Chemotherapy Stewardships Becoming Increasingly Vital

Pharmacists are uniquely positioned to develop and implement chemotherapy stewardship programs that allow them to lead multidisciplinary teams for establishing treatment paradigms that promote evidence-based, cost-effective therapies, according to Jason Bergsbaken, PharmD, BCOP, pharmacy coordinator for regional oncology services at UW Health in Madison, Wisconsin. Like antimicrobial stewardship programs, chemotherapy stewardships can help improve management of a constantly changing treatment landscape.

Chemotherapy stewardship programs provide the tools needed to improve patient outcomes. Currently, the American Society of Clinical Oncology (ASCO) has no guidance on developing or implementing chemotherapy stewardship programs. According to Kristen Ward, PharmD, an oncology pharmacist based in Sacramento, California, any oncology pharmacist can help establish a formal stewardship program by working collaboratively. “The aim of these programs is to train oncology pharmacists to provide high quality, cost-effective, specialty care to patients with cancer and hematologic disorders [in a way] that promotes independent critical thinking, creativity, and a culture of mutual respect with other health care providers,” she said.

Bergsbaken, a member of the National Comprehensive Cancer Network (NCCN) Pharmacy Directors Committee, said pharmacists can facilitate informed patient decision making by incorporating anticipated treatment outcomes and costs. “At the individual patient level, pharmacists may help patients navigate complex treatment authorization networks to minimize out-of-pocket burden to patients,” Bergsbaken said. “The costs associated with cancer care are increasing at unsustainable rates and are a burden for patients, health care organizations, payers, and the entire health care system.”

He said that although recent expansions in treatment options are exciting, incremental improvements in patient outcomes are often overshadowed by substantially increased costs resulting in diminishing returns for society. “It is increasingly important to improve transparency of anticipated treatment outcomes with the overarching goal of maximizing therapeutic benefit while minimizing toxicity through the appropriate, targeted, and efficient use of available resources and therapies,” said Bergsbaken.

One of the primary purposes of chemotherapy stewardship programs is to ensure that facility resources are used appropriately based on gold standard guidelines such as NCCN’s or ASCO’s. Pharmacists typically encounter situations where an option for patient care does not align with these guidelines and is denied by a third-party payer. Matthew Paliughi, PharmD, a staff oncology pharmacist who has worked in inpatient and outpatient settings in Fresno and Clovis, California, said in such situations careful case analysis between pharmacist, physician, and insurance authorization team experts can result in a decision that is not detrimental to the patient in terms of efficacy and untowardly high copayment. The interventions require reviewing phase 2 and 3 study data and reporting to prescribers. “Pharmacists are the front-runners in these scenarios as they use their knowledge of alternative therapies and bring these to the care team as an option,” Paliughi said.

“A current opportunity is the incorporation of biosimilar agents into routine prescribing, where pharmacists can be the initiators of conversation with physicians and facility pharmacy and therapeutics (P&T) committees to help provide staggering cost savings to the organization with zero clinical detriment,” Paliughi explained. Paliughi, who recently returned to an outpatient pharmacy management position that oversees 3 infusion centers, said outpatient oncology staff pharmacists are in the highly advantageous position to not only advocate for patient care but to do so in a manner that provides benefit for organizations to expand on such care.

“Oncology is a rapidly evolving field that sees a newly approved agent entering the market on a nearly monthly basis. Because of this, pharmacy can become an asset when working together with the rest of the team to ensure excellent patient care and organizational success,” he said.