In an in-depth and wide-ranging discussion titled Oncology Pharmacy, Niesha Griffith, RPh, MS, FASHP, CPO (interim), Columbus, OH, invited 5 panelists from the oncology pharmacy sector to share their experiences and insights regarding the impact of the ongoing crisis on the delivery of care. Topics included how personal protective equipment (PPE) shortages have affected pharmacy providers, an overview of the current medication supply chain, and other COVID-19–related challenges.
Mike Ganio, PharmD, Senior Director, Pharmacy Practice and Quality, American Society of Hospital Pharmacists, discussed the way in which pharmacists use PPE. He explained, in contrast to the use of PPE among healthcare providers, pharmacists do not use the equipment to protect themselves. Instead, they use it to maintain a sterile environment in the "clean room," where medications are prepared. Dr Ganio said that in addition to such things as sterile alcohol, which he noted has been difficult to obtain, there has also been a significant disruption in the availability of the widely used N95 respirator masks, which are important in oncology pharmacy practice.
Dr Ganio said that in his practice, he has seen shortages of ICU drugs, ventilators, and sedatives and neuromuscular blockers used to sedate and paralyze patients before intubation. Although there has been some improvement, shortages are still critical, he noted.
Chris Marcum, VP, Enterprise Pharmacy, Cancer Treatment Centers of America, addressed the problem of medication stockpiling and hoarding. He also noted that there has been a problem with supplies of sedatives and antivirals, as well as maintenance medications such as inhalers and insulin. He suggested this is due to shortages that ensued when payers changed the amount of medication covered under a plan from a 30-day supply to a 90-day supply in the wake of the coronavirus.
Bhavesh Shah, Director, Specialty and Hematology/Oncology Pharmacy, Boston Medical Center, built on that point. He said that in the pandemic hot spot of Boston, MA, relief is beginning now, but during the peak of the virus, his facility alone saw a 600% increase in the use of sedatives and paralytics.
The panelists also spoke at length on the response of manufacturers to the economic crisis that many patients are facing. Because unemployment rates are high, pharma has broadened many patient assistance programs so that patients can continue on their medications. “It’s been the quickest response we’ve seen,” said Ali McBride, PharmD, MBA, Clinical Coordinator, University of Arizona Cancer Center.
Home infusion of oncology drugs has also become a hot topic, and the panelists offered their opinions on the feasibility of this option. They said that safety issues must be seriously considered, and it would only be an option for certain patients and drugs with appropriate supervision. Mr Shah acknowledged that it may be an option for patients meeting all the criteria, but it is “not for everybody.”
Stacey McCullough, PharmD, SVP, Pharmacy, Tennessee Oncology, said that home infusion has not been explored in her clinic because they have chosen to focus on safety and convenience for patients who go there for treatments.
A topic that the panelists focused on telehealth and its significance in treating patients in an evolving healthcare environment. However, its applications are still limited for pharmacists.
Another factor of significance for the panelists was what they called the expected “backlog” of patients seeking treatment when the risk of coronavirus is lower. Although there is a lull right now, the demand will be high because of the large number of patients who missed screenings, as well as others with a need for ongoing care that was delayed by the pandemic.