HOPA Now

HOPA Now is the official podcast of the Hematology/Oncology/Pharmacy Association, an organization dedicated to supporting pharmacy practitioners and promoting the advancement of Hematology/Oncology/Pharmacy to optimize the care of individuals impacted by cancer.

These educational podcasts are part of our BCOP Preparatory and Recertification Course, which is designed to prepare oncology pharmacists preparing to sit for the BCOP Certification Exam, as well as meet the BPS requirement to complete a BCOP Preparatory/Recertification Review Course.

In this episode of HOPA Now, Dr. Neelam Patel details the epidemiology, pathophysiology, and staging of breast cancer, one of the most commonly diagnosed cancers in American women. She offers data, diagnosis percentages, and survival rates for breast cancer patients; shares common risk factors, presentation, and common histologies of breast cancer; and details prognostic factors and recent changes to adjuvant treatment guidelines.

In this episode you will learn:

Breast Cancer Fundamentals

• Data, diagnosis percentages, and survival rates surrounding breast cancer
• Common germline mutations in breast cancer patients
• Risk factors regarding breast cancer, including gender, family history, and estrogen exposure
• Common presentation of breast cancer masses and common histologies of breast cancer
• Tumor size, nodal status, and presence of metastatic disease and other prognostic factors including ER/PR and HER2 status and grade of tumors
• Recent changes to adjuvant treatment guidelines

Mentioned in This Episode:

HOPA

Quotes:

“Breast cancer masses usually present as a painless lump that is self-detected or found on screening mammograms.” — Dr. Neelam Patel

“In recent years the AJCC updated their guidelines to include other prognostic factors such as ER/PR and HER2 status and grade of the tumor.” — Dr. Neelam Patel

“One thing to remember is this is a prognostic stage and is more to help the clinician and patient understand what their prognosis is, and does not necessarily dictate treatment.” — Dr. Neelam Patel

HOPA Now is the official podcast of the Hematology/Oncology/Pharmacy Association, an organization dedicated to supporting pharmacy practitioners and promoting the advancement of Hematology/Oncology/Pharmacy to optimize the care of individuals impacted by cancer.

These educational podcasts are part of our BCOP Preparatory and Recertification Course, which is designed to prepare oncology pharmacists preparing to sit for the BCOP Certification Exam, as well as meet the BPS requirement to complete a BCOP Preparatory/Recertification Review Course.

In this episode of HOPA Now, Dr. Neelam Patel highlights various drug regimens and recommendations including adjuvant Anti-HER2 therapy, PIK3CA, characteristics of CDK4/6 inhibitors, and considerations for adjuvant chemotherapy. She details the key role that pharmacists can play in helping manage potential toxicities and ends with recommendations on when to stop therapy and how to employ supported care.

In this episode you will learn:

Breast Cancer Top 10 Clinical Pearls

• Utilizing adjuvant Anti-HER2 therapy based on residual disease versus no residual disease
• The relationship between PIK3CA and the place of Alpelisib in therapy
• Mechanical characteristics of CDK4/6 inhibitors, dosing recommendations, recent changes, and its place in therapy
• NCCN guidelines for using endocrine therapy versus cytotoxic therapy in metastatic breast cancer
• Adjuvant chemotherapy for hormone receptor-positive HER2-negative disease and findings of the TAILORx study
• PARP inhibitors used in treating breast cancers and adjuvant Capecitabine
• Bone modifying therapy and drug dosing recommendations
• The evaluation of metastatic disease, when to stop therapy, and supported care

Mentioned in This Episode:

HOPA

Tweetables:

“Ado-trastuzumab emtansine is recommended in the adjuvant setting if patients have residual disease following neoadjuvant HER2 targeted therapy.” — Dr. Neelam Patel

“Close monitoring and management is one of the key roles that we can play as pharmacists in helping manage these toxicities.” — Dr. Neelam Patel

“If a patient is symptomatic and requires quick disease control, cytotoxic chemotherapy may be recommended.” — Dr. Neelam Patel

“In general, chemotherapy is chosen based on patient-specific risk factors.” — Dr. Neelam Patel

HOPA Now is the official podcast of the Hematology/Oncology/Pharmacy Association, an organization dedicated to supporting pharmacy practitioners and promoting the advancement of Hematology/Oncology/Pharmacy to optimize the care of individuals impacted by cancer.

