S2 Ep56: Insights from a Pharmacy Times Peer Exchange: How to Talk the Talk

Summary

Pharmacy Focus: Insights from a Pharmacy Times Peer Exchange – How to Talk the Talk

Release Date: June 3, 2025

In the final episode of Pharmacy Times' peer exchange feature series on antibody-drug conjugates (ADCs) and HER2-positive breast cancer, experts delve deep into effective patient communication, managing treatment side effects, interdisciplinary collaboration, and addressing social determinants of health that impact patient adherence and outcomes.

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1. Effective Communication with Patients about ADC Therapy

Dr. Hunter opens the discussion by emphasizing the importance of clear communication regarding ADC therapy. Prior to beginning treatment, his institution employs a formalized process that includes a dedicated clinic appointment led by a clinical pharmacy specialist. This session focuses on comprehensive chemotherapy education tailored to each patient's needs.

"I usually will extract the respective clinical trial data into some of the paperwork, make it into a more digestible form so the patient is actually seeing what the benefit would be, but more in layman's terms."
— Dr. Hunter [01:09]

Dr. Hunter has developed handouts for each treatment within his subspecialty, ensuring that patients understand both the potential benefits and the associated risks of side effects. This approach addresses common patient concerns, especially in metastatic settings where patients question the tangible benefits of their treatment amidst discussions of side effects and treatment duration.

2. Managing Side Effects and Interdisciplinary Approaches

The conversation shifts to managing the complex side effect profiles of ADCs. Dr. Taraba highlights the importance of follow-up visits where side effects are monitored and managed actively.

"Working with them to help in management and knowing what to expect and kind of letting them know this is kind of a work in progress throughout their different treatments."
— Dr. Taraba [03:09]

Dr. Hill expands on this by discussing the necessity of an interdisciplinary approach. Collaborating with oncology nurses, advanced practice providers, pulmonologists, cardiologists, and ophthalmologists ensures comprehensive monitoring and prompt management of side effects. He underscores the value of strong interdepartmental relationships to facilitate timely specialist consultations, especially critical in rural settings where patients may travel long distances for care.

"Having those good relationships with those other teams within your institution can be really helpful so that when a potential side effect does show up, you have a person to reach out to."
— Dr. Hill [04:52]

The Moderator reinforces these points, highlighting the role of clinical pharmacists in tailoring patient experiences based on their specific side effects and advocating for an individualized approach to toxicity management.

3. Addressing Social Determinants of Health and Adherence Barriers

Transitioning to non-clinical challenges, Dr. DeMarco addresses how social determinants of health (SDOH) significantly affect patient adherence to ADC therapies. He notes that almost every patient faces some barrier related to SDOH, which can overlap and compound challenges related to treatment costs, accessibility, and insurance coverage.

"What is the point of me prescribing a med that they should use for their supportive care if they can't afford that prescription co-pay on top of their medical visit co-pay on top of their infusion co-pay."
— Dr. DeMarco [08:48]

Dr. DeMarco emphasizes the critical role of pharmacists in identifying and mitigating these barriers. Although his institution has a financial advocacy team, the increasing costs of healthcare necessitate a more robust involvement from pharmacists to find cost-effective medication alternatives and supportive care options.

4. Innovative Initiatives to Overcome Barriers

Responding to the challenges outlined by Dr. DeMarco, Dr. Hunter shares his work at Texas Southern and the Memorial Hermann Cancer Center, where they utilize the Phoenix Toolkit—a validated tool for assessing SDOH in breast cancer patients. This initiative aims to identify specific barriers affecting treatment efficacy and patient outcomes.

"The research that I do is really trying to identify which specific social determinants of health are affecting metastatic breast cancer patients most often, and what are the outcomes of those effects and what are ways that we can possibly support them in a better way."
— Dr. Hunter [10:29]

Dr. Hunter’s efforts focus on understanding how logistical issues, such as clinic visit schedules and transportation limitations, impact treatment adherence. By addressing these practical barriers, his team seeks to ensure that disparities in treatment outcomes due to SDOH are minimized.

