Pharmacists Are Key Care Providers for Patients with CLL

Although pharmacists can often be “behind the scenes,” they play a vital role in many aspects of cancer care, particularly for patients with chronic lymphocytic leukemia (CLL).¹ Broadly speaking, pharmacists are responsible for ensuring accurate dispensing and safe administration of medications, including oral, injected, and infused drugs. Pharmacists who choose to specialize in cancer care work with doctors and nurses to ensure that patients understand their medications and are treated accurately and safely.

Before a patient with CLL starts taking a new treatment, pharmacists are responsible for reviewing the patient’s current medication list for drug–drug interactions, as well as identifying possible challenges with dosage forms.¹ Sometimes, patients have difficulty swallowing tablets or capsules. Other patients might not want to receive injections or infusions. For patients with CLL, accurate review of drug interactions is especially important. CLL is often diagnosed in older people who often have one or more chronic conditions that require oral or injected medications.¹ After an oncologist and patient agree on a treatment plan, pharmacists help with practical issues related to drug purchasing and access. Oral cancer treatments can be quite expensive, such that patients need financial aid to afford them. Pharmacists work with financial coordinators, social workers, insurance company–based caseworkers, and pharmaceutical company–based drug access specialists to help patients receive the medications that are most appropriate for them.¹ Drug manufacturer-administered assistance programs and private charities may also be used to help support patients who cannot pay the out-of-pocket cost of their cancer treatment.²

After treatment is underway, pharmacists are well-positioned to monitor patients to ensure that they are taking their oral cancer drugs as directed. Using information about refill timing, pharmacists can talk with patients and families to learn whether the drug’s out-of-pocket cost or side effects are affecting the patient’s ability to stick with the recommended treatment schedule.¹

Pharmacists also ensure that patients with cancer receive antibiotics or antiviral medications necessary to prevent infections. Each type of treatment option for CLL, including anti-CD20 monoclonal antibodies and oral targeted agents, has distinct recommendations for infection prevention.3 Cancer care teams also look to pharmacists for guidance when making dose changes, considering treatment alternatives, offering patients a treatment break, and considering the best approach to supportive care.¹

Together with doctors, advanced practice providers, nurses, and other support staff, pharmacists bring unique perspectives and medication-related expertise to the care of patients with cancer. For patients with CLL, pharmacist collaboration is valuable in preventing drug–drug interactions and managing side effects, as well as helping with logistics and access to expensive drugs.

References

1. Chen KY, Brunk KM, Patel BA. Pharmacists’ role in managing patients with chronic lymphocytic leukemia. Pharmacy (Basel). 2020;8:pii.E52.
2. Mitchell A, Muluneh B, Patel R, Basch E. Pharmaceutical assistance programs for cancer patients in the era of orally administered chemotherapeutics. J Oncol Pharm Pract. 2018;24:424-432.
3. Tadmor T, Welsau M, Hus I. A review of the infection pathogenesis and prophylaxis recommendations in patients with chronic lymphocytic leukemia. Expert Rev Hematol.2018;11:57-70. Erratum in Expert Rev Hematol. 2018;11:ix.