These educational podcasts are part of our BCOP Preparatory and Recertification Course, which is designed to prepare oncology pharmacists preparing to sit for the BCOP Certification Exam, as well as meet the BPS requirement to complete a BCOP Preparatory/Recertification Review Course.

In this episode of HOPA Now, Dr. Lisa Holle offers an overview of genitourinary cancers, including bladder, kidney, and testicular cancers, their causes and risk factors, appropriate treatment options, and standard survival rates.

In this episode you will learn:

Genitourinary Cancers Fundamentals

• Key differences between the anatomy and pathophysiology of muscle and non-muscle invasive bladder cancers
• Survival rates of bladder cancer patients
• Various types of kidney cancers and their appropriate treatments
• The cause of early-stage prostate cancer and the inhibitors of normal growth of the prostate
• Possible mechanisms of early-stage prostate cancer
• Understanding testicular cancers as germ cell tumors, their subcategories, and common risk factors

Mentioned in This Episode:

HOPA

Quotes:

“Understanding the pathophysiology of bladder cancer relies on the understanding of the anatomy of the bladder.” — Dr. Lisa Holle

“The treatments for clear cell carcinoma are focused on targeting the pathways that are affected.” — Dr. Lisa Holle

“Most testicular cancers are histologically categorized as germ cell tumors.” — Dr. Lisa Holle

 HOPA Now is the official podcast of the Hematology/Oncology/Pharmacy Association, an organization dedicated to supporting pharmacy practitioners and promoting the advancement of Hematology/Oncology/Pharmacy to optimize the care of individuals impacted by cancer.

These educational podcasts are part of our BCOP Preparatory and Recertification Course, which is designed to prepare oncology pharmacists preparing to sit for the BCOP Certification Exam, as well as meet the BPS requirement to complete a BCOP Preparatory/Recertification Review Course.

In this episode of HOPA Now, Dr. Bernard Marini reviews key background information on acute leukemias and MDS. He covers the key mutations, common abnormalities, characteristics, and outcomes of both AML and ALL, and offers diagnosis requirements, exceptions, and guidelines regarding various treatment options.

In this episode you will learn:

Adult Acute Leukemias & Myelodysplastic Syndrome Fundamentals

• MDS median age at diagnosis, common risk factors including exposure to radiation and unbalanced chromosomal changes, and the prognostic scoring system
• Secondary AML characteristics and considerations
• AML diagnosis requirements, exceptions, and NCCN guidelines regarding ELN risk stratification
• FLT-3’s role as both an important predictive and prognostic biomarker
• Characteristics and outcomes of ALL as both a pediatric and adult malignancy
• Common abnormalities of ALL, including the presence or absence of the Philadelphia chromosome
• Understanding IKZF13 as a critical regulator of lymphoid differentiation
• Alternate methods and recommendations for testing measurable residual disease 

Mentioned in This Episode:

HOPA

Quotes:

“For the diagnosis of AML, more than 20% blasts are required unless certain cytogenetic abnormalities are present.” — Dr. Bernard Marini

“FLT-3 is an important predictive and prognostic biomarker.” — Dr. Bernard Marini

“We typically think of ALL as a pediatric malignancy, however, 40-45% of all cases occur in adult patients.” — Dr. Bernard Marini

“MRD at almost every time point is prognostic for relapse in overall survival in ALL.” — Dr. Bernard Marini

HOPA Now is the official podcast of the Hematology/Oncology/Pharmacy Association, an organization dedicated to supporting pharmacy practitioners and promoting the advancement of Hematology/Oncology/Pharmacy to optimize the care of individuals impacted by cancer.