5. Final Thoughts and Future Directions

As the discussion winds down, each expert shares their perspectives on the evolving landscape of breast cancer treatment and the integral role of pharmacists:

• Dr. Taraba expresses excitement about the rapid advancements in breast cancer therapies and the expanding role of pharmacists in toxicity management.

  "It's an exciting time and excited to see what's. What's to come."
  — Dr. Taraba [13:31]

• Dr. Hill highlights the importance of clinical pharmacists' specialization and supporting one another within the profession to keep pace with the evolving treatment paradigms.

  "Continuing to kind of think about ways that we can support each other within the clinical pharmacy profession instead of the hemonk space."
  — Dr. Hill [14:07]

• Dr. Hunter underscores the significance of minimizing toxicity while maximizing treatment efficacy, particularly in the metastatic setting, to enhance patient quality of life and treatment longevity.

  "The more these agents come about, the less toxicity they have versus the efficacy being maintained or better than what you have. Traditional chemotherapy just push us as the practitioners in a better space to take care of our patients."
  — Dr. Hunter [15:09]

• Dr. DeMarco concludes with optimism about future advancements and the continued importance of addressing social determinants to improve patient outcomes.

  "I'm just, you know, really thankful to be here. I learned a lot from all, all of my brilliant colleagues here and just really excited to see what happens in the future."
  — Dr. DeMarco [16:16]

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Conclusion

This episode of Pharmacy Focus provides a comprehensive exploration of the multifaceted approach required to optimize patient care in HER2-positive breast cancer treatment with ADCs. From effective patient communication and managing complex side effects to addressing socio-economic barriers, the discussion underscores the pivotal role of pharmacists and interdisciplinary collaboration in enhancing treatment outcomes and patient quality of life.

For more insights and detailed discussions, listen to the full episode here.

Transcript

[Dr. Hunter]

Foreign.

[Alex Gerlach]

Hi, everyone. You're listening to Pharmacy Focus Oncology Edition, where we bring you the latest trends in the oncology pharmacy space. I'm your host, Alex Gerlach. And today I'm bringing you the final episode in our Pharmacy Times peer exchange feature series on antibody drug conjugates and HER2 breast cancer. In this segment, our pharmacy experts will share how they have discussions with patients about treatment and interdisciplinary approaches to managing side effects to enhance patient care.

[Moderator]

All right, so I know that we've kind of harped on toxicities associated with these agents, how we're managing what we're doing, but when we think about how that translates to a conversation with a patient, I'd be curious to know, Dr. Hunter, at your institution, how are you effectively communicating with patients about ADC therapy? So how are you conveying, you know, risks, benefit and treatment regimens to patients?

[Dr. Hunter]

Sure. So, so even prior to going to epic, we had a formalized process involving the clinical pharmacy specialist on a respective service for them to have a, a clinic appointment, specifically to go through the chemo teaching, which I'm sure everybody in the meeting today is involved with. But in essence with that, I usually will extract the respective clinical trial data into some of the paperwork, make it into a more digestible form so the patient is actually seeing what the benefit would be, but more in layman's terms. And I have made a handout for pretty much every treatment that we have on my particular subspecialty, they, that reflects that, that type of information. So that when we're going in a room, because a lot of times there's, especially in a metastatic setting, there's questions about how does this actually benefit me? Because after you talk about all those side effects and you tell them that you're going to be on this drug for X amount of time or you're going to be on it as long as we can keep you on it until you need to take a break or you become fatigued or we have a unwanted side effect, a lot of people want to know, why am I actually doing this? So the incorporation of actual clinical trial data into patient information in, in layman's terms, if you will, is, is probably one of my top approaches. I think most people, most families appreciate that, especially whether they're, you know, have a healthcare background or they are a person that, you know, regardless of job title or job function, the, the, the information is digestible. So I think the communication piece and what we're, what we're doing there is really focused on making sure they understand not only the highest risk of side effects but also the benefit theoretically that this, this medication is going to do for them in the long run if they go forward with the treatment.

