Pharmacy oncology
Pharmacy oncology, also known as oncology pharmacy, is a specialized area of pharmacy practice focused on improving cancer care by ensuring safe, effective, and economical treatment options for patients with malignant diseases. Oncology pharmacists work collaboratively within multidisciplinary healthcare teams, playing a critical role in the management of pharmacotherapeutic plans and patient education. They aid in the administration of chemotherapeutic agents, monitor patient responses, and help manage side effects, enhancing the overall treatment experience.
To become an oncology pharmacist, one must typically hold a Doctor of Pharmacy (PharmD) degree and complete specialized residency or fellowship training in oncology. These programs provide in-depth knowledge of cancer treatments, pharmacokinetics, and drug management strategies. Furthermore, oncology pharmacists can achieve board certification, which requires meeting specific practice criteria and passing a certification examination.
In their practice, oncology pharmacists offer various services, including drug information management, medication safety oversight, and patient counseling. They contribute to developing clinical guidelines and educational resources, ensuring that both healthcare providers and patients are informed about the complexities of cancer treatment. Given their expertise, oncology pharmacists are essential in optimizing cancer care and enhancing patient outcomes while also addressing the economic aspects of treatment.
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Subject Terms
Pharmacy oncology
ALSO KNOWN AS: Oncology pharmacy, hematology/oncology pharmacy
DEFINITION: Pharmacy oncology is a specialized pharmacy practice with the specific goals of reducing the cancer care burden and promoting optimal, cost-effective, safe cancer care. According to the Board of Pharmacy Specialties, which certifies oncology pharmacists, specialists in pharmacy oncology “recommend, design, implement, monitor, and modify pharmacotherapeutic plans to optimize outcomes in patients with malignant diseases.” When incorporated into multidisciplinary care, oncology pharmacy provides cancer patients the best access to and control treatment options. It also provides educational and research support to other interdisciplinary cancer care team members.
Subspecialties: Community oncology pharmacy, chemotherapeutics
Cancers treated: All
Training and certification: Clinical, registered pharmacists with a bachelor of science in pharmacy (BSP) or doctor of pharmacy (PharmD) may be found working in hospital or clinical settings and nontraditional community oncology settings, such as individual oncologist offices or retail pharmacies that specialize in chemotherapeutic treatments. In addition to practical experience in drug information, intravenous (IV) admixture, and patient interaction, pharmacists have structured educational opportunities to become pharmacy oncology specialists. On-site training with an existing oncology pharmacist and the oncology team is offered to individual pharmacists in institutional or community pharmacies, and residencies and fellowships in oncology are available to newly graduated or practicing pharmacists with a doctor of pharmacy. Residency programs entail one full year of practical study in general clinical pharmacy. Students then apply for a specialty residency in oncology. The specialty oncology residency requires another full year of practical study in a purely cancer-based setting. For this residency, the pharmacist is mentored by an existing specialty oncology pharmacist and participates in patient care as part of the health professional team. Examples of educational instruction topics for oncology residencies include adult medical oncology, bone marrow transplantation, pediatric oncology, palliative and pain care, surgical oncology, immunotherapy, radiation oncology, and pharmaceutical management. Residency programs typically require applicants to possess a doctor of pharmacy. Residency provides the pharmacist with the requirements for more intense training.
For pharmacists interested in training beyond residency programs, fellowship positions in oncology are available. Such postdoctoral fellowships are generally two-year positions that allow pharmacists to focus their knowledge on oncology topics. Fellowship programs are often highly specific and include instruction on topics such as the clinical pharmacology of chemotherapeutic and related medications, study design and analysis techniques, presentation and publication of scientific data, pharmacokinetic and pharmacodynamic modeling, therapeutic drug monitoring of individual agents, and drug information management and analysis. Deeper involvement with the oncology care team and with oncology research is provided in fellowship positions.
The Board of Pharmacy Specialties may award an oncology specialty certification to pharmacists who meet specific criteria—graduate from a pharmacy program accredited by the Accreditation Council for Pharmacy Education (ACPE), have a current license to practice pharmacy, and complete at least four years of practice, with at least 50 percent of time spent in oncology pharmacy activities, or complete a specialty residency in oncology pharmacy plus two years of practice, with at least 50 percent of time spent in oncology pharmacy activities. They must also pass a stringent written test, the Oncology Pharmacy Specialty Certification Examination. After meeting these criteria and applying to the Board of Pharmacy Specialties for certification, the pharmacist may be designated a board-certified oncology pharmacist (BCOP). The pharmacist may retain this title if recertification requirements are met every seven years by retaking and passing the examination or completing one hundred hours of continuing education. The Board of Pharmacy Specialties provides the exam and education.
