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7th January 2025
Significant strides are being taken in oncology, with treatment innovation and expanding skill sets supporting best practice among the multidisciplinary team. Speaking to Saša Janković, clinical and oncology pharmacist and ESOP president Professor Klaus Meier discusses the significant opportunities and challenges in the field and how collaboration is the key to an even brighter future.
‘Oncology works better when we give more power to pharmacists’, says Professor Klaus Meier. It’s a bold but thought-provoking statement, and he practices what he preaches.
As president of the European Society of Oncology Pharmacy (ESOP Global) – the world’s largest multinational oncology pharmacy organisation, founded in 2000 in Prague, and now with a membership of more than 4,500 members from 76 countries – Professor Meier is at the forefront of addressing challenges and harnessing opportunities in this critical specialism. Ultimately, he is a champion of the integration of oncology pharmacy into multidisciplinary clinical practice.
The specialism of oncology pharmacy has grown significantly across Europe since ESOP’s foundation, but the heterogeneity of healthcare systems across the continent remains a key challenge. ‘Every country in the EU has its own responsibility for education, health and related matters, which makes it difficult to implement universal programmes,’ Professor Meier notes.
To address this, ESOP has dedicated efforts to establish standardised education and training for the sector. A full member of the European Cancer Organisation, one of ESOP’s landmark initiatives is the European Certification Program for Oncology Pharmacy (EUSOP) – a comprehensive 100-hour initiative combining e-learning, an international workshop, and national training sessions, with participants achieving the title of European Oncology Pharmacist upon completion to signal their specialised expertise.
‘We aim to give pharmacists the tools they need to contribute meaningfully to cancer care,’ says Professor Meier, ‘and this structured approach underscores the specialism’s role within the broader hospital pharmacy framework, as well as its pivotal contribution to multidisciplinary cancer care teams.’
While medicines shortages and supply issues continue to make headlines across Europe, Professor Meier says one of the most destabilising additional challenges for the oncology pharmacy sector is war and conflict.
‘Much of the work ESOP does is about giving pharmacists the opportunity to come together because we cannot be helpful when we are not full of knowledge, but current conflict situations across the world are hampering these efforts,’ he says. ‘For example, when ESOP started, we initiated an exchange with Russia and Ukraine, and we are waiting for the right moment to pick the personal local exchange up again.’
Further hurdles include the disparity in drug availability across Europe. ‘In some EU countries up to 50% of European Medicines Agency-approved drugs are not available due to governmental or insurance-related barriers, and this impacts not only patients but also clinicians who miss the chance to become familiar with these therapies,’ he says.
ESOP is therefore actively lobbying for cohesive pharmaceutical legislation to ensure equitable access to essential drugs across all EU nations. Its working groups – comprising members from Asia, South America, Europe and Africa – regularly convene to share expertise and develop solutions to dive these efforts forwards.
On the positive side, technological and scientific advancements are reshaping the oncology pharmacy landscape and optimising the care that healthcare professionals can offer patients.
‘Developments such as mRNA cancer vaccines, pharmacogenomics and personalised medicine are going to be transformative for the sector,’ Professor Meier says. And he draws a parallel to the Covid-19 pandemic when pharmacists played a central role when carrying out vaccinations, even in countries where this was previously unprecedented.
‘At the start of the pandemic we knew very little about Covid-19, there was no vaccine, only panic,’ he recalls. ‘But then our pharmacists began to be included in the vaccination programmes in countries where they never have been included before, such as France, but also in community pharmacies, which before had only offered flu vaccinations – like in Germany where it had been unthinkable that pharmacists would do that, as only doctors had the allowance.’
Despite the positive learnings from and progress made during the pandemic, there’s still a long way to go to consolidate pharmacists’ roles, responsibilities and skills across the continent. Professor Meier therefore encourages pharmacists to learn from colleagues and each other and keep an ear to the ground to ensure they are ready for future change.
‘If you made a map of nations, it’s clear that how healthcare is delivered in one is not necessarily how it is done in others, but these advancements underscore the critical need for pharmacists to stay at the cutting edge of innovation and to adapt rapidly,’ he asserts.
To support this adaptation, ESOP places a strong emphasis on education. Its flagship event, the European Congress of Oncology Pharmacy (ECOP), was held in October 2024 in Lisbon and aimed to offer pharmacists a balance of expert scientific content and hands-on guidance.
‘This year’s Congress had high-level lectures about scientific questions, as well as covering a lot of practical training issues, such as how to write a clinical case at the end of the 100-hour education programme,’ explains Professor Meier. ‘We try to make the Congress a useful tool for attendees because when you have no tool you cannot open a box, so we are working on giving everybody the tools to express their knowledge and make collaborative connections with others – and I think we succeeded this year. In fact, I don’t think we’ve ever had a Congress with such positive feedback afterwards.’
