Optimizing the Role of Oncology Pharmacists in Outpatient Care for Advanced Therapies

Sandra Cuellar, PharmD, from the University of Illinois Chicago, highlighted the evolving role of oncology pharmacists in outpatient care, especially as new and complex therapies like bispecific antibodies and chimeric antigen receptor (CAR) T-cell therapies gain FDA approval.

Oncology pharmacists are crucial in selecting appropriate patients, managing complex treatment regimens, and overseeing risk stratification to ensure patient safety. Key factors for successful implementation of alternative care models include rigorous risk assessment, patient education, consideration of health literacy and support systems, and the development of standardized protocols. These measures help determine if patients can safely receive advanced therapies in outpatient settings or if hospitalization is necessary for close monitoring.

This interview was conducted at a recent Institute for Value-Based Medicine^® event in Chicago, Illinois.

Transcript

How do you see the role of pharmacists changing in the management of outpatient oncology care? What additional training or support might be needed to optimize their impact?

So, I think that this is an evolving area for an oncology pharmacist, given the myriad of different types of therapies that are now being FDA approved, in particular the bispecific therapies, as well as CAR T therapies. So oncology pharmacists play an integral role in not only integrating and operationalizing those therapies, but really determining who is an adequate patient, what are those patient characteristics that may influence the therapies that they may get? And so I think we're a part of that team in managing these very complex treatment regimens that are now being FDA approved for these cancer patients.

What do you believe are the key factors for success when implementing alternative care models, particularly in complex oncology cases requiring advanced therapies like CAR-T?

So I think this is a big challenge when we look at how complex these therapies are. And I think we take the first point in looking at these complex therapies is that these complex therapies are associated with significant toxicities that require quite a bit of monitoring. So in looking at administering these therapies—is it appropriate to administer it on an outpatient basis or do we have to hospitalize the patient—that is something that we as oncology pharmacists, and I'm part of the team, we look at and review.

And so what we look at, I think, first and foremost is stratifying the patient who is at high risk for developing complications after administering these, for instance, CAR-T therapies or bispecifics. So looking at risk stratification, looking at patient characteristics, their tumor load, their age, other comorbidities. Are they a good candidate to administer these therapies safely outpatient, or is this someone that requires more intense monitoring and has to be subsequently admitted for monitoring? So I think risk stratification in terms of the patient characteristics [is important].

I think education is also very key in providing that patient with the education needed and making sure that patient has health literacy and a support system before we launch into, "This is the right therapy for you because of your disease." Is it the right therapy for this particular patient given their social determinants of health? What is their health literacy? What is their support system? Are they able to identify and monitor themselves?

So I think risk stratification, patient education, and having standardized protocols are really critical in order to look at alternative places of therapy in terms of, "Does everyone need to be hospitalized, or is this something we can do outpatient and then discharge the patient home?" I think that when we look at all these factors, that's really critically important. Risk stratification, patient education, health literacy, their support system, and the social determinants of health are all key factors in considering that.