Building Better Oncology Pathways With Specialty Pharmacy Integration
Key Takeaways
- Pharmacist-led interventions played a central role in supporting patients receiving oral oncology therapies, contributing to a 92% proportion of days covered (PDC) rate through adherence monitoring, side-effect management, and proactive patient engagement.
- Integrated specialty pharmacy services help identify and address barriers to treatment success, including medication access, financial concerns, drug interactions, dosing complexities, and treatment-related toxicities.
- Embedding pharmacists within oncology care pathways enables earlier intervention for high-risk patients, supports continuity of care between clinic visits, and helps improve patient confidence, adherence, and overall clinical outcomes.
In this first installment of our interview with Kishen Patel, PharmD, clinical pharmacist at Shields Health Solutions, he discusses findings from his Clinical Pathways Congress abstract titled “Pharmacist-Driven Outcomes for Patients on Oral Oncology Medications: Clinical Impact of an Integrated Specialty Pharmacy Model.” Dr Patel explains how pharmacist-led interventions can improve medication adherence, manage treatment-related side effects, and enhance patient engagement. He also shares how integrated specialty pharmacy services and clinical pathways help identify patients who may benefit from additional support throughout their treatment journey.
Kishen Patel, PharmD: My name is Kishen Patel. I am a clinical pharmacist here at Shields Health Solutions. I have been with the company for about 8 ½ years and I work primarily in the oncology space within our team. I also work in different areas including rheumatoid arthritis, HIV, and hyperlipidemia, and I work directly with patient care and direct patient access.
What do these findings tell us about the role pharmacists can play in helping patients stay on track with oral oncology treatments?
Dr Patel: These findings enforce that pharmacists not only play a supportive role, but also a central role in managing oral oncolytic therapies. Within our study, we found 382 individual pharmacist interventions, many of which directly impacted adherence, side effect management, and prevention of complications. With a PDC rate of 92%, it demonstrated that proactive pharmacist engagement can help patients stay on therapy despite the inherent complexity with each treatment regimen. For oral oncology, patients are largely managing their treatments independently at home alone or with a caregiver, which creates a significant need for ongoing support in-between clinic visits.
Pharmacists can play a vital and consistent role by being accessible in touchpoints during the time between a patient’s visits. Within these touchpoints, they can help reinforce instructions, clarify expectations, and help patients navigate day-to-day challenges with their therapy. From a patient engagement perspective, pharmacists are doing much more than dispensing medications. They're actively building relationships with patients. Personally, this is one of my favorite aspects of my job, building those relationships, getting to know these patients, understanding their needs and wants.
Through regular check-ins, education and open communication, pharmacists can help patients feel more confident and more empowered when managing their treatment. They can help identify barriers early, whether those may be side effects, cost concerns, confusion about the dosing, or even emotional hesitation. And they can intervene before these issues lead to non-adherence. The engagement also improves accountability. When patients know someone is consistently monitoring their progress and is available to support them, they're more likely to stay committed to therapy. It's like being at the gym. If you have a trainer or you're going with a friend, you want to stay committed. You want to show them that you care and that you want to succeed.
Additionally, pharmacists can tailor counseling to each patient’s needs. Not everyone is the same. Everyone has different needs, different asks, different wants and we tailor to them. We help reinforce health literacy and ensure patients truly understand their treatment plan, not just what to take, but why taking this treatment matters. Pharmacists are ultimately helping to bridge a gap between what is prescribed and what is actually happening in the real world. They ensure continuity of care, maintain frequent touchpoints, and create a positive feedback loop between the patient and the care team. Overall, patients are not only improving adherence, safety, and continuity of care, but they're also driving meaningful patient engagement. That combination is critical in oral oncology where success depends heavily on the patient's ability and willingness to consistently manage their therapy and have it directly translate to better clinical outcomes.
Many of the pharmacist interventions involved complex therapies like temozolomide and osimertinib. How can clinical pathways help identify patients who may need additional pharmacy support?
