As cancer incidence rises, the oncology industry is facing a worsening shortage of oncologists and oncology nurses.¹ Many oncology practices have reported that they are desperately recruiting oncologists due to high demand, and almost all cancer program leaders that we’ve spoken with have stated that workforce recruitment is a major priority for them in 2024.

Because of this shortage, oncologists are facing increasing workloads and are spending a significant amount of time on non-top-of-license duties.² As demand continues to increase, adjusting the makeup and structure of the care team may be able to mitigate these shortages.

With the number of oncology pharmacists (OPs) in the U.S. projected to increase significantly by 2025, OPs have the potential to make a greater contribution to patient care. The table below illustrates the tasks that OPs often perform today, as well as some of the tasks that OPs could perform if they were working at top-of-license.

Many OPs are primarily tasked with mixing chemotherapy and dispensing medications, despite the number of additional high-value tasks they could be performing. Estimates show that if this growing OP population were to utilize just 50% of their capacity for patient visits, they could conduct more than four million visits in 2025 alone — creating capacity for oncologists and oncology nurses to focus on top-of-license care delivery.³

To address workforce challenges, cancer programs should be actively working to elevate the role of OPs.

The challenge:

The oncology clinical trial market is projected to grow rapidly in the coming years. At the same time, novel trial designs and advancements in treatment innovation are making clinical trials more complex. Together, these factors contribute to the increasing burden of clinical trials on the cancer care team.

How can OPs help?

OPs have the capability and experience to take on various trial activities, such as patient recruitment, conducting patient visits, preparing treatment orders, providing counseling, advising care team members, consulting on adverse event responses, and maintaining clinical trial protocols. With their expertise, OPs can alleviate the burden on care teams and ensure efficient and effective delivery of care in clinical trials. About 30% of OPs were already involved in maintaining clinical trial protocols back in 2018 — and that number could be much higher. Already, there are some organizations that are taking steps to increase OP involvement in clinical trials.

At the University of Colorado, for example, pharmacists play a crucial role in medication therapy management for clinical trial protocols. They review drug interactions and dose modifications, provide patient education, and participate in direct patient care during study-related visits, such as toxicity assessments.⁴

OPs can also be extremely beneficial in clinical trial enrollment. A recent study evaluated the impact of virtually introducing an oncology-trained clinical pharmacist into community cancer centers to support enrollment for one iteration of a clinical trial. The pharmacist identified, screened, and assisted with recruitment of eligible patients for enrollment. The study showed that average monthly enrollment was significantly higher after the pharmacist intervention, going from 3.4 patients per month to 6.8 patients per month.⁵

The challenge:

As the number of cancer patients receiving oral chemotherapy grows, cancer programs are experiencing barriers to delivering high-quality care. For example, oral chemotherapy treatment programs often face difficulties with timely medication access, low patient confidence in self-administration, and lower adherence rates compared to supervised infusion treatments, leading to poorer outcomes and increased morbidity and mortality.

How can OPs help?

OPs can promote medication adherence, educate patients about medications and side effects, develop monitoring plans, conduct scheduled calls, manage prior authorizations, and monitor patient-reported outcomes.

Existing programs have shown that pharmacist-directed interventions can significantly improve adherence to oral chemotherapy, resulting in improved outcomes.

At Johns Hopkins Hospital and Health System, the oncology program utilizes OPs to support oral chemotherapy administration by having the ambulatory care clinical pharmacists work closely with disease-specific teams to assess adherence and toxicities and improve outcomes in those areas. They then coordinate filling the medication at the specialty pharmacy.⁶

The challenge:

Today’s precision oncology techniques allow providers to use molecular profiling to determine the most effective treatment. However, despite the rapid advancement of precision medicine, real-world challenges — such as insufficient tumor tissue, long turnaround times, inconsistent availability of results, and difficulties in interpreting testing reports — hinder its implementation. This has led to a gap in translating molecular data into patient care.

How can OPs help?

Pharmacists are ideal candidates to serve as molecular oncology subspecialists on the care team due to their longstanding involvement in the overlap of genomics and medicine through the rise of pharmacist-led pharmacogenetics/pharmacogenomics services. Additionally, while formal training programs in precision oncology are limited for physicians, there are many well-established, accredited postgraduate pharmacogenomics residencies and fellowships for pharmacists.

OPs have successfully participated in molecular tumor boards, and they are extremely valuable in triaging patients based on genomic mutations, acquiring off-label therapies, and reducing bottlenecks in the interpretation of next-generation sequencing (NGS) results.

For example, Moffitt Cancer Center established a Precision Medicine Clinical Service (PMCS) led by appointed pharmacists. These PMCS pharmacists serve as the subspecialists leading the dedicated molecular oncology service. Together, they review almost 300 clinical somatic NGS reports per month. Incorporating PMCS pharmacists into the dedicated molecular oncology service has successfully addressed bottlenecks and streamlined the efficiency of NGS result interpretation at Moffit Cancer Center.⁷

As the demand for oncology care continues to rise, it is crucial to utilize the skills and expertise of OPs to their full potential. By granting them expanded responsibilities, such as leading clinical trials and supporting precision medicine, cancer programs can strengthen their care teams and improve patient outcomes.