Services and procedures performed: Oncology pharmacists provide numerous services to the healthcare team and patients. Oncology pharmacists may be found in hospital-based or office-based oncology clinics or stand-alone community pharmacies that service nearby cancer providers. Although they vary between settings, all services provided by oncology pharmacists fall into a handful of categories—educational and counseling services, drug administration and monitoring services, supportive care services, research and guidelines development services, medication safety services, and economic benefits.
Oncology pharmacists regularly provide educational services to other healthcare team members and counseling services to patients. Pharmacists provide safe-handling instructions to nurses who handle and administer cytotoxic drugs. They also instruct pharmacists and technicians on intravenous (IV) admixture to prevent chemotherapy incompatibilities and IV administration to prevent medication errors. Oncology pharmacists educate all healthcare team members about medication error prevention, including instruction about confusing, similar-sounding, or similarly written medication names. They often contribute to developing and enforcing the institution’s best practices in cancer care.
In direct interactions with patients, pharmacists provide safe handling and administration instructions for cytotoxic drugs, and they provide dosing suggestions and methods to manage medication side effects. In addition, pharmacists who counsel cancer patients have the opportunity to reinforce the treatment goals and address adherence issues or other patient concerns. In community settings, oncology pharmacists contribute to the continuity of care by supporting and managing even complex outpatient treatments, thus keeping patients out of the hospital for longer durations and providing another source of communication between the patient and primary cancer care provider.
Drug information services are a primary responsibility of pharmacists on the oncology care team. In addition to providing specific drug suggestions and knowledge about drug interactions and incompatibilities, side effects, and handling risks associated with chemotherapy, pharmacists can evaluate the pharmacokinetic and pharmacodynamic effects of drugs and regimens. They interpret laboratory changes and other treatment-related problems and adjust chemotherapy regimens accordingly. By performing therapeutic drug monitoring for specific agents, pharmacists also anticipate and prevent drug toxicities or subtherapeutic risks. In addition to providing information about chemotherapy regimens, oncology pharmacists perform chemotherapy admixture safely. They can provide this service even to outpatients in a community oncologist office setting.
Supportive care services offered by the oncology pharmacist include antiemetic and pain-control care. By developing and implementing antiemetic regimens according to the emetic potential of chemotherapy regimens, oncology pharmacists help minimize or even eliminate this common side effect. Pharmacists often oversee the provision of pain management and palliative care with medications. Because of their extensive medication knowledge, oncology pharmacists can manage these cancer-related concerns and also anticipate and prevent the associated side effects or drug interactions that may occur with the drug therapy of pain or emesis.
Pharmacists often contribute to the interdisciplinary team by providing access to drug-related databases and presenting research findings on drug therapy or updated regimens within an institution in a continuing education setting or to the larger medical field through journal publications. Oncology pharmacists also play a role in developing institutional treatment guidelines for specific cancers or cancer-related health issues along with other team members, evaluating medication use practices, and offering improvements. Related to these contributions, oncology pharmacists provide medication safety services, such as reporting medication errors to MedWatch or other oversight and reporting organizations. They also ensure that cytotoxic medications are properly stored and prepared by professionals and ensure that professionals use appropriate protective measures during preparation.
Lastly, oncology pharmacists reduce cancer care costs to patients and providers by ensuring the smooth delivery of cancer care. In particular, oncology pharmacists can recommend affordable treatment options, decrease waste from incorrect medication handling, and streamline treatment plans by removing unnecessary or replacing overly toxic medications.
Related specialties and subspecialties: Related specialties in the cancer field include medical oncology, nursing oncology, and radiation oncology. Together with oncology pharmacists, these fields make up a typical interdisciplinary cancer care team.
Related specialties in pharmacy include IV admixture pharmacy, nutrition pharmacy, pain-management pharmacy, clinical pharmacology, and pharmaceutics. Pharmacists may also complete certification programs in nutrition pharmacy and clinical pharmacology.
Bibliography
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