These educational podcasts are part of our BCOP Preparatory and Recertification Course, which is designed to prepare oncology pharmacists preparing to sit for the BCOP Certification Exam, as well as meet the BPS requirement to complete a BCOP Preparatory/Recertification Review Course.

In this episode of HOPA Now, Dr. Bernard Marini highlights the main clinical pearls of adult acute leukemias and myelodysplastic syndrome, including unique factors that affect dosing, drug monitoring factors, and guidelines, and the oncologic stewardship and dosing caps for various drug usage.

In this episode you will learn:

Adult Acute Leukemias & Myelodysplastic Syndrome: Top 10 Clinical Pearls

• There are unique lenalidomide sensitivities for patients with deletion 5q.
• Thrombopoietin mimetics and growth factors for patients with MDS
• Guidelines for use of potent ASAL antifungals
• Denosumab azomycin and oncologic stewardship and dosing caps
• Secondary AML and oncologic stewardship outcomes and alternatives
• Characteristics and management of IDH inhibitors and differentiation syndrome
• Asparaginase and therapeutic drug monitoring and a comparison of adult versus pediatric patients reactions and survival rates
• Blinatumomab and inotuzumab use and outcomes in patients with less disease burden
• Balancing safety and efficacy of TKIs in patients with ph positive ALL

Mentioned in This Episode:

HOPA

Quotes:

“Patients with deletion 5q are uniquely sensitive to lenalidomide.” — Dr. Bernard Marini

“Given the flaws in the alpha trial and the meta-analysis, this is potentially a place for oncologic stewardship in avoidance in risk in a drug with no overall survival benefit.” — Dr. Bernard Marini

“IDH inhibitors in AML are fascinating agents.” — Dr. Bernard Marini

“Adults and young adult patients have significantly worse survival rates compared to pediatric ALL counterparts.” — Dr. Bernard Marini

HOPA Now is the official podcast of the Hematology/Oncology/Pharmacy Association, an organization dedicated to supporting pharmacy practitioners and promoting the advancement of Hematology/Oncology/Pharmacy to optimize the care of individuals impacted by cancer.

In this episode of HOPA Now, Nelly Adel, PharmD, BCOP, BCPS and Deanna Argentieri, PharmD, aim to identify the basic requirements to have students on an oncology APPE site, illustrate the various structures for APPE rotations, set expectations for students versus residents on same rotation, highlight the requirements for delivering and providing timely and appropriate feedback to enhance student performance in an oncology setting with a focus in the ambulatory setting, and demonstrate the essential roles of an oncology pharmacist career in Oncology.

This podcast is part of a General Pharmacy Education Self-Paced Study Module in HOPA Learn. To view the full course and claim credit, please visit HOPA Learn and register for the course.

In this episode, you will learn:

Guidelines for establishing an oncology site

• Determine the affiliations established between the site where you are practicing and the school of pharmacy.
• Considerations include student access to a computer, distance from the university, access to EMRs, and the duration of the rotation.
• Qualifications of preceptors and student interest in oncology
• Article information outlining the process and guidelines Creighton University pharmacists and faculty used to establish an oncology elective
• Understand the specific school curriculum and guidelines for APPE.
• Identify prior student experiences and rotations to determine interest.

Setting expectations for students in their rotations

• Communication, interest, and a clearly-defined plan is a critical step to understanding what the student is hoping to get out of the rotation.
• Investing time in students will ensure that you have their best interests in mind.
• Recommendations for syllabus details that will clearly outline your expectations.
• Taking on students is a time commitment from everyone, but setting expectations will result in a greater payoff in the end.