[Moderator]

Thank you. It's a very helpful answer. Anyone else doing anything differently or anything that they found to be helpful in terms of when discussing not only efficacy but side effects and management with patients within their clinic space.

[Dr. Taraba]

For us, we're seeing them at the follow up visits. So a lot of that has been discussed up front. But really, you know, as patients are developing some of these side effects, working with them to help in management and you know, knowing what to expect and kind of letting them know this is kind of a work in project progress throughout their different treatments and being able to adjust some of those, you know, antiemetics kind of screening for the, you know, ild, pneumonitis, you know, are they having symptoms of that? Do we need to order a scan, those type of things and then just ensuring some of that cardiac monitoring is, is getting done as well as those. So like I said, more of a, you know, we do more of a, you know, on treatment type of follow up type of thing. But again, kind of reinforcing some of the things that Dr. Hunter alluded to as well at those visits.

[Dr. Hill]

Perfect.

[Moderator]

Yeah, I've, I found that it's really been helpful as we have more complex toxicities associated with these agents that really kind of meeting patients where they are discussing these are the side effects that you may have, this is how we can prevent them, this is how we can manage them. Trying to really when we think about patients on their therapies, trying to tailor them to the experience, the side effects that they're having. So I think sometimes that can certainly be helpful too. Kind of going back to our toxicity profiles and we've talked about ild, we've talked about ophthalmic side effects, we've talked a lot about the side effects that we see with these agents. I think, Dr. Hill, what are your thoughts in terms of interdisciplinary approaches to care that can help optimize some of the outcomes for these patients? I think you've discussed this a little bit earlier but would love to know your thoughts here as think about collaboration and interdisciplinary measures.

[Dr. Hill]

Thank you. I think we've, like you mentioned, we've talked a lot about the side effect profile of these agents and what we're doing to manage them. But I think just thinking about how the most effective way to be able to both monitor and manage these side effects is going to be kind of taking Advantage of everyone on our teams. Right. So from like an oncology clinic standpoint, utilizing our oncology nurses and our advanced practice providers, as well as our pharmacists, to both monitor and manage all of these side effects that could potentially happen for these patients. And then, as you alluded to, outside of the oncology clinic, we're also working a lot with our colleagues in our pulmonology space and our cardio oncology space and now our ophthalmology space. And so I think for each institution, that might look a little bit different, But I think what's important is educating the providers in those other areas of what sort of side effects can happen from these medications, as well as the importance of the timeliness of not only their initial assessments, but then getting them in to be seen when we are concerned that a side effect is appearing. I think all of us are probably very well aware that if you just put a referral into the computer, they'll get scheduled for three or more months out with a. With a specialist. And so having those good relationships with those other teams within your institution can be really helpful so that when potential side effect does show up, you have a person to reach out to, to say, hey, we have this person. This is what we're seeing. Can you see them? Because that's going to get you a lot further than simply putting in the referral and then it getting scheduled three months from now. And they really need to be seen much quicker and much more acutely than that. And so that's kind of what we try to do. We try to work very closely and have good relationships with them that way. When. When patients do need to be seen fairly quickly, it's a lot easier. Easier to be able to do that. Our state is very rural, so a lot of our patients are traveling very, very far, like four or more hours for their treatment sometimes. And so I'm very appreciative of our colleagues in those other areas. When we kind of say, can you see them on this day? Very often, the answer is yes, because they. They also know what our patient population looks like. And so I'm sure those are challenges that lots of institutions are facing. And there's no one right answer to do it, but definitely something, as Dr. Taraba mentioned, that's a work in progress with all. All of these agents is. Is kind of managing some of these side effects.

