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Now More Than Ever, the Oncology Pharmacist Can Play a Variety of Roles on the Health-Care Team

A Conversation With Susannah E. Koontz, PharmD, BCOP, FHOPA


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Susannah E. Koontz, PharmD, BCOP, FHOPA

Susannah E. Koontz, PharmD, BCOP, FHOPA

Susannah E. Koontz, PharmD, BCOP, FHOPA, is a consultant for clinical pharmacy services, research, and education in the areas of pediatric hematology/oncology, stem cell transplantation, and cellular therapy. She has held positions at the Children’s Cancer Hospital at The University of Texas MD Anderson Cancer Center, as well as at the University of Houston College of Pharmacy and The University of Texas at Austin College of Pharmacy. 

Dr. Koontz earned her PharmD from the University of Michigan and completed both her pharmacy practice and oncology pharmacy residencies at the University of Kentucky. She served as President of the Hematology/Oncology Pharmacy Association (HOPA) for the 2017–2018 term. 

In a wide-ranging interview with The ASCO Post, Dr. Koontz discussed her experience as HOPA President, the role of the oncology pharmacist in health care, the importance of mentorship, and the development of immunotherapy and other novel agents. 

HOPA Activities 

As HOPA President for 2017–2018, what kind of initiatives were you involved in? 

In May 2017, we hosted about 70 stakeholders at the National Press Club for an inaugural policy summit, where we discussed intravenous drug waste in cancer care as our initial topic. This was based on Dr. Peter Bach’s research published in The BMJ [formerly the British Medical Journal] in 2016,1 where he and his colleagues at Memorial Sloan Kettering evaluated drug waste at their institution and estimated annual drug waste in the United States. 

Pharmacy administrators have known about waste for years, but the summit focused a public eye on a critical need right now, especially as the Trump administration commits to lowering drug prices. We’re starting a conversation about how we can optimize the use of available drugs to prevent waste and this huge economic burden—or financial toxicity—on our patients and the health-care system. 

We continued advocating on Capitol Hill for the pharmacist’s role in health care. Our members visited congressional offices and moved the needle on legislation2,3 that would allow pharmacists to have provider status under key sections of the Social Security Act. Provider status would authorize pharmacists to be reimbursed for certain services and expand them into outlying communities that don’t have immediate access to other health-care professionals. HOPA’s voice is being heard on Capitol Hill, and we’re being viewed as medication experts and leaders in the field.

“The pharmacist’s role is always evolving. Twenty years ago, a pharmacist often would either go to work in a community pharmacy or a hospital fulfilling orders and dispensing prescriptions. But now, that role can take many forms.”
— Susannah E. Koontz, PharmD, BCOP, FHOPA

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We formally launched a joint initiative at our Annual Conference in March. HOPA, the Association of Community Cancer Centers, the Oncology Nursing Society, and the National Community Oncology Dispensing Association created patient education sheets specific to oral chemotherapy. Freely available to anyone online (at oralchemoedsheets.com), these sheets concisely summarize important information about oral oncolytics. We will eventually have about 70 sheets, and they will be continuously updated. This is going to be a valuable resource for all health-care providers. 

Annual Conference 

Tell us about this year’s HOPA Annual Conference. What do you see as some of the highlights or take-home messages? 

This was the first year the HOPA Annual Conference had a theme: Targeting the Future of Oncology Pharmacy. Targeted therapy continues to be a mainstay of treatment for cancer patients. We had panel discussions on implementing biomarkers in cancer care and developing molecular tumor boards. We had sessions on targeted therapy side effects, which are different from the ones we’re used to seeing with chemotherapy. And we had a session devoted to chimeric antigen receptor (CAR) T-cell therapy, the associated toxicities patients experience, and how they can be managed. 

This conference was also more interactive. In our exhibit hall, we had a designated area for “Continuing the Conversation,” where speakers were available to attendees after presentations to answer additional questions. We also designed our exhibit hall so that research posters were integrated among exhibitors’ booths. These changes facilitated networking and building relationships among attendees. 

Importance of Mentorship 

During your final remarks as HOPA President at the Annual Conference, you stressed the importance of women having mentors. Who are your mentors? 

As we know, female leadership faces some challenges that are different from those of men. But it’s important for anyone, whether you’re female or not, to have mentors. When we enter the profession, many of us are influenced by faculty members. But I also encourage people to seek mentors outside of their profession, to gain alternative perspectives. 

