Navigating Oncology Pharmacy Practice During the COVID-19 Pandemic

In a video interview with Drug Topics®, Doug Hackenyos, oncology pharmacy clinical coordinator at the University of Connecticut, discusses the effects of COVID-19 on cancer care pharmacy.

Drug Topics®: Hi, my name is Gabrielle Ientile with Drug Topics® and today we're speaking with Dr Doug Hackenyos, oncology pharmacy clinical coordinator at the University of Connecticut. And we're talking about the current COVID-19 pandemic. Dr Hackenyos, thank you so much for joining us today.

Hackenyos: Of course, thanks for having me.

Drug Topics®: So I'd love to start with a little bit of your professional background how you came to your place at UConn and a little bit about your current position and responsibilities. Sure,

Hackenyos: I'm a graduate from the Massachusetts College of Pharmacy and Health Sciences, or MCPHS University, up in Worcester, [Massachusetts]. I graduated there and then did my PGY1 training at Tufts Medical Center in Boston, my PGY2 in oncology at Dana Farber, just across town again in Boston and then returned to Tufts for a little over five years as an ambulatory care pharmacist in their outpatient cancer center. And then I've been at UConn Health for a little over 6 months at this point. And so far, it's been going well, though, it's been very atypical. The first, probably 5 or so months was spent with USP 800 related construction and pretty disheveled pharmacy, and now we're diving right into COVID. So it's, it's been a trial by fire so far, but it's going well.

Drug Topics®: So in relation to the current pandemic, how has cancer patient care that you've seen, in general been altered as a result of the pandemic?

Hackenyos: So I'll say so far my experiences, I could put it one way would probably be a little bit of the calm before the storm. Things have been a bit quiet and eerily so. We have worked really to keep as many patients out of clinic as we can, really trying to take and embrace the social distancing as much as possible. So, narrowing it down to those visits that are absolutely necessary, those infusions that are absolutely necessary. And even with employees, too, we're also trying to work remotely as much as possible. In fact, we're testing some of that out in the pharmacy department today, and we're really working as much as we can to limit those unnecessary interactions.

Drug Topics®: Can you tell me a little bit more about like the telemedicine techniques that you have been using?

Hackenyos: I can speak more so for the pharmacy side than anything else. We do fortunately have a lot of the ability to verify orders remotely, and then also do a lot of our IV checking remotely with fortunately, remote access for our epic system, and then our dosage IV checking systems as well. We do have a number of platforms for pharmacists to communicate electronically as well, some messaging systems and then obviously phones. We really worked pretty hard and actually have a really nice kind of infrastructure to be able to let pharmacists work remotely. This is probably the biggest time that we've had to test all those systems out, and I’ll knock on wood, that so far they've really been a huge benefit for us.

Drug Topics®: And then can you give us some specific guidelines for patients of different types of cancer amid the pandemics such as breast cancer, lung cancer or other examples that you might have?

Hackenyos: I can give you a little bit. I'll speak to what we are seeing in clinic here, at least one I can. Again as I mentioned, I've been here for about 6 months and my hands have really been tied, not tied but really involved more so with managing some of the operational changes with our USP 800 prep.

And now, again, managing some of the operations and really working to make our way through this COVID situation. So some of the changes that I've noticed, I would say that overall, our patient volume for infusions is probably about half of what we had seen prior to COVID and again, we're really working to cut back on some of those infusions that aren't necessarily incredibly time sensitive or critical for patient care. So, one part of that we do have an ambulatory infusion center for patients that are being treated for non-oncology indications here. We have worked with providers and some of those clinics, rheumatologists, dermatologists, some of those other areas to cut back on some of those infusions. Those patients are treated on the same floor here. So again, just trying to cut back on some foot traffic and space out some of those biologic therapies that might not be quite as time sensitive for certain patients.

For our cancer patients, which I know is the focus here, we have seen some modifications to treatments and I know the NCC guidelines do have or the NCCN has released some short statements on various treatment types. And breast cancer is 1, melanoma, colorectal cancer. So those are nice. I would encourage people to check those out. But in terms of what we're seeing here and some of the modifications that we've made for patients - some of those patients hadn't previously been getting weekly paclitaxel, we have consolidated some of those treatments to larger every 3 week doses, they cut back on some of the frequency of their visits.

We do have a larger colorectal cancer patient population here too, for our older patients with non-resectable metastatic disease, those patients outside of this kind of scenario that might be eligible for breaks at certain points in our treatment, we are probably being a little bit more lenient and taking advantage of those breaks now. So spacing out some of their treatments, giving people treatment vacations, really weighing some of the risks versus benefits when we're looking at risk for disease progression versus risk for potential infection they could have with additional contact here in the clinic.

Other things, we're really working on optimizing our growth factor support. Making sure patients aren't becoming neutropenic having any sort of admissions to the emergency department, really trying to cut down on any of the volume they might have there. We're exploring things like on body injectors, working with patients and family members to ideally have injections at home if we're able to spare them from coming back for a return visit. Those are those are some of the real-world live time things I've seen in place here.

There has been talk about modifying some of our immunotherapy regimens. We know from some of the studies and also that our kinetics, understanding for those drugs, that they do have long half-lives, we could potentially administer them on a less frequent basis. We haven't made large scale changes at this point. We are trying to put people on every 4 week map wherever appropriate, if they had otherwise been getting it every 2 weeks, but those might be things we revisit down the road depending on exactly how things are going to shake out.

Drug Topics®: Dr Hackenyos, thank you so much for your time today and stay safe.

Hackenyos: Of course, thanks, you as well.

Editor’s note: This interview transcription has been lightly edited for style and clarity.

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