Despite largely being aimed at oncology pharmacists, a welcome cohort of community pharmacy colleagues also participated in the Congress. Professor Meier says it’s important to acknowledge that the treatment and care of cancer patients is much broader than just the therapies provided in clinics, partly due to the success of these therapies. The subsequent reduction in morbidity increases the number of chronic patients that need long-term support, which can be provided in a variety of settings. As such, Professor Meier is clear that the community pharmacy sector plays a key role in maintaining joined up working and best practice across cancer care.
For example, a pioneering ESOP initiative in Germany seeks to engage the country’s 18,000 community pharmacies in supporting oncology patients.
The Oral Cancer Therapy Initiative provides community and hospital pharmacists with essential information about cancer drugs, side effects and adherence, while patients are given tools to document their experiences and facilitate better communication with the healthcare professionals they come into contact with throughout the system.
‘Community pharmacists can give patients a plan that makes sure they are able to take their cancer drugs in the right way at the right time,’ says Professor Meier. ‘If after two or three days they are having side effects, the patient can go back to the community pharmacist and check they have taken the drug in the right way, and if they still feel bad the pharmacist can make an immediate appointment with their doctor to check if what is prescribed is the right concentration or not – positioning community pharmacists as the coordinator between the patient and the doctor.’
Available in 10 languages, the initiative has recently been rolled out in Poland, and it is also due to commence in Hungary in 2025. A working group is poised to ensure it is then implemented further afield. And for pharmacies that are not yet equipped for its full application, the ESOP website offers a scaled down version with basic information in English that each country can translate into its own language.
Dismantling barriers to cancer care is a recurring theme in Professor Meier’s vision and this was his key message at the ECOP Congress.
‘As pharmacists, we are part of the multi-professional action that enables comprehensive care for patients,’ he says. ‘It is not drugs that is the measure of all things, but the implementation culture with the direct involvement of the other players in the healthcare system and, above all, the patients.’
ESOP’s quality standards, first published in 1996, serve as a foundation for such collaboration. These essential requirements for best practice, now in their seventh iteration as QuapoS 7 and translated into 23 languages, cover everything from aseptic preparation to drug administration and education and, according to Professor Meier, ‘enable oncology pharmacists to work confidently and collaboratively, whether they are in Bulgaria, South Africa or Mexico’.
Looking ahead, Professor Meier is optimistic about the future and the ability for pharmacists to proactively support progress in oncology. He concludes: ‘Our goal will continue to be to empower oncology pharmacists to use their knowledge to its fullest potential, embracing advancements in technology and personalised medicine, while continuing to advocate for patients in the face of systemic challenges, so oncology pharmacists can make even greater strides in optimising cancer care.’
31st July 2023
Dr José López-Sendón, clinical cardiologist and scientific director at La Paz University Hospital’s Institute for Health Research, discusses the Institute’s work, the importance of teamwork and the current and future challenges in cardiology.
Spending much of his working life within intensive care cardiology, Dr José López-Sendón is the former director of the cardiology department, La Paz University Hospital and the Autonomous University of Madrid. Although now retired from clinical practice, he is is involved in research and administration at La Paz University Hospital’s Institute for Health Research (IdiPAZ), where he serves as the scientific director.
IdiPAZ belongs to the Carlos III network of biomedical research institutes in Spain and includes La Paz University Hospital, the Autonomous University of Madrid, Getafe University Hospital, the European University and the Foundation for Biomedical Research. It has strong links with the major areas of research in La Paz University Hospital’s cardiology department, which is itself a specialist centre covering a population of over one million people.
The department undertakes all major procedures in invasive cardiology including advance heart failure and complex adult congenital heart diseases, transplant and advanced heart failure. Other major research areas of the IdiPaz include neurosciences, infectious diseases and immunity, cancer and human molecular genetics, maternal and infant child and youth, surgery, transplant, and health technologies.
Dr López-Sendón describes the strength of La Paz University Hospital as being built upon three key pillars: treatment of patients, education and research. The hospital and the cardiology department have, over many years, been consistently classed as a renowned centre.
He feels that there are three main reasons why the hospital has continued to remain a high-ranking centre: belonging to a prestigious university, teamwork between the directors of the hospital and the university, and ensuring that the institution has an exceptional basic and clinical team of staff. In short, he believes the ultimate value for a biomedical research institute arises largely because of the people working within it.
Although IdiPAZ, which is made up of nearly 1,000 staff, has collaborative links across Spain and abroad, another underlying reason behind its success, Dr López-Sendón says, is the collaborative mentality of the various departmental directors.