Rosemary Berardi, PharmD, Chair of Clinical Sciences at the University of Michigan, was an excellent mentor to me. She was a national thought leader in gastrointestinal medicine, and while that was not a professional interest of mine, I was fascinated to learn how she developed her renowned reputation in that area. Valener Perry, MEd, was Assistant Dean for Student Affairs at the University of Michigan and a great guiding hand on my shoulder throughout school. Kelly Smith, PharmD, is a professor focused on pharmacy practice models at the University of Kentucky. It’s been rewarding to follow her, see the work she’s done, and have her as someone I can turn to for guidance. And Cindy Ippoliti, PharmD, started pharmacy services for the largest stem cell transplant program in the world at The University of Texas MD Anderson Cancer Center. It was great watching her in action and learning from such an impactful clinician. 

Evolving Role of the Pharmacist 

Please tell readers about the role of the oncology pharmacist in the health-care team. 

The pharmacist’s role is always evolving. Twenty years ago, a pharmacist often would either go to work in a community pharmacy or a hospital fulfilling orders and dispensing prescriptions. But now, that role can take many forms. 

Today, pharmacists are working alongside health-care practitioners to provide medication and patient education. Pharmacists are assisting with writing orders, helping to build electronic health records, and creating clinical pathways. They’re members of the pharmacy and therapeutics committee making decisions on which products their health-care facilities will be utilizing. We see pharmacists in the “C-suite” with business executives, and we have many working in specialty pharmacies, with more cancer drugs being delivered through these outlets. 

We’re also seeing pharmacists working in pharmaceutical companies in areas of research, medical affairs, patient access, and advocacy. We have pharmacists working at government agencies, creating guidelines and education materials. And some of our colleagues are now working for insurance companies in outcomes and health economics. 

Growing Armamentarium 

An increasing number of U.S. Food and Drug Administration (FDA)-approved oncology drug products have been added to the oncologist’s armamentarium over the past several years. What are your thoughts on the development of these novel drugs and how they will impact cancer care? 

It’s moving at the speed of light. But this is an exciting opportunity for pharmacists to be the gatekeepers of all this information and quickly educate the rest of the health-care team on these medications. We see it as a challenge, but a good challenge that will help further define our role in health-care provision. Our tagline at HOPA is “Pharmacists Optimizing Cancer Care.” We want to be that individual our colleagues can come to for help sorting through all this information and determining which treatment is best for their patients. 

In addition to approved drugs, how do you and other pharmacists keep up with all the investigational drugs on the horizon in oncology? 

Rather than trying to focus on individual drugs, sometimes it’s helpful to focus on the pathway. If you understand the implications of a pathway in a particular tumor type, then when you hear about a drug being developed, you can recognize its role in cancer treatment. And for some drugs, by knowing the pathway, you can sometimes predict their toxicity. 

“If you understand the implications of a pathway in a particular tumor type, then when you hear about a drug being developed, you can recognize its role in cancer treatment. And for some drugs, by knowing the pathway, you can sometimes predict their toxicity.”
— Susannah E. Koontz, PharmD, BCOP, FHOPA

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Impact of Immunotherapy 

Can you comment on the development of immunotherapy and how it has impacted the future of cancer care and the role of the oncology pharmacist? 

Harnessing the immune system, in certain patients, has led to cures that were not plausible 20 years ago. And more targeted, immune system–focused therapies will be developed. Using traditional chemotherapy in a formalized and systematic fashion for the past 70 years, we’ve been able to make strides in certain cancers. But in others, we haven’t made much progress; we need to be doing something different, and immune therapy appears to be our immediate answer. 

That said, immunotherapy brings new challenges. Some of these therapies are not currently amenable to administration in local physician offices, often requiring patients to travel to academic medical centers. At HOPA, we believe there’s a great opportunity for pharmacists—and all health-care providers—to educate patients and caregivers on the unique nuances of immunotherapy before returning home. This is particularly crucial for our colleagues in remote communities who remain involved in the care of patients receiving immunotherapy. How we best do that remains to be seen, but it’s critical because an increasing number of health-care practitioners will be interfacing with these patients. ■

DISCLOSURE: Dr. Koontz has served on speakers bureaus for Shire and has received consulting fees from Cumberland Pharmaceuticals, Leadiant Biosciences, and Spectrum Pharmaceuticals. 

REFERENCES 

1. Bach PB, Conti RM, Muller RJ, et al: Overspending driven by oversized single dose vials of cancer drugs. BMJ 352:i788, 2016

2. H.R. 592: Pharmacy and Medically Underserved Areas Enhancement Act. Available at https://www.congress.gov/bill/115th-congress/house-bill/592. Accessed April 19, 2018. 

3. S. 109: Pharmacy and Medically Underserved Areas Enhancement Act. Available at https://www.congress.gov/bill/115th-congress/senate-bill/109. Accessed April 19, 2018.


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