The Challenges and Rewards of Working on Behalf of Our Patients

Katie E. Long, PharmD
Hematology/Oncology Clinical Pharmacist
Markey Cancer Center
University of Kentucky HealthCare
Lexington, KY

I had been told that during the course of my career I would encounter patients who would impact me in such a way that I would never forget them and they would even transform the way I work. I was fortunate enough to meet one such individual during the first year of my first job as a clinical pharmacist in an outpatient oncology clinic. This is the story of Ms. X and how meeting her truly changed my perspective on the role of a clinical pharmacist, my passion for the care of oncology patients, and my life.

Ms. X was a delightful woman in her 60s who had a textbook case of anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer: she was a healthy, lifelong nonsmoker with aggressive disease and had an impressive, but short-lived, response to initial treatment. At the time of her disease progression her physician asked me to investigate ways in which we could gain access to ceritinib, an investigational second generation ALK-inhibitor that was in phase 1 trials at the time. In my pursuit to obtain this medication for Ms. X, I contacted the drug company to apply for an individual compassionate use trial and enroll Ms. X in an expanded treatment protocol. In the midst of this process, the U.S. Food and Drug Administration approved ceritinib. The next 3 weeks included a flurry of activity as I worked tirelessly to gain access to the drug for Ms. X. I vividly remember the day I received a call from one of the many specialty pharmacies I had reached out to, informing me that they had access to the drug and would be able to ship a prescription to Ms. X the next day! I could barely contain my excitement as I called Ms. X to give her the great news. The joy I felt that day had nothing to do with me or the time I had spent working to gain access to this drug for Ms. X. The emotions I experienced—excitement, joy, and relief—were focused solely on Ms. X.

Prior to this experience, I did not fully appreciate all of the challenges surrounding the prescribing of oral chemotherapy or realize how vital the role of a pharmacist could be in the process. Providing appropriate clinical review and patient education were obvious needs, but navigating a complex network of insurance providers and specialty pharmacies were challenges I had not anticipated. As the clinical pharmacist working in the outpatient oncology clinic, I was in an ideal position to coordinate the efforts of many members of the healthcare team in the provision of oral chemotherapies. The physician looked to me to assist in procurement of this new oral chemotherapy agent. The patient and her family counted on me to answer questions and provide education about her new medication. The insurance company and specialty pharmacies valued my ability to act as a liaison for both the patient and physician.

In recent months, I have transitioned to a new position within my institution that allows me to focus my efforts on the care of patients receiving oral chemotherapy. As the oral chemotherapy clinical pharmacist, I serve as a liaison between the patient, physician, insurance company, and specialty pharmacy. This unique position provides me with the ability to counsel patients, coordinate prior authorizations and refills, and collaborate with physicians to ensure appropriate monitoring and dose adjustments of oral chemotherapy. I value the relationships I have developed with my patients and their families, and I look forward to going to work every day because I know I will significantly affect the care of my patients. My experience with Ms. X allowed me to see the need for a pharmacist devoted to oral chemotherapy management, and I count myself incredibly lucky to have been afforded the opportunity to turn my vision into a reality.