[Moderator]

Yeah. Thank you. I think that's a great explanation of not only how we can work with, you know, interdisciplinary teams within our clinic, but also other providers in different departments. But I think it really brings to point also the roles and responsibilities and possibilities of clinical pharmacist. We think about oncology trained pharmacists and specifically thinking about toxicity, all of the opportunities that we have to really integrate ourselves within clinic and the importance of patient care here. So I think you guys have done a great job so far of showing like why we're so special. So thank you guys for that. All right. And then finally, I do think we've talked about this a little bit, but I would love to hear more discussion on this because I think we've talked about limitations for patients on clinical trials and barriers and social determinants of health. But I would love to know, you know, patients receiving antibody drug conjugates at your practice experiencing adherence barriers due to social determinants of health treatment, cost, accessibility, insurance coverage. We know that, you know, these are some of the non clinical issues that directly impact adherence and availability for treatments and overall outcomes for these patients. So they are so important. Dr. DeMarco, I would love to hear your thoughts on this.

[Dr. DeMarco]

Thank you. I think this is such an important question and I'm so glad that we are kind of bringing that up here because I'd be hard pressed to pick one patient of mine that doesn't have some type of barrier related to a social determinant of health. And I'm sure that you would all agree. And I think what we know is that these social determinants of health are not silos. They overlap. And patients will often experience barriers in more than one way. And it's become something that everybody needs to think about. I mean, I think traditionally, even as I was in school, we weren't thinking about this in pharmacy school. But this is something that is coming up in every single one of my conversations with my patients. And you know, what is the point of me prescribing a med that they should use for their supportive care if they can't afford that prescription co pay on top of their medical visit, copay on top of their infusion co pay. So these are definitely things that we need to think about. And we do see barriers. I mean, we have an incredible financial advocacy team that is really working to close those gaps. But there's only three people on our team for the entire institution and the cost of healthcare is only going up. So this is kind of transcending financial advocacy, it's transcending social work and case management. And I think it is a role that pharmacists can play. We can do our best to figure out what is the most effective, but still the least expensive medication that we can provide, especially when it comes to supportive care options. And I just, I think there is a lot of work that still needs to be done here. Dr. Hunter, you have told me before what you're doing in Texas, and I think the world should hear it. Do you want to give us kind of a rundown of the work that you're doing over there?

[Dr. Hunter]

Absolutely, Dr. DeMarco, thank you. And yeah, this is by far like the, I guess, the apple of my eye when you think about what I've been focusing on from a faculty perspective at Texas Southern and at the cancer center. I practice at Memorial Herman, funded by the National Institutes of Health. We are using the Phoenix. It's a Phoenix toolkit, which is actually a validated social determinants of health toolkit to assess all of my breast cancer patients different barriers that they will possibly. Will possibly show up and how it's actually affecting efficacy, how it's affecting outcomes. I think something. And to give you an example, we were talking about the cetuzumab and how we give growth factors. Have a patient who can only come to the clinic on Thursdays, and then coming to the clinic on Thursdays means that you only have the option to give the growth factor on Fridays if you have a Monday through Friday clinic. So that type of limitation, as far as the transportation is concerned, does have a possibility to affect how we keep them on track, how we keep them on schedule, and what growth factors we give. So things that have nothing to do with biological changes. Trope 2 Her 2 Low it's just, just, just like life in general. So the, the research that I do is really trying to identify which specific social determinants of health are affecting metastatic breast cancer patients most often, and what are the outcomes of those effects and what are ways that we can possibly support them in a, in a better way for them to be able to receive their treatment. And let's not have these disparities in outcomes solely off of a social determinant of health. So something that I think we as pharmacists aren't always involved in, but something that we're like, primed and ready with our position, having the rapport and the communication level that we have with the patients to get involved with and help with social determinants of health, identify them as early as possible and ultimately address them, which will address. Which will benefit them from a efficacy standpoint. Just as just as much as, you know, us prescribing a medication and actually coming to get it.