Handling students vs. residents

• Many practice sites have students and residents — be sure to delineate between student and resident expectations.
• The benefits of providing layered learning as an effective way to integrate multiple learners into a practice setting.
• Clearly define the goals and objectives of the rotation, preceptor, and learner.
• Students and residents need to have clear and distinct differences between their objectives and expectations, including in their rubrics.
• Students and residents should NOT have access to the same information based on their differing levels of verification.

Feedback for students vs. residents

• Feedback is crucial in learner growth and essential to help students develop the necessary clinical skills for practice.
• Feedback should be the backbone of the learning experience.
• Feedback can be formal or informal but should be done regularly to assess performance and set future goals and expectations.
• Ongoing feedback helps to encourage interest and motivation and has been linked to satisfaction of the preceptor.
• Feedback allows for self-reflection and the ability to assess their impact on the team/service.
• Ideas for giving effective feedback that is descriptive, adapted to the situation at hand, succinct, and include first-hand knowledge
• Ineffective feedback that should be avoided in all situations

Role Model — Careers in Oncology

• Role modeling is one of the crucial roles of a preceptor as it demonstrates the skills that a pharmacist performs in a given time as well as shows to the student how they can practice in the future.
• Precepting can give students various insights on how an oncology pharmacist can practice in any setting, including inpatient and outpatient settings.
• Roles can extend to hospital satellites, a clinical specialist, a manager, a coordinator, a faculty, and more.
• A variety of options for practice can vary among several hospital systems.

Mentioned in This Episode:

HOPA

Literature for this Episode:

Nystrom KK, Pick AM. An oncology pharmacy practice elective course for third-year pharmacy students. Am J Pharm Educ. 2013; 77(1) Article 12.

Bates JS, Buie LW. A study of layered learning in oncology. Am J Pharm Educ. 2016; 80(4) Article 68.

Hall A, Miguel A, Weitzel K. Providing feedback to learners in outpatient and ambulatory care practice settings Curr Pharm Teach Learn. 2015; 7:348-356

Quotes:

“There are many opportunities to teach a student on rotation, not only about the oncology topics but insights into future career options.” — Nelly Adel

“Investing time in students from the beginning of their practice experience really helps to establish that trust and assurance that you have their best interests in mind.” — Deanna Argentieri

“Keep in mind that the senior preceptor is the major driver of pharmacy services.” — Deanna Argentieri

“For preceptors, it’s important to note that when discussing topics or patient presentations there is a variation between what a resident can see versus a student.” — Nelly Adel

“Feedback should be the backbone of the student’s learning experience. It should be informal, given regularly, and in a timely manner.” — Deanna Argentieri

HOPA Now is the official podcast of the Hematology/Oncology/Pharmacy Association, an organization dedicated to supporting pharmacy practitioners and promoting the advancement of Hematology/Oncology/Pharmacy to optimize the care of individuals impacted by cancer.

These educational podcasts are part of our BCOP Preparatory and Recertification Course, which is designed to prepare oncology pharmacists preparing to sit for the BCOP Certification Exam, as well as meet the BPS requirement to complete a BCOP Preparatory/Recertification Review Course.

In this episode of HOPA Now, Brian Doe offers an overview of the fundamentals of lymphomas, including biopsy recommendations, histological determinations, and screenings that are commonly administered during treatment. He highlights the indicators for starting follicular lymphoma treatment and shares guidelines and criteria for administering high dose methotrexate, and concludes with information regarding various B-cell lymphomas and mycosis fungoides.

