On Wilmot Cancer Center’s seventh floor, Carissa Treptow stands at a computer on wheels, scrolling through patient charts, looking for drug interactions and medication changes. A pharmacist with advanced training in oncology, she’s on morning rounds with an attending physician, medical resident, nurse practitioner, and oncology nurses. Their patients are being treated in the hospital for acute leukemia, a devastating cancer that requires strong drugs to wipe out all malignant and normal blood cells, with the goal of generating a new, healthy blood supply. They talk fast and efficiently, their sentences thick with medical terminology: “renal function,” “platelet counts,” “chemotherapy,” “comorbidities.”
Treptow is embedded on this team for many reasons, but it boils down to safety and education.
“Cancer is high risk and involves a lot of high-cost drugs,” she says. “We ensure what’s best, what’s the safest, and provide continual drug monitoring. We also ensure that nurses feel comfortable administering them. Being involved, being right there, is so important.”
By integrating pharmacists into the inpatient and outpatient clinical teams, Wilmot Cancer Institute is part of a national trend in oncology. Pharmacists act as watchdogs for treatment decisions and bring a perspective like no other: catching details such as an individual’s change in weight that could profoundly impact drug dosing, toxic interactions among medications, and changes in a patient’s liver and kidney function, essential because those organs filter drugs through the body.
“When a pharmacist is involved on the care team, safety is enhanced,” says Curtis Haas, Pharm.D., chief pharmacy officer for the University of Rochester Medical Center. “And it’s not just about drug safety. They help the entire team focus on improving safety for patients while they’re undergoing care.”
Hidden Superheroes, Ready When Called
Pharmacists are everywhere in an academic medical center, but they tend to be invisible — until they aren’t.
“Patients don’t see all of the things that pharmacists do,” says Stephen Valentine, head of Wilmot pharmacy operations. “They are integrated in so many ways. There are pharmacists that review all of the infusion orders; they look at all of the patient’s home medications, especially high-cost oral chemotherapies, and counsel patients; we write guidelines and review treatment plans. We provide a lot of support in the background.”
Sometimes they do step out from the shadows, and when that happens, Marilynne Santangelo saw firsthand how they can save the day.
The 74-year-old Rochester woman was diagnosed with acute lymphoblastic leukemia three years ago. Treptow and Santangelo’s care team discovered that Santangelo was not likely to tolerate the standard chemotherapy regimen for that disease. Santangelo had few options — but a novel Pfizer drug that could help was available through a study, and had shown value in a recently published scientific article. Santangelo’s insurance would not approve it, however, despite pleas from her oncologist and Treptow.
“This particular medication was vital to me,” Santangelo says.
Treptow didn’t give up. She spent hours doing homework, something that’s routinely part of her evenings, reviewing the latest publications, podcasts, and data for cancer drugs. For Santangelo, she wrote letters, compiled financial and medical information, and appealed to Pfizer. The drug company eventually authorized use of the therapy.
“She’s unbelievable,” says Santangelo, who’s health has been stable ever since. “I don’t know what I would’ve done without her.”
Advocates and Teachers
Treptow is part of a larger team of more than 20 pharmacists at Wilmot that care for patients in the hospital, at outpatient infusion centers, and at home when they are taking medications provided by the Specialty Pharmacy.
Many have completed a voluntary post-graduate residency, an eight or 10-year educational commitment, that starts with a bachelor’s degree followed by pharmacy school. They also contribute to the research mission by conducting independent studies to improve quality of care, says Travis Dick, director of clinical pharmacy practice, research and education for URMC.
Patient education is a major part of the job for oncology pharmacists, Treptow says.
“I talk to people a lot about what to expect, especially with chemo,” she says. “It makes it real for them, and at some point, they realize that this is happening. It’s a shock. Cancer is hard. So, I go back and talk to them again, because they probably didn’t hear a word I said the first time.”
She walks them through the chemotherapy cycle, to anticipate when extra fatigue may set in. She explains temporary emergencies, such as blood counts that are too high or too low, and the role of supportive drugs such as antibiotics and anti-nausea medications. When individuals are ready to go home, she puts their medications in order.
“With advances in oncology, we have more and more medications in our toolbox,” Treptow says. “We work hard as a team to get patients into remission.”