The Role of Pharmacists Expands Beyond Dispensing for Novel Cancer Therapies: Eileen Peng, PharmD

Eileen Peng, PharmD, of Astera Cancer Care

The role of pharmacists in cancer care has undergone a significant transformation, particularly with the advent of novel therapies like chimeric antigen receptor (CAR) T-cell therapy and bispecific antibodies, explained Eileen Peng, PharmD, vice president, chief administrator, and pharmacy officer, Astera Cancer Care.

This evolution has moved pharmacists from a traditional dispensing-only role to more comprehensive involvement in patient management, side effect mitigation, and care coordination. Peng also emphasized the pharmacist's crucial role in patient selection, proactive toxicity management, and their growing influence within value-based care models.

A critical aspect of this expanded role is patient selection for therapies. Not every patient is eligible for CAR T-cell therapy or bispecifics, and, in addition, there are a multitude of treatment options available for which a patient could be eligible.

“The right patient selection is very, very important,” she said. “We need to know…when is the right time and what type of patient could benefit from [the therapy].”

Pharmacists are also instrumental in proactively managing and mitigating potential toxicities associated with these novel therapies. Working in close proximity with patients and lab results allows them to often be the first one to realize a patient is experiencing a side effect or has a subtle change.

“We can actually use our knowledge to adjust the dose or change treatment and even put some…prophylaxis there to treat the side effect and keep [the] patient on treatment longer,” Peng said.

Pharmacists will also play an evolving role going forward in value-based care models, she said, because they are experts at selecting the correct medication and managing side effects.

“We can choose the medication that's cost-effective and manage patient adherence to avoid a lot of hospitalization or ER [emergency room] visit[s],” Peng said.

As someone who has worked on multidisciplinary teams, she noted that physicians highly trust pharmacists when they work together, which is evident in instances where physicians call pharmacists to discuss patient cases and ask for input on treatment changes or dose adjustments based on lab changes or patient-reported symptoms. Pharmacist collaboration in these teams also extends to nurses, especially triage nurses, who consult pharmacists for recommendations on managing patient symptoms at home to avoid emergency department visits and continue to manage the patient safely in the outpatient setting.

Identifying and addressing medication adherence issues is another critical aspect of the pharmacist's role. For infusion treatments, Astera Cancer Care utilizes a system that tracks what day a patient should be in for the infusion for their current cycle, and if a patient misses an infusion, the scheduler will call them to understand the reason. For oral medications, pharmacists closely monitor prescriptions and will review the physician's notes and ensure the patient has a visit before their next refill. In addition, pharmacists view lab results to assess how the patient is tolerating the treatment. If all is well, the pharmacist will call the patient to remind them the refill is coming up and verify the number of pills remaining, which helps identify potential adherence problems.

“If we identify a patient [is] not adherent, not only would we tell them how important it is to adhere to their treatment, we also will inform our physician and let them know, ‘Maybe set up [an] appointment and ask [the] patient to come in,’” Peng explained.

Peng recently participated in an Institute for Value-Based Medicine® event hosted by The American Journal of Managed Care® in Princeton, New Jersey, alongside experts from other local institutions, such as Rutgers Cancer Institute of New Jersey, Memorial Sloan Kettering Cancer Center, and Hackensack University Medical Center.