Innovations in Cancer Care Improve Outcomes, but Cost Remains a Barrier: Christine Pfaff, RPh

Although innovations in oncology therapeutics have led to less toxicity and better outcomes for many patients in recent decades, the financial toxicity that accompanies these cutting-edge treatments remains a barrier for patients, as well as for clinicians who aim to provide the best possible treatments without adversely impacting their patients financially, said Christine Pfaff, RPh, senior regional director of operations at American Oncology Network.

Christine Pfaff, RPh

In an interview with The American Journal of Managed Care^® (AJMC^®), Pfaff discussed the roles of immunotherapy and precision medicine in oncology, as well as considerations for optimizing treatment strategies for patients with cancer.

AJMC: Can you share insights into the role of precision medicine in oncology and how it guides the selection and administration of cancer drugs for individual patients?

Pfaff: Sure, that's been a huge change from when I first started practicing in oncology 20 years ago. Before we would give the traditional chemotherapy, which had your kind of bad side effects—you know, nausea, vomiting, hair loss, just a lot of fatigue, neutropenia. We still sometimes give products that cause those things, but a lot of times it's in combination with immuno-oncology products, and so, we've increased survival for patients.

And then for some of the diseases, we just give immuno-oncology products or targeted therapies. We can do testing on a patient's tumor—either a blood test or a tissue test—and decide what product might be best for them based on these mutations. And so, rather than kind of giving a general chemo that kills all your healthy cells along with your cancer cells, we're able to give products that kind of go right to the problem. In lung cancer, we've had a lot of targeted therapies, breast cancer—it's really across the board. It allows patients to have less side effects, and in some cases, better outcomes and longer life.

AJMC: In the context of oncology pharmacy, what challenges or considerations are unique to ensuring patient safety and optimizing treatment efficacy, and how do you address these at Zangmeister?

Pfaff: A lot of patient safety goes back to your institutional standards for safety. At the very beginning of treatment when the provider is entering an order on a patient, double-checking that the dose is correct, that it follows the package insert or [National Comprehensive Cancer Network] guidelines. [It’s] also having double and triple checks to make sure the patient got the right dose. For example, if I have a patient sitting in the chair and their weight is [listed as] 150 pounds, and you see the patient and think there's no way they weigh 150 pounds, we need to second guess whether the weight was entered appropriately. There’s so many places along the way that we can make sure the patients get the right dose.

From a safety perspective, I think all the preparation up to the patient receiving the drugs is really important. And then for oral medications, a lot of patients are taking oral medications at home and not coming in for treatment. We kind of want to do the same thing—we want to have a pharmacist call and speak to the patient about how many pills a day they need to take, when, and with or without food. [We’re] really working hard in our center to counsel patients, both when they receive infusion therapy and oral.

We have a teaching that's set up with the patient and family—it's always important to include any caregivers—to explain what's going to happen. It’s the same with an oral medication that they get at home, making sure that the patient's educated properly. We always learned in pharmacy school to have the patient teach you back. And that's a good way to see if they understand. It's so overwhelming to have a cancer diagnosis, let alone be responsible for taking your medication correctly at home with or without food and all those things, and the cost of the medication is huge. So [we’re] really trying to just give the patient resources that they can reach out to if they have questions, and not feel bad about asking questions.


AJMC: What are some of the most significant advancements or changes in oncology pharmaceuticals that you have seen in your 2-plus decades of practice, and how have they impacted cancer treatment?

Pfaff: I think kind of what we just spoke about a little bit is the idea of precision medicine, and changing from generalized treatments to very specific treatments based on individual patients. That's been such a huge shift. A lot of the products are immunotherapy products, which means they're helping your immune system fight the cancer, as opposed to just killing all rapidly dividing cells, which is kind of your traditional chemotherapy.

I also think with that innovation comes cost, and that has been a huge barrier for all of our patients. We have these great products, we know they work, we want you to try them, but [when] it's going to be $5000 a month or something like that, that's a dealbreaker for a lot of patients. So [it’s] really figuring out, you know, we have a product and we think it's going to work, the patient wants to take it. The next step is how do we how do we get paid for it? And how do we get the patient help so that they can pay for it? With all this innovation and change has come something we didn't have a long time ago, which is dealing with the financial toxicity.