There’s a natural tendency, he explains, for directors to attract funding or expertise to their own department, but he has sought to overcome this bias with ‘a kind of roundtable, with representatives from the universities and the hospitals’. Dr López-Sendón’s main aim is to convince members of the importance of a collective benefit; that the whole is greater than the sum of the individual parts.
IdiPaz is currently involved in several areas of research and has a large involvement in clinical trials. For instance, the department has had a relationship with the TIMI Study Group for more than 20 years, and is actively collaborating on secondary prevention work. The Covid-19 pandemic provided another opportunity for research and the Institute has studied both the cardiac effects of Covid-19 and the role of anticoagulants in its management.
Another area of research Dr López-Sendón has worked on is the cardiotoxic effects of chemotherapy. This collaborative project involved colleagues from cardiology, oncology, hemato-oncology, radiology and radiotherapy oncology within Spain and overseas.
Cardiotoxicity is a concept that has been growing over the last 10 years, and this work has revealed that rather than it being binary – patients either have or don’t have cardiotoxicity – it is best described along a continuum of severity. The group has published work that helps clinicians to define the characteristics of cardiotoxicity that have to be treated, in other words, most patients will experience some level of insult on the heart but not all need to stop their chemotherapy.
‘Severe cardiotoxicity that would require cessation of chemotherapy is needed in only about 2-3% of cases and most cases occurred in patients who have a previous heart disease,’ he says.
Interestingly, traditional risk factors for heart disease, such as smoking, type 2 diabetes, and elevated cholesterol, also pose a risk for cardiotoxicity during chemotherapy. It’s this point that Dr López-Sendón feels is often not appreciated by oncologists or even by cardiologists. As an example, the prevalence of common cardiovascular risk factors remains unchanged during and after chemotherapy, in spite of close teamwork with cancer and cardiology specialists. The advice to remain as physically active as possible is not enough, which he thinks is a mistake.
Dr López-Sendón notes that to date the majority of oncology treatment guidelines attach a low level of evidence that is based only on expert opinion. This is largely due to the lack of much needed strong evidence from large, multicentre clinical trials.
Cardiovascular disease remains the largest global cause of mortality, and the number of people with cardiovascular diseases is increasing. While mortality from specific cardiovascular causes is actually constantly decreasing, longer life expectancy offsets this decrease, as older people are more susceptible to cardiovascular disease.
‘Forty years ago, the mortality from acute myocardial infarction was 30% whereas now it is only 5%,’ says Dr López-Sendón. ‘When you take out those arriving at hospital with cardiogenic shock, the mortality reduces to 2%.’ In short, it is the prevention of cardiovascular diseases that is an increasingly important challenge.
A further major challenge in cardiology, Dr López-Sendón notes, is to ‘improve the quality of life for people with chronic cardiovascular diseases’, but what this means in practice is far from clear. After all, a current limitation in cardiovascular research is that patient’s priorities – what they perceive as required to improve their own quality of life – are invariably absent in trials.
Things could change in the coming years as regulatory authorities – who are the principal funders of healthcare – demand a clearer view of benefit. For instance, when a patient says, ‘I want to live more and better at no cost’, this only serves to confound the issue and raises further questions. What is meant by more, how do you define better and what should be deemed as cost effective? Greater awareness of the patient’s perceived unmet needs must be developed.
While aligned with virtually all cardiologists on the importance of patient education on lifestyle risk factor modification as a way to reduce the risk of cardiovascular disease, Dr López-Sendón accepts this messaging often fails to be implemented in practice. ‘It is so difficult because it involves changing someone’s way of life,’ he says.
While focusing on this behaviour modification is important, he believes it is equally important to educate the younger generation about these risks: not starting smoking, making exercise a part of their life and adopting a healthy diet. Ensuring healthy behaviours are entrenched in people from a young age means difficult changes in beliefs and attitudes will not be required further down the line.
Dr López-Sendón anticipates that the pace of innovation and change will accelerate in all areas of cardiology, demanding a subspecialisation that is already in practice. Artificial intelligence, for example, will increasingly be involved in the diagnosis and treatment of cardiovascular diseases. He imagines that simple robotics, such as smartphones and wearable and implant technologies, will play an even greater and more important role in everyday clinical practice.
A major challenge, however, is teamwork between different protagonists. With basic research more active than ever, Dr López-Sendón says healthcare providers, legislators, scientific associations, the industry, regulatory agencies and the patients must work together and not ignore, or work against, each other.
Finally, Dr López-Sendón maintains that patient education will continue to be vital in helping patients to understand the importance and need to adopt healthy lifestyle measures to reduce their risk of developing cardiovascular disease in the future.
‘Wise men and women predict that cardiovascular diseases will no longer be a problem for the future generations born in 2050 and this will be mainly the result of effective CV prevention,’ he says. ‘Then, the healthcare challenges with be different, but let’s wait and see.’
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