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Smilow Cancer Hospital at Yale-New Haven

TOP - February 2013 VOL 6, NO 1

The Smilow Cancer Hospital treats more cancer patients than any other hospital in the state of Connecticut. Smilow offers a comprehensive treatment plan for each patient that can include surgery, medical oncology, radiation oncology, a combination of treatments, or conservative monitoring. One of Smilow’s 12 multidisciplinary disease state specialty teams is available to discuss each patient’s diagnosis and therapy options. Smilow Cancer Hospital is a leader in personalized cancer care through innovative tumor profiling techniques used to analyze every patient’s cancer. In addition, Smilow continues to expand its clinical research and involvement in clinical trials.
The Oncology Pharmacist spoke with Scott Soefje, PharmD, MBA, BCOP, the Associate Director of Oncology Pharmacy Services at the Smilow Cancer Hospital at Yale-New Haven.

What is your role at the Smilow Cancer Center?
Scott Soefje (SS):
I am the associate director in charge of the oncology service line at the Smilow Cancer Hospital at Yale New Haven Health System. I manage both the inpatient and outpatient services as well as 9 satellite sites for our health network. We are in the process of integrating our network for the Yale New Haven Health System, and when this process is completed, there will be 4 hospitals and 9 or 10 satellite sites.

What approach does your institution take to treating people with cancer?
SS:
We are an NCI-designated comprehensive cancer center, but we are not part of the National Comprehensive Cancer Network. On the medical side, we have divided the physicians’ practices into 12 disease state specialty teams.

In pharmacy, we don’t have enough staff to supply 1 pharmacist for every disease team. We have pharmacists who cover medical oncology (solid tumors), hematology (including bone marrow transplant), the women’s infusion center for gynecologic oncology and breast cancer, and pediatrics.

How does this approach translate to better outcomes?
SS:
We have multidisciplinary teams in the disease clinics that include surgeons, radiation oncologists, and medical oncologists. Our eventual goal is to have a pharmacist on each multidisciplinary team, and we think this is an achievable goal.
Our facility has the ability to analyze 400 genes in a relatively rapid period of time and customize patient care according to the results of the genetic analysis of the patient’s tumor. We believe that in the near future, we will be able to analyze 1000 genes, and in the next few years the whole genome in a cost-effective manner.
We are using the genetic analysis to improve drug selection accordingly. This strategy helps us to identify the drugs that have a better chance of working. It’s been said that the most expensive drug is the one that does not work. We can therefore provide a patient with personalized therapy with an improved chance of working, resulting in improved outcomes and reduction in waste.

What are you excited about right now in the field?
SS:
I am focused on 2 things. One is the personalizing of oncology care, with the ability to target therapies to the patient’s tumor type and genetics.
I am also interested in the transition in healthcare moving from fee for service to a disease management strategy. Part of this movement is due to healthcare reform, but a large part is due to the need to reduce cost and improve patient care. The focus is no longer on what we did to the patient, but what we are doing to improve the patient’s outcome. At Smilow, the oncology pharmacy is positioning itself to help design pathways and guidelines for disease management. This should improve quality of care and reduce costs.
We hope to develop standardized pathways for the approximately 80% of patients with cancer who can be treated with standard protocols and customize therapies for the remaining 20% who do not fit the standard approach. This breakdown comes from managed care strategies, where the goal was standardization of approaches.

What about the genetic abnormalities found in patients’ tumors? How would you standardize that?
SS:
Genetic abnormalities and their targets would be incorporated into the pathways for disease management. As we learn about new abnormalities and have newer targeted therapies, these would be accounted for in the pathways. The pathways actually get easier to build and follow as we learn more about the targets that are driving tumor growth.

How has the role of the oncology pharmacist changed in the past
5 years?

SS:
At Smilow, we are moving away from focusing on making sure chemotherapy is being delivered to working with providers to make sure we are getting the right drug to the right patient with the right protocol. This trend in pharmacy is evident across the country—moving away from a product focus to focusing on the clinical outcomes of the patient. We are seeing more emphasis on making sure our patients are educated about their drugs and how to take them. This is particularly important with oral therapies. We let patients know what to expect, when they should call their doctors, and which side effects can be discussed at a regular clinic visit.
Discussions with pharmacists tend to have patients direct their attention to the drugs they are receiving, whereas discussions with physicians are focused on the disease, and discussions with nurses are focused on administration of the drug.

What advice would you give pharmacists entering the field of oncology?
SS:
It is important to learn about the clinical aspects of oncology. A projected shortage of oncologists in the coming years means that pharmacists will have the opportunity to give clinical care and in some instances become primary providers for patients. Pharmacists will have to get ready to manage that role.
I would encourage new graduates to enter residence programs, get as much training as possible, and get board certification if they want to take on a clinical role. This education will prepare them to become clinical care providers.

If you weren’t a pharmacist, what would you be doing?
SS:
Teaching chemistry in high school and coaching football or baseball.

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