[Moderator]

I think you're exactly right. I think both of you have outlined and discussed some of the, you know, so important of. Of having and being aware of these barriers within clinics and the importance of resources that can help these patients. So I think that's something that we especially need to focus on. And Dr. DeMarco, as you mentioned, it really should be a part of curriculum. When we think about pharmacy students, health care students, anyone, I think that's involved in the clinical space really should have some level of training and understanding of some of these barriers and social determinants of health that can directly impact outcomes for so many patients. Well, I would like to thank you all for this very rich and informative discussion. It's been a great time. I've really enjoyed getting all of your perspectives and discussing so many of these relevant topics in this ever evolving treatment paradigm for breast cancer. Before we conclude, I would like to get final thoughts from each of you. So we'll start with Dr. Taraba.

[Dr. Taraba]

Thank you. I think it's a very exciting time in breast cancer. I think there's just a number of agents coming out and being studied and trying to answer some of these questions that we. It's moving so fast that we're unable to. I think also too, the side effect profiles of the newer antibody drug conjugates. I think it's great opportunity for pharmacists to, as you alluded to earlier, just really being heavily involved in some of those toxicity management and those type of things. So again, really exciting time and excited to see what's. What's to come.

[Moderator]

Thank you, Dr. Hill.

[Dr. Hill]

I definitely agree with Dr. Taraba that that was going to be my thought as well. I think we've talked a lot about the different things that we're doing at our institutions and in our clinics to help our patients starting on these therapies. And so I think it's just a really good example of all of the roles that clinical pharmacists can have in oncology clinics. And I think potentially thinking of ways that those of us that are able to subspecialize in particular areas can continue to help our clinical pharmacist colleagues that work in less specialized areas. I could not keep up with every single cancer that is out there. It is hard enough just to keep up with breast cancer. So continuing to kind of think about ways that we can support each other within the clinical pharmacy profession instead of the. The hemonk space.

[Moderator]

Awesome. Yes. Echo all of those things. Dr. Hunter.

[Dr. Hunter]

Yeah, definitely have certainly Thoroughly enjoyed myself talking to you all. Tonight has been a robust conversation. I think we've, you know, touched on so many things and, you know, honestly, you know, they're with the data being so new, it's probably the first conversation actively anybody has had about some of these things because we're talking about situations that just occurred two days ago. So this is right on time. It's very up to date. So I'm glad to be a part of it. And I think that for our patients, the more options become available. In this sense, when you really think about side effect profiles, we talked about what manageable side effect profile is much different. And I think the longevity, especially in this metastatic space, is what we're looking for. We're looking for how long can a patient tolerate it and what kind of efficacy as far as mileage can we get out of it. And the more these agents come about, the less toxicity they have versus the efficacy being maintained or better than what you have. Traditional chemotherapy just push us as the practitioners in a better space to take care of our patients.

[Moderator]

Well said. And Dr. DeMarco, yeah, I don't know.

[Dr. DeMarco]

If I have anything else to add after those three brilliant thoughts, but I'm just, you know, really thankful to be here. I learned a lot from all, all of my brilliant colleagues here and just really excited to see what happens in the future.

[Moderator]

Thank you all again and to our viewing audience, we hope you found this Pharmacy Times peer exchange to be useful and informative.

[Alex Gerlach]

Thanks for listening to this final episode in our ABCs and HER2 breast cancer series. If you loved it and you want more, you can find the videos of this peer exchange on our [e-mail] we have another exciting episode coming up at the end of June. I spoke with Alan Rappert, a resident of St. Louis, Missouri, who was diagnosed with stage four squamous cell carcinoma and given few treatment options and a poor prognosis. Then he met Dr. Jason Williams, founder of the Williams Cancer Institute. Through the use of intratumoral immunotherapy, Dr. Williams was able to turn the tide for Allen. So don't go far and stay tuned to hear the full story from Alan and Dr. Williams themselves. Take care. I'll see you next time.