By Emma Hitt, PhD

In August of 2001‚ some cancer patients in Kansas City had to worry that their cancer drugs were not as strong as they should have been. Missouri pharmacist Robert Courtney admitted to diluting the chemotherapy of at least 30 cancer patients; officials estimate that the number may have been more than 150.

Suspicions arose when a pharmaceutical sales representative noticed that Courtney’s pharmacy had purchased only about one third of the amount of a drug it had supposedly provided and billed to patients.

Samples from the pharmacy tested at an independent lab were found to be highly diluted. The case‚ a rarity‚ highlighted the importance of the pharmacist’s role in patient care‚ especially cancer patients.

Although many well-trained pharmacists work solely with cancer patients‚ there are about 300 pharmacists in the United States who have taken the rigorous test required to become board-certified oncology pharmacists (BCOPs).

According to Barry R. Goldspiel‚ PharmD‚ at the National Institutes of Health‚ Bethesda‚ Maryland‚ pharmacists specializing in oncology are especially knowledgeable about ways to handle the toxicities associated with many cancer drugs. They are also well versed in the interactions between herbal medications and chemotherapy and are aware of important resources for cancer patients.

“The oncology pharmacist assists oncology physicians and nurses by providing supportive care to the patient‚ including antiemetic [nausea] and pain management‚” says Betsy Althaus‚ PharmD‚ BCOP‚ Senior Pharmacist at the University of California‚ San Francisco‚ Comprehensive Cancer Center.

“Not all patients need extra help in these areas‚ but if a patient is having uncontrolled pain or nausea‚ the pharmacist is called upon to help develop a regimen that is tailored to the patient’s needs‚” Althaus says. “They then follow the patient over time and‚ in consultation with the team‚ adjust medications as needed.”

“Most major hospitals have pharmacists who specialize in oncology‚ which‚ in part‚ helps make sure there are no errors in dosing‚ since chemotherapy dosing errors could be deadly‚” says William D. Figg‚ PharmD‚ a pharmacology researcher at the National Cancer Institute‚ Bethesda‚ Maryland.

Althaus says that because of the toxicity associated with chemotherapy‚ oncology pharmacists must make several checks when they fill an order. The selection of chemotherapy drugs must match the disease; the ordered regimen must match the standard published regimen; the physician’s calculations must be double-checked; the patient’s lab work must be checked to make sure it is safe for them to receive the chemotherapy; antiemetic medicines must be checked to ensure they are strong enough to prevent nausea.

“Every pharmacist double-checks prescriptions and drug orders‚” Althaus says‚ “but the difference for the oncology pharmacist is the complexity of cancer and the drugs used to treat it.”