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Economics/Practice ManagementBoard-certified oncology pharmacists: partners in the multidisciplinary care of cancer patients Dawn Marie Stull, PharmD, BCOP,1 Andrea Iannucci, PharmD, BCOP,2 and Richard J. Bertin, PhD, RPh31 Specialty Council on Oncology Pharmacy, Medical Science Liaison, Millennium Pharmaceuticals, Inc, Cambridge, MA,2 Specialty Council on Oncology Pharmacy; University of California Davis Medical Center, Sacramento, CA, and 3 Board of Pharmaceutical Specialties, Washington, DCIncluding an oncology pharmacy clinical specialist on the treatment team for cancer patients improves outcomes for patients, reduces the length of hospital stays for adverse events/complications, and reduces medical errors in both ambulatory and inpatient settings. Practicing in a variety of settings, oncology clinical pharmacists play an important role in the treatment of patients with cancer, as well as the management and prevention of cancer- and treatment-related complications. O ncology pharmacy specialists are sidered the advanced practice specialty level. There are experts in the pharmacology of specific educational and experience-based criteria that cancer chemotherapy, including a candidate must meet to be eligible to sit for one of the therapeutic and toxic effects of the five established specialty area examinations with-these agents. Specializing in oncol-in pharmacy practice.1,2 Eligibility criteria are shown ogy pharmacy requires years of clinical experience in Table 1. (For more information related to eligibility and/or additional postgraduate training. The servic-criteria, registration, and the examination process, refer es of oncology pharmacists can help coordinate the to the BPS Web site at or cal the continuity of care for patients as well as ensure the BPS at 202-429-7591.) optimal use of medications in various treatment set-To obtain the designation of Board-Certified On-tings. In addition, oncology pharmacists help facili-cology Pharmacist (BCOP), candidates must demon-tate reimbursement for a more efficient practice. strate an ability to design, implement, monitor, and modify pharmacotherapeutic plans to optimize out-Board of Pharmaceutical Specialtiescomes in patients with malignant disease. Table 2 lists The Board of Pharmaceutical Specialties (BPS) the areas of expertise that must be mastered. To date, was established in 1976 by the American Pharmaceu-nearly 600 pharmacists have earned a BCOP creden-tical Association, now known as the American Phar-tial, most of whom practice in the United States.macists Association (APhA). BPS certification is con-Pharmacy expertiseWith their experience and training, oncology ����������pharmacy specialists become highly skil ed clinicians, equipped to practice in a variety of acute and ambu-Oncology pharmacists are highly educated experts in drug therapy related to cancer treatment and supportive care.latory care practice settings. Many oncology pharma-cists are directly involved in patient care in an inpatient Direct pharmacist involvement with a patient care team medical oncology unit or outpatient cancer treatment can decrease the risk of medication In these settings, pharmacists:■ Coordinate orders and prescriptions for che-The expertise of oncology pharmacists also helps reduce adverse events which lowers costs.Manuscript received December 8, 2005; accepted April 17, 2006.Oncology pharmacists are a valuable resource to Correspondence to: Dawn Marie Stull, 345 East 93rd Street, nurses, physicians, patients, and caregivers in providing New York, NY 10128; telephone: 212-706-2407; fax: 212-600-education and information about chemotherapy drugs. 1537; e-mail: [email protected] Oncol 2006;3:284–286 © 2006 Elsevier Inc. All rights reserved.284 COMMUNITY ONCOLOGY ■ May 2006www.CommunityOncology.netBoard-certified oncology pharmacists ECONOMICS/PRACTICE MANAGEMENTThe making of an oncology specialty pharmacistTHE BOARD OF PHARMACEUTICAL The specialty councils are composed of cists will have completed a Doc-SPECIALTIES (BPS) has four primary six pharmacist specialists and three phar-tor of Pharmacy degree (PharmD). responsibilities:macists who are not in the specialty. Further training is provided through ■ Recognizing specialties in phar-a general pharmacy practice resi-macy practiceLicensure vs certificationdency. Focused training in oncolo-■ Establishing standards for certi-Like other professions, pharmacy re-gy is provided through an oncology fication and recertificationquires that al pharmacists have a valid specialty residency. ■ Evaluating individuals seeking license to practice in the state in which A pharmacy practice residency