In this episode you will learn:

Lymphomas: Top 10 Clinical Pearls

• Biopsy recommendations for making an accurate diagnosis
• Ensure necessary workup is completed and considered prior to initiating treatment
• Proper management and prevention of Hepatitis B reactivation
• Understanding Rituximab and the biosimilars and NCCN recommendations
• Indications for starting follicular lymphoma treatment
• Prevention of toxicities in HD methotrexate and indicators for alternate treatment options
• Dose-adjusted R-EPOCH treatment guidelines and criteria
• Prevention of bacterial and other infections
• CNS prophylaxis for patients with diffuse large B-cell lymphoma
• Maximizing patient care for patients with various B-cell lymphomas and mycosis fungoides

Mentioned in This Episode:

HOPA

Quotes:

“It is important to delay the use of corticosteroids until obtaining the biopsy when possible as lymphomas are sensitive to steroids and specimens may be affected.” — Brian Doe

“If Hepatitis B surface antigen or core antibody screening is positive, a consultation to a gastroenterologist or infectious disease expert is recommended.” — Brian Doe

“When we think about late-stage disease, we sometimes immediately jump to consider treatment, however not all patients benefit and may be better managed with the watchful waiting approach to minimize treatment-related toxicities.” — Brian Doe

HOPA Now is the official podcast of the Hematology/Oncology/Pharmacy Association, an organization dedicated to supporting pharmacy practitioners and promoting the advancement of Hematology/Oncology/Pharmacy to optimize the care of individuals impacted by cancer.

These educational podcasts are part of our BCOP Preparatory and Recertification Course, which is designed to prepare oncology pharmacists preparing to sit for the BCOP Certification Exam, as well as meet the BPS requirement to complete a BCOP Preparatory/Recertification Review Course.

In this episode of HOPA Now, Dr. Kirollos Hanna highlights the fundamentals regarding multiple myeloma, the 14th most common cancer in the U.S. He offers details regarding diagnosis data and risk factors, the pathophysiology and molecular biology of multiple myeloma, the tools used to stage select patients and the importance of patient adherence to varying degrees of therapy regimens.

In this episode you will learn:

Multiple Myeloma: Fundamentals

• Diagnosis data and figures surrounding multiple myeloma
• Risk factors for developing multiple myeloma
• The main differentiating factors for MGUS smoldering and active myeloma
• Pathophysiology and disease-related symptoms of multiple myeloma
• C.R.A.B. symptoms, their causes, and common resulting effects
• Molecular biology of myeloma and cytogenetic abnormality prognostic factors
• High-risk differentiating factors and the tools used to stage select patients
• The importance of patient adherence to therapy regimens

Mentioned in This Episode:

HOPA

Quotes:

“We know that cytogenetic abnormalities oftentimes have a lot to do with preventing normal differentiation of apoptosis.” — Dr. Kirollos Hanna

“It is very rare or uncommon to see patients have IGM or IGD myeloma, and extremely rare to see patients not have any M proteins present in the blood or the urine.”  — Dr. Kirollos Hanna

“Response criteria ranges anywhere from stringent and complete response all the way to progressive or refractory disease.”  — Dr. Kirollos Hanna

HOPA Now is the official podcast of the Hematology/Oncology/Pharmacy Association, an organization dedicated to supporting pharmacy practitioners and promoting the advancement of Hematology/Oncology/Pharmacy to optimize the care of individuals impacted by cancer.

These educational podcasts are part of our BCOP Preparatory and Recertification Course, which is designed to prepare oncology pharmacists preparing to sit for the BCOP Certification Exam, as well as meet the BPS requirement to complete a BCOP Preparatory/Recertification Review Course.

In this episode of HOPA Now, Dr. Kirollos Hanna details the top ten clinical pearls for managing patients with multiple myeloma. Topics include the goals of therapy, the proper approach to treatment and transplant options, details of inhibitors and administration guidelines, the role of the pharmacist in managing complex regimens, and more.

