Ethics, Moral Distress Shape Oncology Pharmacy Practice: Karen Fancher, PharmD, BCOP

When asked, “What ethical or emotional challenges do oncology pharmacists face that you think deserve more attention and support?” Karen Fancher, PharmD, BCOP, associate professor of pharmacy practice at Duquesne University and clinical oncology specialist at University of Pittsburgh Medical Center Passavant Hospital, reflected on her growing interest in ethics within oncology pharmacy and the emotional burden many pharmacists experience in cancer care settings. Fancher recently presented “Navigating Complexities in CLL Therapy: A Practical Guide for Community Oncology Pharmacists” alongside Evan Slater, PharmD, pharmacy director at Rocky Mountain Cancer Centers, at the 2026 Community Oncology Conference.

Fancher explained that her interest in ethics developed unexpectedly, noting that she had no formal ethics training during pharmacy school. Her involvement began after an ethics professor at Duquesne approached her seeking real-world patient scenarios involving ethical dilemmas, believing oncology would provide meaningful examples. According to Fancher, that assumption proved correct, as oncology pharmacy is filled with emotionally and ethically complex situations that clinicians navigate daily.

She described collaborating with colleagues to develop papers and presentations focused on helping pharmacists better recognize and discuss ethical challenges in their work. A major issue she highlighted was “moral distress” among oncology pharmacists. Pharmacists frequently witness patients struggling with the realities of cancer treatment, including the inability to afford medications, severe or intolerable adverse effects, and the overwhelming complexity of managing cancer alongside multiple other diseases. Fancher emphasized that these experiences can take a significant emotional toll on providers.

Importantly, she noted that many pharmacists lack the language to articulate their own emotional struggles or uncertainty about where to turn for support. As a result, pharmacists may internalize stress and distress without recognizing them as professional and ethical challenges worthy of discussion. Fancher suggested that one of the first steps toward addressing the issue is simply helping pharmacists identify and name what they are experiencing.

She said her recent work in ethics has focused on questions such as how pharmacists can better recognize emotional and ethical strain, how institutions can create channels for support and discussion, and how pharmacists can escalate concerns when necessary. Ultimately, Fancher stressed the importance of balancing personal well-being with patient-centered care, acknowledging that oncology pharmacy can be emotionally difficult work. She underscored that creating space for open conversations about moral distress could help pharmacists better support both themselves and their patients.