Memorial Sloan-Kettering Cancer Center (MSKCC) is 1 of 41 National Cancer Institute–designated comprehensive cancer centers. Founded in 1884 as the New York Cancer Hospital, the hospital had its name changed in 1916 to the General Memorial Hospital for the Treatment of Cancer and Allied Diseases. The facility moved to its current location in New York City in 1936. The Sloan-Kettering Institute, established in 1945, incorporated with Memorial Hospital in 1960 to better apply laboratory advances to the care and treatment of patients.
Today, MSKCC has 469 inpatient beds and provides state-of-the-art outpatient services, offering comprehensive care using the latest technology via a multidisciplinary approach. MSKCC is also a fertile ground for clinical trials that advance the standard of care nationwide.
Richard Tizon, PharmD, BCOP, clinical pharmacy manager, talked to The Oncology Pharmacist about his work at MSKCC and the role that oncology pharmacists play in multidisciplinary care.
What is your job description?
Richard Tizon (RT): Our clinical program began in 2008 under our pharmacy director, Charles Lucarelli, and our clinical pharmacy manager, Nelly Adel, who is also our PGY-2 oncology residency director. The program has successfully expanded from 3 clinical specialists covering leukemia and transplant, to over 20 specialists who are integrated into multiple services within leukemia, transplant, lymphoma, and neuro-oncology. We also have clinical pharmacy specialists in our ancillary services, such as infectious disease, geriatrics, and pain and palliative care.
I joined MSKCC as a clinical pharmacy specialist in 2008, and I recently assumed a managerial role within the program earlier this year. On the day-to-day level, I coordinate the activities of the clinical pharmacy specialists, collaborate with other health professionals in the institution to promote pharmacy services, and develop strategies to expand clinical pharmacy support to new oncology service teams, particularly in the solid tumors. Over the next 3 years, we will be expanding coverage into the breast medical oncology, head and neck cancer, sarcoma, and melanoma services, with the ultimate goal of providing fully integrated clinical pharmacists to all the hospital teams.
How does the multidisciplinary team approach improve patient care?
RT: We are unique in that we have highly specialized services dedicated to specific disease states; instead of treating all hematologic malignancies grouped together, leukemia, lymphoma, and stem cell transplant are treated separately. This allows for greater ability to tailor patient care. In my experience, the collaborative approach provides a great advantage to physicians and to all the team members, including physicians, nurses, pharmacists, and a growing body of mid-level practitioners, including nurse practitioners, physician assistants, and clinical pharmacy specialists. Few things can fall between the cracks with a team approach.
What are you excited about in the field of oncology right now?
RT: Improved understanding of the molecular biology of tumors has moved the field forward so that targeted therapies and targeted immunotherapies are now available to treat a variety of cancers. We are able to benefit quickly from research at MSKCC involving new drug targets as our ability to design smaller, more relevant (to a specific target) clinical trials has increased.
This world of targeted therapy comes with more challenges and complexities in treating and supporting cancer patients. We need to keep up-to-date as new agents become available and are used in the clinic. We have to learn how to manage side effects and interactions of these newer agents.
Many targeted therapies come in an oral formulation, so patient adherence is a major factor to the success of the therapy. As a team, we have to be vigilant in how we counsel and educate patients.
How has the role of the oncology pharmacist changed in the past 5 years?
RT: The most obvious change is integrating pharmacists into the front lines of clinical care and including them in the consults on patients’ treatment plans and support. We have gone from being in the back room preparing and dispensing drugs to the patient’s bedside. Recently New York, through no small effort from our pharmacy leadership, has finally joined many other states in allowing collaborative drug therapy management between physicians and pharmacists. I think this is a major step forward in relieving some of the workload from our traditional providers while maintaining work flow and patient safety.
What inspired you to become an oncology pharmacist?
RT: Although oncology is sometimes perceived as a depressing specialty, I believe it is a calling that requires not only a high level of expertise, but also compassion and commitment. Throughout high school and pharmacy school, I worked at a retail pharmacy, and I was able to have meaningful contact with patients. I wanted to continue to have that experience. A mentor in pharmacy school encouraged me to become an oncology pharmacist to reclaim contact with patients by providing education and counseling. The better job we do with patient contact, the more improved patient adherence to therapy and outcomes will be. Once I decided to become an oncology pharmacist, I never looked back.
What advice would you give to someone entering the field?
RT: Oncology pharmacists are asked to wear many hats. They also have to deal with drug shortages, which are not going away anytime soon. We need to develop policies and practice standards to ensure that our drug supplies go to the right patient. Also, we provide support in designing clinical trials and take a front-end position in drafting protocols for use of new technology.
Oncology pharmacists are increasingly asked to wear many hats in service to the hospital. In response to the unfortunate reality of drug shortages and the accelerated availability of new treatments, pharmacists are playing a larger role in developing policies and guidelines that affect practice on a larger scale.
With the trend toward smaller, more efficient, clinical trials, I see pharmacists assuming a larger supportive role in research. Lastly, the ushering of healthcare into the digital and information age is revealing many complex challenges that should be met with a pharmacist’s perspective. To meet these challenges, I would advise the person to adopt skills outside their comfort zone; for example, in business training, computer science, and informatics. This is in addition to the oncology pharmacy residency and board certification. Expanding your skill set beyond pharmacy will add greater depth and dimension to your expertise.
