Improving access to cancer care

Patients receiving oral anticancer therapy are receiving better support thanks to a Waterloo Pharmacy alum and a team at the Waterloo Regional Health Centre (WRHN) Cancer Centre who have launched the Medication Assessment by Pharmacist (MAP) clinic.

Jackie Diebold (BScPhm '14, PharmD ’21), a clinical pharmacist, was backed by interim director of pharmacy Anthony Amadio (BScPhm ’11) oncology pharmacy co-ordinator Anna Granic and pharmacy manager Kathy Planinac to implement the new model to improve cancer care delivery while optimizing each clinicians’ skill set.

Today, more than half of all oncology drugs are being developed as oral treatments, and their approved uses continue to grow. These medications offer advantages over intravenous (IV) formulations, including flexible timing, convenient at-home administration and reduced invasiveness. However, they also bring challenges: missed doses can reduce effectiveness, some drugs can cause serious side effects, and certain therapies require close monitoring, adding pressure to an already overextended health care system.

“In the MAP clinic, patient care is shared between our oncology pharmacists and oncology physicians,” Diebold explains. “Prior to starting treatment, the patient will see the MAP pharmacist alongside the oncologist for a baseline assessment, medication review and counselling on their new oral anticancer agent. Follow up appointments are then booked with either the MAP pharmacist or the oncologist based on a predetermined schedule.”

The MAP clinic provides more than just a monitoring service. Through the aid of delegated acts and protocolsdeveloped with the oncologists, pharmacists can manage treatment independently during follow-up visits. This involves ordering appropriate laboratory tests and diagnostics along with pausing or adjusting therapy when needed. If concerns arise, care is escalated to a physician for additional evaluation and management.

“This clinic gives us an incredible opportunity to practice at our full scope,” Diebold says. “We are providing safe, comprehensive care for patients while freeing up physicians to focus on more complex cases and new referrals, which directly improves access to care. By applying our knowledge and unique skill set, we’re making a meaningful impact for patients in the region.”

Over the past nine months, the clinic has freed up space for more than 167 physician visits and saved time for nursing staff and clinic aides.

“The pharmacist also plays a significant role in identifying and resolving medication-related issues, averaging two drug therapy interventions made per patient visit, with 290 interventions completed to date,” Diebold says.

Drawing from successful pharmacist-led models from British Columbia and Newfoundland, Diebold and the WRHN team created a framework designed to address key challenges and improve workflow at their own center. The pharmacy team is now exploring ways to integrate this approach for other systems and specialties within the hospital.

"This new role represents how we are moving health care forward at WRHN, and the addition of a clinical pharmacist in this capacity highlights our commitment to transforming patient care through collaboration and innovation,” Amadio says. “Through integration of a dedicated clinical pharmacist, we are enhancing the patient experience, improving safety and enabling every member of the care team to work to their full scope. This collaborative approach reflects our focus on innovation and ensures patients receive the most comprehensive, personalized care possible.”

The MAP clinic began with a pilot group of patients receiving treatment for breast cancer, and has expanded to monitor patients with chronic lymphocytic leukemia who require intensive follow-up including eight pharmacist visits in four weeks. Due to the success of the clinic, the team has been asked to take on management of other oral anticancer treatments including targeted therapies for prostate and ovarian cancer.

The clinic is growing, and Diebold hopes the workload will soon allow for more than one pharmacist in the role at a time. Alumni Quinn Thompson (BSc ’14, PharmD ’20) and Michael Collins (BScPhm ’11, PharmD ’16) alongside Mona Abdallah, clinical pharmacist and Waterloo Pharmacy clinical preceptor, are all trained to deliver care in the MAP program.

Physicians strongly endorse the model and refer patients best suited for pharmacist-led monitoring. Patients give consent to participate, which builds trust and promotes autonomy in their care.

“This initiative represents a pivotal step in both patient care and our practice,” says Dr. Shelley Kuang, medical oncologist at WRHN. “The collaborative approach between the pharmacists and physicians at WRHN Cancer Centre has allowed patients to feel better supported when starting new oral anticancer medications, preparing them for potential side effects and optimal management strategies.”

To evaluate pharmacist activities within the MAP clinic, current pharmacy resident Nasab El-Dassouki (PharmD ’25) will be using the newly launched ambulatory oncology clinical pharmacy key performance indicators (AOcpKPIs) developed by a national team including Dr. Tom McFarlane, associate professor at the School of Pharmacy. The clinic will also serve as a training site for future pharmacy residents, with plans to include student co-op and patient care rotations.