patients with advanced or metastatic non-small cell lung cancer (NSCLC) has changed dramatically in the past decade amid efforts to tackle this leading cause of cancer-related mortality. Immune checkpoint inhibitors (ICIs) targeting the programmed cell death protein 1 (PD-1) receptor and its ligand PD-L1 are an important therapeutic option for patients whose tumors lack genetic alterations that dictate response to molecularly targeted therapies. With a growing number of FDA-approved ICI monotherapy and combination therapy options for first-line therapy, the use of biomarkers such as PD-L1 expression has become increasingly important in guiding therapeutic decision making. Presently, PD-L1 expression remains a key biomarker in this setting, in spite of its limitations. This article will evaluate the current and evolving clinical trends in the use of ICIs in the frontline management of metastatic NSCLC, as well as the challenges associated with PD-L1 expression analysis and biomarker implementation.

Clinical strategies for optimizing infusion center care through a pandemic.

The national pandemic resulting from the novel coronavirus, COVID-19, has made the delivery of care for patients with cancer a challenge. There are competing risks of mortality from cancer versus serious complications and higher risk of death from COVID-19 in immunocompromised hosts. Furthermore, compounding these concerns is the inadequate supply of personal protective equipment, decreased hospital capacity, and paucity of effective treatments or vaccines to date for COVID-19. Guidance measures and recommendations have been published by national organizations aiming to facilitate the delivery of care in a safe and effective manner, many of which, are permanently adoptable interventions. Given the critical importance to continue chemotherapy, there remains additional interventions to further enhance patient safety while conserving healthcare resources such as adjustments in medication administration, reduction in laboratory or drug monitoring, and home delivery of specialty infusions. In this manuscript, we outline how to implement these actionable interventions of chemotherapy and supportive care delivery to further enhance the current precautionary measures while maintaining safe and effective patient care. Coupled with current published standards, these strategies can help alleviate the numerous challenges associated with this pandemic.

The Expanding Role of the Oncology Pharmacist.

Although oncology pharmacists have been involved in the care of cancer patients for over 50 years, the role of the oncology pharmacist continues to expand. Initially, pharmacists were primarily based within either an inpatient or outpatient pharmacy setting and their work focused on providing the necessary safety checks to dispense cancer-related medications. With technology freeing up pharmacists from dispensing functions and advanced training in direct patient care (e.g., oncology residency, oncology fellowship), the oncology pharmacist was able to provide direct patient care at the bedside or within the clinic where treatment decisions are made by the healthcare team. In fact, they have become integral members of the healthcare team. This Issue describes several expanding roles of oncology pharmacists in stem cell transplant, hematology, gastrointestinal oncology, and precision genomics, as well as oncology pharmacists preventing a reduction in cancer patient visits as the oncology physician shortage occurs. Oncology pharmacists are an integral part of the cancer care team; their value has been documented in several studies, and is highlighted in this Issue. We encourage the profession to continue to document their value so that one day each patient can have an oncology pharmacist as part of their cancer care team.

Establishing clinical pharmacist telehealth services during the COVID-19 pandemic.

PURPOSE: After community transmission of the novel virus that causes coronavirus disease 2019 (COVID-19) was detected in the State of Washington in February 2020, innovative measures, such as telehealth appointments, were needed to safely continue to provide optimal pharmaceutical care for patients with chronic conditions and cancer. SUMMARY: Prior to the COVID-19 pandemic, federal regulations limited the scope of telehealth pharmacist services. However, enactment of the Coronavirus Preparedness and Response Supplemental Appropriations Act, followed by guidance by the Centers for Medicare and Medicaid Services and the Department of Health and Human Services, allowed currently credentialed providers (including pharmacists) to continue to provide patient care services via telehealth with fewer restrictions. Our health system has numerous credentialed pharmacists across multiple ambulatory care clinics. In this article, we highlight our process of expediting the implementation of telehealth services. This process included obtaining authorization for the credentialed pharmacists to provide telehealth services, completion of training modules, implementation of new technology platforms, development of new workflows, and utilization of resources for providers and patients to facilitate successful completion of telehealth visits. We also highlight the consent and documentation components crucially important to the telehealth visit and share some of our successes, as well as identified limitations, in providing pharmacist services via telehealth. CONCLUSION: In the setting of the COVID-19 pandemic, our institution was able to swiftly implement clinical pharmacist telehealth services for many patients, offering a safe and effective way to continue providing a high level of care. This article discusses our experience with and potential limitations of telehealth to assist other pharmacists seeking to implement and/or expand their telehealth services.

Demonstrating the value of the oncology pharmacist within the healthcare team.

