The Indiana University Health Simon Cancer Center was established in 1992 under the leadership of Stephen D. Williams, MD, and in 1999, the center was designated by the National Cancer Institute as a clinical cancer center. The Indiana University Research Institute was opened in 1997, financed in part by federal funding. The name of the center was changed in 2006 to honor the philanthropic support of Melvin and Bren Simon.
The Simon Cancer Center is a patient care, research, and educational institution within the Indiana University (IU) School of Medicine on the main campus in Indianapolis. The physicians and scientists who work at the center are mainly from the faculty of the IU School of Medicine, the IU Schools of Nursing and Dentistry, and the Purdue University School of Science. The staff works with a team of other professionals to address the full spectrum of the needs of cancer patients, including physical, emotional, psychological, and spiritual needs.
Over the past decade, many milestones have been reached, including launching of the Indiana Genomics Initiative, opening of the Biotechnology Research and Training Center, expanding research space for the Walther Oncology Center, breaking ground on a new research facility, dedication of a new 405,000 square foot patient care center, and dedication of the largest research building on the campus, the Joseph E. Walther Hall, at 238,371 square feet.
The Oncology Pharmacist spoke with Patrick Kiel, PharmD, BCPS, BCOP, Cancer Pharmacy Specialist, Hematology and Stem Cell Transplant, Indiana University Health Simon Cancer Center, about the approach to managing patients at the center and his role as an oncology pharmacy specialist.
What is the approach to treating cancer patients at the Simon Cancer Center?
Patrick Kiel (PK): We are an NCI-designated cancer center, and we employ a multidisciplinary approach. Physicians handle diagnosis and treatment, and the oncology pharmacists monitor treatments, develop symptom reports, and participate in developing treatment algorithms and standard operating procedures. Our nursing staff includes magnet-trained nurses, and we have case managers and social workers. There is a good dynamic between case managers and pharmacists at our center to ensure that patients get their treatments covered by insurance, or if not, by assistance programs from the pharmaceutical company or the Simon Center to offset costs so that patients can afford their treatments.
Is cost becoming more of an issue with regard to treatment?
PK: Yes, there is a push nationally as well as here at our center to contain costs to help doctors and nurses be aware of the direct and associated costs of treatment; for example, considerations as to whether a treatment can be given as inpatient versus outpatient and the amount and frequency of monitoring a treatment requires.
How does this approach translate to better outcomes?
PK: The benefit comes from the more eyes that are on the patient, and that includes the pharmacist’s eyes. Also, patient education is a multidisciplinary effort. The pharmacist reinforces physician’s education about treatments and their side effects. I tell patients, “You are not a car getting a type of oil. You are a person, and whenever you get a medication, you should ask what this medication is for, what the side effects are, and how they can help monitor for side effects.”
What are you excited about now in the field of oncology?
PK: I am excited about new therapies. We have already covered the low-hanging fruit, that is, treatments that affect multiple disease states and benefit large numbers of patients. Those days are over. Now the emphasis is on targeted treatments for subgroups and rarer diseases. Oncology pharmacists are becoming involved in clinical trials and bench research. I have just been given a grant to work with a physician scientist on studying PARP inhibition in leukemias and lymphomas. Pharmacists are also involved in clinical outcomes research, for example, on potential treatments to address neurotoxicity of chemotherapy, or immune suppression outcomes in stem cell transplant patients and how we can improve upon safety.
How has the role of the oncology pharmacist changed over the past 5 years?
PK: What has changed the most is going from having oncology pharmacists at large oncology centers to now having a demand for them from smaller hospital-associated clinics and private practices. In these smaller practice settings, pharmacy is becoming integral to the management of chemotherapy-induced toxicities and monitoring associated side effects.
What inspired you to become an oncology pharmacist?
PK: I was always interested in genetics as well as pharmacotherapy of disease states. At Midwestern University Chicago College of Pharmacy, I studied with David Frame and Deb Drager (both PharmDs) who taught me how to evaluate clinical trials and the rationale behind them. I gravitated toward evidence-based medicine. Oncology is a field where you can establish long-term relationships with patients that can last for many years. The best experience is a routine visit from a patient who is doing well in his or her life after being treated for cancer.
What advice would you give an oncology pharmacist just entering the field?
PK: The most important aspect of your job is to talk to patients about their experiences on therapy and get their perspective. Always see patients first, and then go to the computer to look up laboratory reports. The computer is important, but the patient should be the top priority.
What work would you be doing if you weren’t an oncology pharmacist?
PK: I have always been interested in chemistry and food. If I weren’t a pharmacist, I would be a brewmaster or a food critic, as long as the food was for free! One of my favorite TV shows is Alton Brown’s “Good Eats.”