A Pharmacist’s Perspective on Optimizing Therapy Selection and Deprescribing in Oncology: Jason Bergsbaken, PharmD, MBA, BCOP

At a recent Institute for Value-Based Medicine^® event, Jason Bergsbaken, PharmD, MBA, BCOP, highlighted the critical role of oncology pharmacists in institutional precision molecular tumor boards, noting their contributions to maintaining up-to-date, evidence-based guidance documents and providing patient-specific recommendations for complex or atypical cases. Bergsbaken, interim manager of oncology pharmacy at UW Health and clinical assistant professor at the University of Wisconsin-Madison School of Pharmacy in Madison, emphasized the importance of active pharmacist participation, collaborative decision-making, and continual review of common mutation guidance to ensure consistent, high-value care. This is the third interview in a series with Bergsbaken.

Bergsbaken also addressed the challenges of deprescribing or de-escalating therapy in end-of-life care, citing institutional data showing frequent active treatment within the last month of life. He underscored the pharmacist’s role in facilitating shared decision-making with patients and providers, aligning treatment strategies with patient goals, and considering when supportive care may offer greater value than continued active therapy.

This transcript was lightly edited; captions were auto-generated.

Transcript

What strategies have been most effective in integrating clinical pharmacists into tumor boards or precision medicine workflows to optimize therapy selection and value?

At our institution, we do have an institutional precision molecular tumor board that was created before I was in my role. I think at the time, and as we go on, there's been a recognition that oncology pharmacists do provide a lot of value to that work, and we have a unique skill set to contribute to the decisions that are made, both at a tumor board level in terms of how we validate our standard guidance document, and also at the patient level, when we see cases that maybe would challenge or be different than that standard document. I think it was number one, just having pharmacists involved in that conversation with the attitude and capabilities to contribute, really placing a strong emphasis on teaming and continually updating that guidance document so that we are making consistent decisions as it relates to common mutations that we are seeing. Then finally, again, at the patient-specific level, having pharmacists participate in those boards to help collaborate with other stakeholders in the process to make specific patient recommendations when we do see particular configurations.

What lessons have emerged from pharmacy-led initiatives to deprescribe or de-escalate therapy in end-of-life care or in response to emerging evidence of limited benefit?

Yeah, this is a really difficult one. I think as health care providers, we're always wanting to provide recommendations for what's next for patients. We develop relationships with patients, and we want to do everything we can to help them reach their goal, whether it's cure, whether it's slowing progression and meeting that next goal of theirs. I think when we get to that more end-of-life setting, sometimes that can be challenging in terms of the conversations that we do have, where maybe an after treatment might not be the best choice, in their case, for some sort of other supportive care.

Actually, at our institution, one of our team members, Jason Jared, PharmD, BCOP, he's on our inpatient team, and about 8 years ago, he published some information regarding looking at our own institutional data regarding our patient-specific or nonstandard requests, which did show that the frequency of time in which we were treating patients with active therapy within that last month of life was very frequent. I think there's probably a number of ways which we can go about this. I think it's really on the pharmacist side, working with other providers and really participating in those discussions, to really have a shared decision in terms of, based on that patient's presentation at the time, what really is the best route for them? Is it an active treatment? Or, to your question, maybe de-escalation or de-prioritization, vs more of a supportive route as they move to an end-of-care setting—what would provide more value to that patient in that setting? I think it's really understanding their unique goals and being more comfortable and well-equipped as health care providers to have that conversation and come to that shared decision.