certification and recertification they work. Candidates for licensure in is a prerequisite for most oncology ■ Serving as a source of informa-the United States must pass the North specialty residency programs. There tion and a coordinating agency for American Pharmacist Licensure Exam-are approximately 35–40 oncology pharmacy specialties. ination as wel as a pharmacy law exami-residency positions available each Nine members comprise the Board:nation. When candidates for pharmacy year in the United States.3 ■ Six pharmacistslicensure have successful y completed The American Society of Health-■ Two healthcare practitioners out-these examinations and a state license System Pharmacists accreditation side pharmacyis conferred, they may use the abbrevia-standards for oncology pharmacy resi-■ One public/consumer member.tion RPh (Registered Pharmacist).1 In dencies require that programs include Currently, there are five recognized contrast, certification is a voluntary pro-exposure to a variety of common ma-specialty areas in pharmacy practice: cess by which a practitioner’s education, lignancies (eg, acute leukemias; lym-■ Oncology pharmacy, recognized experience, knowledge, and skil s are phomas; lung, colorectal, breast, ovar-as a specialty in 1996, the most re-confirmed by one’s profession as meet-ian, and prostate cancers) and core cently established specialty area ing or surpassing a standard beyond that rotations in medical oncology, malig-■ Nuclear pharmacy (established required for licensure. BPS certifica-nant hematology, and bone marrow in 1978)tion is considered to be at the advanced transplantation.4 ■ Nutritional support pharmacy practice specialty level. The designation Many programs offer additional (established in 1988)Board-Certified Oncology Pharmacist experience in pediatric oncology, ra-■ Pharmacotherapy (established in (BCOP) is awarded upon successful diation oncology, pal iative care, nu-1988)completion of the BPS oncology spe-tritional support, infectious diseases, ■ Psychiatric pharmacy (estab-cialty examination. and investigational drug services. The lished in 1992).programs also provide training in pre-Each specialty has a council that Education and training paring, dispensing, and administering operates under the auspices of the BPS. Most oncology specialty pharma-chemotherapeutic agents. motherapy as well as supportive tals and schools of pharmacy. ■ Help develop treatment guidelines medicationsto ensure the optimal use of support-■ Review orders for accuracy and Practice partners safety TABLE 1Patient careEligibility criteria for BPS oncology ■ Provide formulary review for new oncology drugsPharmacists work together with pharmacy specialty examination■ Provide clinical services to cancer physicians and nurses to:■ Entry-level pharmacy degree (BS or PharmD)patients, including those undergoing ■ Provide information about chemo-■ Current, active pharmacy licensebone marrow transplantation therapy medications ■ Three years of oncology pharmacy practice ■ Develop and implement policies re-■ Facilitate optimal chemotherapy experience orlated to medication safety and proper drug dosing■ Completion of an oncology pharmacy specialty handling of cytotoxic agents.residency and■ Coordinate safe and timely ad-The role of an oncology pharma-ministration of chemotherapy drugs ■ One year of oncology pharmacy practice experiencecist can be further expanded to teach-and supportive therapies■ $600 application feeing pharmacy students and pharmacy ■ Help coordinate prescriptions for BPS = Board of Pharmaceutical Specialties; BS = Bachelor of residents in academic teaching hospi-discharge and home medicationsScience; PharmD = Doctor of PharmacyVolume 3/Number 5 May 2006 ■ COMMUNITY ONCOLOGY 285 ECONOMICS/PRACTICE MANAGEMENT Stull/Iannucci/BertinTABLE 2References1. Council on Credentialing in Pharma-Areas of expertise that must be mastered to earn a BCOP credentialcy. CCP resource document: credentialing in Optimize drug therapy for patients with cancer through the design, recommendation, implementa-pharmacy. 2004. Available at: www.pharma-tion, monitoring, and modification of individualized pharmacotheraputic plans in collaboration Accessed December 27, with the healthcare team2005.Contribute to the care of patients with cancer through research, the application of research results, 2. Wel s BG. Encyclopedia of Clinical Phar-and educationmacy. Board of Pharmaceutical Specialties. Avail-able at: the safe, ef ective, and appropriate use of medications in patients with cancer through the im-713477406~db=enc. Accessed April 18, 2006.plementation of guidelines and the development and modification of pharmacy policies and systems3. Li E. Oncology pharmacy practice resi-Raise awareness among the public and healthcare providers regarding cancer-related issues (risk dency programs. Am J Health Syst Pharm factors, prevention, screening, treatment)2005;62:1980–1981.4. American Society of Health-System Pharmacists. ASHP supplemental standard ive care medications (eg, antiemetics investigatorsand learning objectives for residency training and growth factors) and better out-■ Taking responsibility for the in oncology pharmacy practice. Available at: comes for patientsaccountability and processing Ac-cessed December 27, 2005.