In this episode you will learn:

Multiple Myeloma: Top 10 Clinical Pearls

• The goals of therapy regarding the disease state of multiple myeloma
• C.R.A.B. symptoms as the hallmark representation of multiple myeloma patients
• The approach to treatment and transplant options is based on various patient factors.
• The efficacy and complexities of triplet therapies
• Details of the three main proteasome inhibitors, administration guidelines, and common adverse reactions
• Approved immuno module drugs and their associated increased patient risk factors
• Highlighting the role of the pharmacist in managing complex regimens
• Novel upcoming mechanisms for managing multiple myeloma patients

Mentioned in This Episode:

HOPA

Quotes:

“It’s important to note that multiple myeloma remains, to date, an incurable disease.” — Dr. Kirollos Hanna

“Proteasome inhibitors are indicated in numerous frontline and relapse refractory regimens in multiple myeloma, regardless of transplant eligibility.” — Dr. Kirollos Hanna

“Pharmacists really play an integral role in managing these patients.”  — Dr. Kirollos Hanna

“It’s likely that we will see some of these therapies come to light within the next several years for the multiple myeloma patient population.” — Dr. Kirollos Hanna

HOPA Now is the official podcast of the Hematology/Oncology/Pharmacy Association, an organization dedicated to supporting pharmacy practitioners and promoting the advancement of Hematology/Oncology/Pharmacy to optimize the care of individuals impacted by cancer.

In this episode of HOPA Now, HOPA president Dr. David DeReemer moderates a discussion on the current landscape of pancreatic cancer care, treatment, and research. Dr. DeReemer is joined by CEO and President of PanCAN, Julie Fleshman; FORD model and pancreatic cancer advocate Maria Montgomery; and Dr. Thom George, a Professor of Medicine and director of the GI Oncology Program at the University of Florida and Director of the Cancer Center Experimental Therapeutics Incubator and Associate Director of Clinical Research. They discuss ongoing initiatives and current volunteer and advocacy opportunities of PanCAN, the future of pancreatic cancer treatment and research, and the exciting work that is happening with PanCAN’s Precision Promise trial.

In this episode, you will learn:

Ongoing initiatives of PanCAN ● Fund research including peer-reviewed grants and large research initiatives ● Advocating in Washington D.C. for increased federal research funds ● Patient services including information that is available through a call center and email ● Building a community of volunteers, patients, families, researchers, and stakeholders ● Telehealth has received increased support and provides quality care during the COVID-19 pandemic. ● Virtual advocacy has been widely successful and effective during the pandemic. ● Volunteer activity for fundraising is supported by passionate people who have been touched by pancreatic cancer.

A story of patient treatment, care, and advocacy ● Maria shares the story of her dad’s pancreatic cancer journey ● A look at common challenges in care, including a physical and emotional support system ● The silver linings that come with caring and advocating for a pancreatic cancer patient ● Go Fund Me information for Maria’s pancreatic cancer journey documentary ● The number one change Maria would like to see in cancer prevention

Looking to the future of pancreatic cancer care ● Details on immunotherapeutic strategies such as ICI in combos and CAR-T ● Possible reasons that early treatment approaches have been unsuccessful ● A combination approach including chemotherapy and stimulating the immune system will offer the most promising future for pancreatic cancer care.

PanCAN’s Precision Promise trial ● This Clinical research trial platform allows for testing different treatments at the same time. ● The platform is FDA-registration-enabled, allowing questions to be asked and answered that could lead to practice changes that would be FDA approved. ● The adaptive part is the most innovative program with a learn-as-you-go approach to offering treatments to patients as they are showing promise. ● Current national enrollment information ● Key inclusion and exclusion criteria of the study patient population

Mentioned in This Episode: HOPA PanCAN Pancreatic Cancer Documentary (by Maria Montgomery) Go Fund Me

Tweetables:

“Our goal at PanCAN is to take bold action by improving the lives of everyone impacted by pancreatic cancer.” — Julie Fleshman

“Although there are sad stories there are also so many positive stories about how we connect to each other. So many good people are touched by this disease.” — Julie Fleshman

“The challenges of caring for a pancreatic cancer patient were more than I’d ever realized but watching people come together and support you during that time is the silver lining.” 
— Maria Montgomery

“Early treatments we have tried haven’t worked because the cancer has gotten a head start.” 
— Thom George

“At the end of the day, we all just want to save lives and make people’s lives better.” 
— Julie Fleshman