Pharmacy Is Essential to Navigating Breast Cancer Treatment: Danielle Roman, PharmD, BCOP

As an oncology clinical specialist and manager for the clinical pharmacy team in oncology with Allegheny Health Network in Pittsburgh, Danielle Roman, PharmD, BCOP, treats patients in the community who are living with breast cancer, as well as many other disease states. In this interview from the recent Institute for Value-Based Medicine^® event held in Pittsburgh, she addresses the numerous challenges that pharmacists encounter as they treat their patients, including prior authorizations, and how integrating pharmacy services into the care plan can help support long-term recovery.

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

Transcript

What challenges do pharmacists face in ensuring that genomic test results are acted upon efficiently?

I think there are a lot of challenges here. I think even to the very basics of making sure we can access the testing results in the chart. Oftentimes, we're using different testing companies, and those results may need to be scanned into the chart, so just making sure that we have good access to those results. Making sure that we're getting the necessary testing done in the first place for what we need to make treatment decisions, and I think from there, it is the challenges of making sure that we're seeing this on all patients, that we are applying our guidelines to be able to make appropriate treatment decisions for patients. As this field grows and we have more biomarker-directed therapies, it becomes more and more challenging to track all of this.

How do prior authorization or step therapy requirements affect timely access to breast cancer therapies?

Needing a prior authorization for high-cost prescription medications is very, very common for us. I think that, in terms of how it really impacts things, it certainly can cause a delay in patients being able to access these therapies, and there's a lot of staff time and resources needed to manage all of this. I think it presents challenges in that way for our patients to be able to access treatments, but also on the health care provider side, just being able to manage the process of trying to complete these in a timely manner can be a huge challenge.

What strategies have you found effective in navigating these barriers for patients?

Some of the strategies that I think have been most effective, at least in my practice, is having dedicated people to do this work, so having clear delineations of responsibility for those responsible for completing the prior authorization process, communicating this information with the patients and the provider teams, and I think just having dedicated lines of communication in order to be able to effectively get the work done.

How can care teams better integrate pharmacy services to support long-term physical and emotional recovery following breast cancer?

There can be a lot beyond just the immediate treatment period for patients. Examples of that could just be the supportive care needs that are maybe a result of toxicities from treatments patients have received. Very common, patients may be struggling with peripheral neuropathy from certain types of chemotherapy, menopausal symptoms from the treatments that they're receiving, cardiotoxic results from treatment. There’s a lot here. It can be very complicated. I think integration of a pharmacist is incredibly important. I think one way to do that is to integrate pharmacists into the survivorship care planning process, making sure that we have a clear plan up front for how this patient should be followed throughout treatment, what sort of services or supportive care needs they might have, and making sure there's a plan to address that.