Dr Patel: Clinical pathways are incredibly valuable because they help standardize care and identify patients who may need more intensive support. In our findings, we saw higher rates of pharmacist intervention with therapies like temozolomide or osimertinib. These type of medications tend to have either more complex dosing schedules or higher toxicity risks. Pathways can incorporate these characteristics to flag patients who are more likely to benefit from patient involvement. For example, patients on high-risk oral therapies, those with expected toxicity concerns, or even those with prior adherence challenges can be proactively identified. This allows the care team to shift from a reactive approach to a more proactive approach where pharmacy support is already built in from the very beginning.
Let me give you an example of how Shield's care model works. Let's say you have Jane Doe who has been recently diagnosed with breast cancer and after discussion with the doctor, they decided to try a new oral oncology medication called capecitabine. The doctor goes over the information with the patient about what the dosing may be and potential side effects. The patient is also given a printout about the medicine. The appointment may be quick longer, but it can be overwhelming going over all the information at once. Jane Doe is going to ask the questions, "How do I get this medication? Where do I get it? Am I able to afford it?”
After the appointment, she'll receive a phone call from our liaison who works within the specialty pharmacy. The liaison helps this patient navigate her deliveries and her refills and how to pay for the medicine, looking into what financial assistance are available—whether it be through foundations and grants—to make this medication affordable. Once that is done and the patient feels comfortable with their copayment, they can schedule the initial delivery and Jane Dole will receive a phone call from a pharmacist about 2 days before she receives and starts treatment.
The pharmacist at that point will go over with the patient in detail the dosing of capecitabine because it inherently has a tricky dosing schedule. It also has a high risk for toxicity. So, the pharmacist will go over the dosing, proper administration, side effects and how to mitigate these side effects, what are the signs to call the doctor, non-pharm lifestyle modifications options and vaccines—it’s always good to stay up to date. The pharmacist will go in detail with Jane Doe and answer her questions along the way, but all in all, help reinforce what was discussed earlier with the provider. They'll also review Jane Doe's medication list. Let’s say she forgot to mention to the doctor earlier that she is taking a proton pump inhibitor, which impacts the capecitabine and may lead to less effectiveness of the medicine. So, the pharmacist would recommend potentially switching to an H2 blocker or an antacid. This would help the treatment be more successful, taking away that drug interaction.
The pharmacist also had let Jane Doe know that they had checked her kidney function and the dosing of the capecitabine requires a lesser dosage, which means less pills to take, which also means a better chance to succeed on therapy because of less risk for side effects. They had collaborated with the provider before delivering the medicine and the pharmacist was able to reinforce this with the patient. As a result, the patient feels more comfortable. She admits that it was a little overwhelming initially but now feels more comfortable and confident about starting the treatment. The pharmacist at that point will tell the patient they will reach out the following week. A week later, the patient started the capecitabine for about a week and she notices a few side effects, maybe of stomach, diarrhea or some irritations to her hands and feet. That's where the pharmacist will do a check-in because the patient won't see the doctor probably for another month. So, the pharmacist is able to intervene, recommend maybe a few additional recommendations to help with these side effects, whether it be over-the-counter Imodium (loperamide) or moisturizer to her hands and feet
The pharmacist will reach out to Jane Doe a month later, around the same time she might have her next follow-up with a doctor. At that point when the pharmacist reaches out again, Jane Doe's feeling better because of the interventions and consult, and she feels more comfortable with therapy. She feels more willing to stay on the therapy and the doctor is pleased with her response. And from there on out, the pharmacist would reach out every 1 to 3 months to check in to make sure she continues to tolerate therapy well. In between, the liaison who initially coordinated the initial delivery will call Jane Doe once a month to do her monthly refills to help keep her on track. This example is ultimately to show how integrating pharmacy into pathways helps ensure that resources are directed where they'll have the greatest impact for our patients.