INTRODUCTION: Although many oncology pharmacists are embedded members within the healthcare team, data documenting their contributions to optimal patient outcomes are growing. The purpose of this paper is to demonstrate the value of the oncology pharmacist within the healthcare team and describe the knowledge, skills, and functions of the oncology pharmacist. METHODS: A systematic literature review of articles that were published on PubMed between January 1951 and October 2018 was completed. Identified abstracts were reviewed and included if they focused on measuring the value or impact of the oncology pharmacist on provider/patient satisfaction, improvement of medication safety, improvement of quality/clinical care outcomes, economics, and intervention acceptance. Review articles, meta-analysis, and studies not evaluating oncology pharmacist activities were excluded. Studies were thematically coded into four themes (clinical care, patient education, informatics, and cost savings) by 10 oncology pharmacists. RESULTS: Four-hundred twenty-two articles were identified, in which 66 articles met inclusion criteria for this review. The selected literature included 27 interventional and 38 descriptive studies. The value of the oncology pharmacist was demonstrated by published articles in four key themes: clinical care, patient education, informatics, and cost savings. CONCLUSION: With an expected shortage of oncology physicians and the ongoing development of complex oncology therapies, the board-certified oncology pharmacist is well suited to serve as a physician extender alongside nurse practitioners and/or physician assistants as the medication expert on the oncology care team. The demonstrated value of the oncology pharmacist supports their role as frontline providers of patient care.

2018 Hematology/Oncology Pharmacist Association Best Practices for the Management of Oral Oncolytic Therapy: Pharmacy Practice Standard.

PURPOSE: The aim of the current work was to present a pharmacy practice standard from the Hematology/Oncology Pharmacy Association (HOPA) on the management of oral oncolytic therapy. METHODS: The HOPA Standards Committee organized a work group of oncology pharmacist specialists to create a pharmacy practice standard for the management of oral oncolytic therapy that describes the pharmacist's role on the cancer care team, provides examples of practice tools and resources, summarizes current data related to outcomes, and discusses opportunities to enhance the care of patients with cancer who receive oral oncolytic therapy. We reviewed primary literature, including currently published oral oncolytic guidelines and HOPA's Scope of Hematology/Oncology Pharmacy Practice. RESULTS: Management of oral oncolytic therapy was divided into the following primary areas: prescribing, education, dispensing and distribution, and monitoring and follow-up. Pharmacists' roles were summarized in each area with a focus on interprofessional collaboration, communication, patient safety, and quality of patient care. Standards describe the best practices in each area ( Table 1 ). CONCLUSION: Multiple opportunities exist for pharmacists to enhance the care of patients with cancer who receive oral oncolytics through collaboration with oncology care team members. The role of the oncology pharmacist in the care of this patient population is critical given the complexities related to cost, tolerability, and safety of oral oncolytic medications; issues of access; and the monitoring and follow-up of patients receiving this therapy.

Collaborative practice model for management of pain in patients with cancer.

PURPOSE: The use of a collaborative drug therapy agreement (CDTA) by oncology pharmacists in a comprehensive pain clinic is described. SUMMARY: Recognizing the complex clinical services required by patients with cancer, the Seattle Cancer Care Alliance began offering cancer pain management through a specialized pain service. Initially, the clinic was staffed by one attending physician; however, as the volume of patient referrals increased, the clinic expanded into an interprofessional team that includes physicians, advanced practice providers, nurses, and pharmacists. Through an extensive credentialing process and under the guidance of a CDTA, pharmacists in the pain clinic are able to evaluate patients, develop treatment plans, and prescribe pain medication therapies for oncology patients. By having pharmacists provide these services, the pain clinic can improve medication dosing, ensure that medications are managed consistently, improve patients' quality of care, and save providers time by allowing tasks to be completed by appropriately trained ancillary staff. For cancer-related pain, the pharmacist, in conjunction with the attending provider, develops a pain medication plan following the principles of the World Health Organization's analgesic ladder. The pain clinic has implemented the routine use of several validated tools for screening and assessment of opioid risk as well as state guidelines for managing chronic opioid therapy. The pharmacists in the pain clinic also emphasize functional goals and improvement in functional status rather than complete relief of pain. CONCLUSION: As members of an interprofessional pain clinic team, oncology pharmacists use their specialized knowledge of cancer and pharmacotherapy to help manage and treat pain in complex cancer cases.

Oral chemotherapy food and drug interactions: a comprehensive review of the literature.

INTRODUCTION: Oral chemotherapy is rapidly becoming a popular dosage form for cancer treatment. These medications have a narrow therapeutic index, and their metabolism can be easily affected by food and/or drug interactions. These interactions can significantly reduce the effectiveness of oral chemotherapy, which could possibly result in harm to patients. METHODS: A systematic evaluation of 58 oral chemotherapeutics was conducted. Drug and food interactions were analyzed using US Food and Drug Administration-approved product labeling, primary literature, and tertiary databases. RESULTS: Our evaluation identified information about drug and food interactions. We present the recommended dose adjustments in our article. CONCLUSION: Oral chemotherapy is associated with a significant number of medication and food interactions. It is essential that health care providers evaluate patients' diet and concurrent medications to provide accurate patient education, therapeutic monitoring, and, if necessary, alternative recommendations whenever oral chemotherapy is prescribed.