A Conversation About Cancer Care During COVID-19: Part 2

In part 2 of our video interview, Robert Brunault, PharmD, a clinical pharmacy specialist in hematology and oncology at Rhode Island Hospital and the Lifespan Cancer Institute, discussed drug shortages, FDA emergency use authorizations, and the biggest concerns for pharmacists. In case you missed it, you can watch part 1 of the discussion here. 

Drug Topics® :Hi, my name is Gabrielle Ientile with Drug Topics®, and today I’m talking to Dr Robert Brunault, who is a clinical pharmacy specialist of hematology and oncology at Rhode Island Hospital, and Lifespan Cancer Institute. Dr Brunault, thanks so much for joining us today.

Brunault: Thanks for having me.

Drug Topics®: What do you think are the biggest concerns right now regarding health system pharmacists and COVID-19?

Brunault: I would say probably the biggest concern for everyone within the health care system is just the lack of or difficulty acquiring personal protective equipment (PPE). So I think especially in these times, we need to be prepared - as hospitals, and as a country and the health system as a whole – ensuring that all of our hospitals can get the necessary personal protective equipment. So I think that’s probably a concern that’s at the forefront of most people’s minds, but again I think our hospital and a lot of hospitals that I’ve heard about are taking necessary precautions and really trying to promote social distancing, telemedicine, and things like that.

Drug Topics®: Given that there have already been shortages of some injectables, what problems are you foreseeing moving forward into this pandemic in terms of drug production.

Brunault: Fortunately our hospital hasn’t had too much difficulty with procurement, but I’ve definitely heard of shortages regarding IV opioids, to certain drugs that have been thought to help with some of the symptoms associated with more severe cases of the virus that have going on shortages as well. I think right now it’s such a moving target as to which treatments are providing the most benefit, and I think that’s good in a way, because everyone’s trying something a bit different, and that might be a better way of finding something that can be beneficial.

Drug Topics®: And then creating a broader scope, from an oncological perspective, why is it imperative to put social distancing into practice?

Brunault: I think this is so important, especially for cancer centers and hospitals that deal with oncology or hematology treatment population because a lot of these patients have to come into the cancer center to get treatment. We have to have health care providers here, and by practicing social distancing, it really prevents one person from giving the virus to a health care worker or a patient and then really having that run rampant through an area that potentially has a number of immunosuppressed patients who have a decreased ability to fight off the infection. And I think it’s important to note that there’s not an unlimited supply of health care workers as well. So if the general public takes the necessary precautions as well it really helps make sure that there will always be healthy workers here to provide the best possible care for the patients.

Drug Topics®: In your opinion, has the national and also the societal response been enough to protect at risk people? How do you see the next few weeks unfolding?

Brunault: A lot of good steps have occurred, especially with closing non-essential business, although difficult decisions, promoting stay at home hours, and I think that’s been helpful. Again to go back to PPE, promoting manufacturing and ensuring that health care workers have access to that equipment is really keep especially in the weeks to come. In some projections I’ve seen, the worst is still yet to come. It’s difficult to 100% be prepared for these situations, and we’re constantly refining our approach to patients coming in, anticipated surgeries. We actually had a phone call this afternoon discussing what we anticipate, how we’re going to approach it when that search happens. As a society, and as a country, we’re taking steps in the right direction and we’re continuing to refine them, so hopefully that will be enough in the coming weeks to help keep everyone safe.

Drug Topics®: The FDA has allowed access to chloroquine and hydroxychloroquine in treating hospitalized patients. How do you feel about the FDA authorizing these drugs without finishing the clinical trials and going through the entire process?

Brunault: That’s a really good question. I’ve been following the FDA alerts as well, and consulting with our infectious disease pharmacists as well to make sure that we all have a good grasp on this. Right now a lot of the drugs being used are still in the experimental stages – I had mentioned that there were other drugs that were going on shortage that they’re believed to help with some of the more severe cases; there’s also some antivirals that are being studied as well. So I think that endorsement of some of these drugs is good to help promote – if something has little benefit, it’s good to try it for patients. As we learn more about the virus, there will be a more streamlined approach to treatment, and we’ll able to rule in and out which treatments are most effective. But in the short term, it’s nice to know that we may have some drugs that are beneficial and are helping the patients who suffering most from the virus.