■ Obtain prior authorization, iden-of investigational drugs used in 5. Kucukarsian SN, Peters M, Mlynarek M, tify alternative funding resources, investigational protocolsNafziger DA. Pharmacists on rounding teams and/or procure medication assistance reduce preventable adverse drug events in hos-■ Assisting in the collection, man-pital general medicine units. Arch Intern Med from pharmaceutical companies to agement, and evaluation of data for 2003;163:2014–2018.provide patients with the medica-presentation at medical meetings and 6. Simpson JH, Lynch R, Grant J, Alroomi tions they needpublication.L. Reducing medication errors in the neonatal intensive care unit. Arch Dis Child Fetal Neo-■ Help decrease the potential for natal Ed 2004;89:F480–F482. medication errors.5–11 Practice management 7. Gandhi TK, Weingart SN, Borus J, et Drug-related problems including al. Adverse drug events in ambulatory care. N Educationadverse events are estimated to cost Engl J Med 2003;348:1556–1564. Pharmacists play a key role in more than $175 billion per year.12 In 8. Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug educating:the oncology setting, where complex events among older persons in the ambulatory ■ Other members of the healthcare and toxic therapies are routinely used, setting. JAMA 2003;289:1107– about chemotherapeutic medi-the chance of encountering drug-9. Locke C, Ravnan SL, Patel R, Uchizono cations and their expected side effects related problems is high. Having a JA. Reduction in warfarin adverse events requir-ing patient hospitalization after implementa-and managementknowledgeable pharmacist involved tion of a pharmacist-managed anticoagulation ■ Patients, family members, and helps to ensure the safe, effective, and service. Pharmacotherapy 2005;25:685–689.other caregivers, who may feel over-appropriate use of complex regimens. 10. Bond CA, Raehl CL. Pharmacist-pro-vided anticoagulation management in United whelmed by their diagnosis, treat-States hospitals: death rates, length of stay, ment, and side effectsConclusion Medicare charges, bleeding complications, and ■ Members of the public who want to Oncology pharmacists with spe-transfusions. Pharmacotherapy 2004;24:953–know about cancer risk factors, preven-cialty certification are skilled indi-963.11. Buurma H, De Smet PA, Leufkens HG, tion strategies, and recommendations viduals who have taken the initiative Egberts AC. Evaluation of the clinical value of for screening and early detection. to obtain additional training focused pharmacists’ modifications of prescription er-on the unique aspects of cancer treat-rors. Br J Clin Pharmacol 2004;58:503–511.Research ment as well as the management and 12. Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-More than 60% of patients in clin-prevention of cancer- and treatment-of-illness model. J Am Pharm Assoc 2001;41: ical trials are recruited by communi-related complications. The services of 192–199. ty practices, and an on-site oncology oncology pharmacists can help en-pharmacist can play an active role in sure the optimal use of medications, ABOUT THE AUTHORSfacilitating such studies by:which can result in positive economic Affiliations: Dr. Stull is Chair, Specialty Council ■ Writing research grants and inves-benefits through reduction in hospital on Oncology Pharmacy, Medical Science tigational protocolsadmissions, length of hospital stays, Liaison, Millennium Pharmaceuticals, Inc., Cambridge, MA. Dr. Iannucci is Co-Chair, ■ Participating in institutional re-adverse drug events, repeated office Specialty Council on Oncology Pharmacy; view board approval of clinical trials visits for medication-related prob-Oncology Pharmacy Specialist, University of California Davis Medical Center, Sacramento, as well as scientific review and moni-lems, and the suboptimal manage-CA. Dr. Bertin is Executive Director, Board of toring committeesment of the expected adverse effects Pharmaceutical Specialties, Washington, DC.Conflicts of interest: None disclosed.■ Serving as primary or collaborative associated with cancer treatment. 286 COMMUNITY ONCOLOGY ■ May