The Kimmel Cancer Center (KCC) at the Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, is a National Cancer Institute (NCI)-designated clinical cancer center. The center, founded in 1991, received the NCI designation in 1996, confirming KCC’s position as a leader in treatment, research, and education.
KCC focuses on treating patients with innovative therapies in an environment of collaborative care. KCC’s more than 150 members also focus on oncology research, with programs in basic and clinical science, working to translate scientific discoveries to improved care for patients. Patients have access to more than 120 clinical trials taking place at the cancer center. KCC recently developed a Medical Oncology Phase 1 program to expand the opportunity for patients to receive promising new therapies. The phase 1 clinical trials program encompasses inpatient and outpatient services and studies may involve all oncology disciplines.
The Oncology Pharmacist spoke with Anne Marie Valorie-Oberle, PharmD, BCOP, an advanced practice clinical pharmacist in oncology at KCC, about her position and the evolving role of the oncology pharmacist.
What are your responsibilities at Kimmel?
Anne Marie Valorie-Oberle (AMV-O): My job in the outpatient infusion center consists of providing drug therapy and symptom management recommendations, providing patient education, and being involved in the development of clinical pathways and standards of care.
Most of my days are spent on the frontline with nurses, physicians, and patients, providing education and answering questions.
What approach does your institution take to the treatment of people with cancer?
AMV-O: The KCC truly employs a multidisciplinary approach. We focus on the “comprehensive” aspect of patient care by utilizing many key team players when developing a care plan for each patient. In addition to caring for the patient’s physical needs, team members address other needs, including those related to emotional, financial, and general health issues, through collaboration with physicians, nurse practitioners, pharmacists, magnet nurses, social workers, nutritionists, financial support through drug replacement and reimbursement specialists—the list goes on. We are heavily engaged in clinical trials and community outreach programs that provide cancer screening and prevention education. We also have an integrative medicine program for patients to help address lifestyle factors as well, including diet and exercise, vitamins, and supplements.
How does this approach translate to improved outcomes for your patients?
AMV-O: I think that each team member from a specific discipline brings a unique expertise to the table when we collaborate on patient management, to meet both the physical and emotional needs of the patient. In the rare case that one team member overlooks something, another team member will pick up on that. I feel this approach leads to a better overall care of the patient; even when the outcome is not ideal for a patient, it can improve the patient’s quality of life during a difficult time.
What are you excited about right now in the field of oncology?
AMV-O: Targeted therapies. Now that genetic abnormalities can be identified in cancer patients, we have new drugs that target those abnormalities for many cancers. These drugs have changed the natural history of the cancer.
Targeted therapies, whether oral or IV, provide more options for patients who have otherwise run out of options. We are able to help patients that we couldn’t in the past. Some of these newer therapies can change a terminal diagnosis to more of a chronic condition for several cancers. For example, chronic myelogenous leukemia and multiple myeloma—patients can live for years on these newer therapies before they need to go to transplant.
Myelodsyplastic syndrome is another disease that was previously treated with best supportive care. Now we have hypomethylating agents that allow patients to live for many years.
Most recently, people are excited about T-DM1, an antibody drug conjugate just approved by the FDA for the treatment of HER2-positive breast cancer. This drug appears to improve outcomes compared with trastuzu- mab—the first HER2-specific targeted therapy.
How has the role of the oncology pharmacist changed in the past 5 years?
AMV-O: In the past 5 years, I have transitioned from being an inpatient clinical pharmacist to an outpatient clinical pharmacist, and I think this is a growing trend in the field of oncology. With new oral chemotherapy agents, the demand is more in the outpatient setting in terms of symptom management and education. Our role has evolved to become more collaborative in the outpatient setting.
Also, as an oncology pharmacist, I now have a closer focus on being fiscally responsible for both the institution and the patient, making sure patients are treated in the appropriate setting and that they can afford their therapies. It’s not just the hospital worrying about money; the patient worries about whether he/she can afford the expensive new targeted therapies.
Oncology pharmacists work with other healthcare practitioners in symptom management clinics. Our teams make sure patients are taking their medications and are being monitored appropriately.
In the future, we may start seeing some cancers managed with oral therapies alone.
What inspired you to become an oncology pharmacist?
AMV-O: When I was in pharmacy school, I asked for a bone marrow transplant rotation. This combined my interest in immunology with cancer therapy. It turned out to be my favorite rotation.
An oncology pharmacy position opened up, and I decided to take it. I have been an oncology pharmacist for more than 12 years. I cannot imagine myself working in any other specialty. It is rewarding for me and I feel I am where I was meant to be. The one thing about this specialty, you can never complain about being bored. You have to keep up with it, or the field will pass you by.
What advice would you give to people entering the specialty today?
AMV-O: I have students and residents rotate with me. I tell them not to be scared and to put themselves out there. I emphasize that it is important to take chances and work in practice areas that they aren’t really sure they want. They may be surprised by what they end up enjoying the most.
What would you be if you weren’t an oncology pharmacist?
AMV-O: If I had all the money in the world and could do anything I wanted to, I would probably like to do event planning, especially the cooking/catering aspect of that. But then, if I did that for a living, I wouldn’t love cooking as much as I do now. My husband says I approach cooking like a pharmacist—very organized and careful about measurements. So there must be some relationship!