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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.’
14th October 2024
Recommendations to mitigate burnout among the oncology workforce have been shared by the European Society for Medical Oncology (ESMO). The paper outlines how to manage psychosocial risks, optimise wellbeing, and reduce burnout among oncology healthcare professionals (HCP) to support staff, improve efficiencies and help maintain the delivery of optimal cancer care.
The series of 11 recommendations targets improvements in three areas: information and training to support HCPs development and practice, resources to safeguard HCPs psychological and physical health, and activism and advocacy to support the wellbeing of the oncology workforce. The proposals are aimed at individual healthcare professionals, institutions and national and international societies.
A diverse, multinational panel of interprofessional experts developed the evidence-based plan designed to address the growing pressures placed on the profession and mitigate the threat they pose to the quality and equity of cancer care. The recommendations are based on the key findings from three previously reported ESMO Resilience Task Force (RTF) surveys, which included more than 3,700 responses from professionals in over 100 countries.
The measures include providing more training and individualised mentoring to support HCPs, allowing them to restore control over their career development. In addition, plans to ensure manageable workloads and offer more flexible working conditions are suggested, as well as the need to create more pleasant working environments with suitable equipment and the time and space to communicate with colleagues and reduce isolation.
ESMO stated that the recommendations are ‘fundamental’ for the future of cancer care. They warned that failing to make the necessary changes would cause the quality of cancer care to deteriorate across Europe, whilst global health inequalities would increase as high-income countries deplete the medical workforces of low- and middle-income countries to try to meet their labour needs.
For each area of action, the paper highlights various initiatives that ESMO is undertaking to help address the issue and provide tangible support to practitioners, including efforts to push for necessary political measures to protect the oncology workforce.
Commenting on the recommendations, Dr Jonathan Lim, member of the ESMO RTF and consultant medical oncologist in advanced immunotherapy and cell therapy at the Christie NHS Foundation Trust in Manchester, UK, said: ‘As oncologists on the ground, we see every day that morale is low and that the workforce is in crisis. Our hope is that this work will now serve as an evidence basis that individuals can use as leverage to advocate for change within their institutions, taking from the recommendations what is most valuable and feasible within their respective countries, cultures and working environments.’
In June, the Royal College of Radiologists warned that escalating workforce shortages were causing ‘growing delays’ in cancer diagnosis and treatment in the UK and ‘putting patients’ lives at risk’.
3rd May 2023
NHS England has tasked hospitals with turning around diagnostic test results for suspected cancer within 10 days.
Hundreds of patients who have been referred under the urgent pathway will receive faster news about whether they have cancer or not helping to reduce anxiety and start treatment more quickly, NHS England said.
A letter sent to local health leaders has also asked teams to prioritise diagnostic tests like MRI scans for cancer in community diagnostic centres (CDCs) or to free up capacity within hospitals by moving elective activity into the centres.
Earlier this month, figures showed more than 42% of patients are waiting more than 62 days for their first cancer treatment from urgent GP referral.
It follows a report from the Public Accounts Committee in March which warned that cancer waiting times are at their worst ever level and NHS England was unlikely to meet its recovery target of moving back to 85% treated within 62 days of referral.
But the latest figures did show some improvement in two week wait times from the previous month with 86% of people seen by a specialist within a fortnight of urgent referral up from 81%.
In February, NHS England said it achieved the faster diagnosis standard for suspected cancer for the first time, with three quarters of those referred receiving a definitive diagnosis or all clear within 28 days – 171,453 people.
There has been high demand for services with up to one in four GP referrals a month for cancer.
In March 2022 to Feb 2023, 470,000 more people were checked for cancer compared with the same period before the pandemic, the figures show.
There are now 105 CDCs in place and offering a ‘one stop shop’ for tests, NHS England confirmed.
Dame Cally Palmer, NHS national director for cancer, said: ‘It is a testament to the hard work of NHS staff that we are seeing and treating record numbers of patients for cancer, and have made significant progress bringing down the backlog and achieving the target for diagnosing three quarters of people within 28 days – all despite huge demand and pressures on the system.
‘Fortunately, the vast majority of suspected cancer patients waiting for a diagnostic test will not have cancer, but for those waiting it can be a very anxious time, so we are asking trusts to aim for a 10-day turnaround time between GP referral and tests results for patients – so we can get people the all-clear faster, or in some cases ensure patients diagnosed with cancer are able to start treatment sooner.’
Professor Mike Osborn, president of the Royal College of Pathologists, said: ‘We welcome the announcement of support for pathology services which will help our members provide the quicker diagnoses that patients need.
‘Pathologists have long asked for improvements in digital pathology and infrastructure to help them provide better patient care. We fully support this initiative and the fresh focus on pathology which it should provide will, we hope, make a real difference to patients.’
This news story was originally published by our sister publication Pulse.
15th October 2021
The COVID-19 pandemic has had a major impact on the provision of healthcare across all specialities. In Australia, the government decided that tele-health was to be a weapon against COVID-19 and expanded consultation services available through this medium. According to a study by a team from Canberra Hospital, Australian, in the future, telephone and or tele-health consultations may have a more prominent role in the provision of radiation oncology services. Prior to the pandemic, there was already some evidence that follow-up telephone consultations were able to provide similar outcomes for breast cancer patients and those with stage-I endometrial cancer.
For their study, the Australian team set out to determine the percentage of telephone/tele-health radiation oncology consultations that led to the need for a subsequent face-to-face consultations during the first wave of the 2020 COVID-19 pandemic. In addition, where face-to-face consultations were required, the authors examined the reasons behind the need for such appointments. The team employed a retrospective design and obtained a de-identified dataset report created from the department’s oncological information system (ARIA) spanning a 10-week period from 23 March to 28 May 2020. Using the information system, the team extracted patient demographic data including the area of residence and diagnoses based on ICD-10 codes and additional data from the clinic appointments such as the appointment type, e.g., initial or follow-up. The patient’s medical records were then reviewed to categorise the reasons for the subsequent face-to-face consultation and these were recorded as frequency counts.
Findings
During the study period, there were a total of 1159 radiation oncology consultations undertaken with 973 patients. Overall, 696 (60%) of all consultations were conducted via the telephone, of which, 649 were for a follow-up appointment and the remaining 47, an initial appointment. However, less than 1 per cent of all (4/696) were conducted using tele-health. Of those who had a telephone/tele-health consultation, only 66 (9% of all telephone/tele-health consultations) subsequently required a face-to-face consultation. Among these 66 patients, the most common reason (45%) was the need for written consent prior to radiotherapy. Other reasons included the need for a clinical examination of a new problem (24%) and for a new investigation (7.5%). For the 16 (24%) patients needing a clinical examination for a new problem, the primary sites of disease were breast (4), mucosal head and neck (3), skin (3), endometrium (2), oral cavity (1), rectal (1), lung (1), and prostate (1).
The authors concluded that “A large proportion of radiation oncology appointments can be completed using telephone/tele-health, with a relatively small number of these requiring subsequent face-to-face appointments.” Nevertheless, they cautioned that “careful patient selection and accounting for multiple variables would be needed to ensure effective and safe healthcare is provided.”
Source. It’s a sign of the times:Our experience with telephone/tele-health consultations for radiation oncology patients in Canberra during the COVID-19 pandemic. The Royal Australian and New Zealand College of Radiologists conference 2021.
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