CAPhO Conference 2021

The availability of real world evidence (RWE) is pertinent in assessing patient outcomes, but how does one start to utilize this data? This program will discuss how to assess RWE and enrich clinical practice through two important oncology discussions. The first segment, presented by Kimberley Kuik, will analyze and discuss the application of RWE in CDK4/6 inhibitors in advanced breast cancer (aBC). The second segment, presented by Dr. Leigh Revers, will assess recent RWE in oncology biosimilars.  Join us as we explore and discuss real-world evidence (RWE) and how it can inform Canadian oncology practice. 

Learning Objectives:

1. Review long-term data supporting the use of current therapies for CLL;
2. Recognize potential adverse events that may occur with select therapies for CLL and how best to manage them; and
3. Identify points to consider when discussing treatment expectations with a patient.

The rapid advance of oral oncology therapeutics means that general pharmacy practitioners need to be familiar with the mechanisms of actions involving many new genetic and molecular targets. This presentation will describe the mechanisms of actions of selected classes of new oral agents, and provide resources and tools for general pharmacy practitioners to learn more about managing oral oncology drugs.

Learning Objectives:

1. Understand the importance of knowing more about oral oncology drugs in clinical practice;
2. Describe the mechanisms of actions of selected groups of recently introduced oral oncology drugs (approved within last 5 years); and
3. Describe some tools and resources that can be used to learn more about these drugs.

In the province of Alberta, pharmacy technicians traditionally have not performed tech check tech duties for oral and parenteral chemotherapy preparations. As technician regulation came into force on January 1, 2016 CancerControl Alberta (CCA) Pharmacy was faced with a technician workforce that had a new expanded scope of practice and professional responsibilities. As a result, in the spring of 2015 CCA Pharmacy began to look at workforce optimization and developed a certification program to have technicians fill the role of chemotherapy checkers in order to allow technicians to practice to their full scope while at the same time supporting pharmacists in expanding clinical roles within CCA Pharmacy. Although technicians are the main focus of the chemotherapy checking certification program, it is also applicable to new and existing pharmacists within CCA Pharmacy.

Learning Objectives:

1. Be able to identify CCA Pharmacy’s policies and procedures for Authorized Chemotherapy Checking certification;
2. Be able to identify 3 tools developed or the Authorized Chemotherapy Checker certification program;
3. Be able to identify 5 critical steps in CCA Pharmacy’s embedded worksheets and checking process; and
4. Gain the tools to be able to develop a chemotherapy checking certification program/process for pharmacy technicians (and pharmacists).

Research is within the purview of many oncology pharmacists, but as a profession we often don’t see ourselves as researchers. Even if we have a research idea, sometimes it’s difficult to know how to get started, especially for those not working in a teaching or academic centre. Although there are barriers to conducting research in the oncology pharmacy world, it is still something that can be done with the right supports and strategies. This presentation will give a high-level overview of the steps involved in taking a research question forward to a full project.

Learning Objectives:

1. Understand what makes a good research question;
2. Recognize strategies for answering a given research question;
3. Understand the elements of a successful research proposal;
4. Explain the ethics of research with human participants and how to navigate ethics applications; and
5. Summarize the components of a successful grant application.

Patients with a hematological malignancy often present with infectious complications. During their disease trajectory, it is estimated that 80% of these patients will experience an episode of febrile neutropenia; 70-80% of these episodes will not have an identifiable source. Others are found to be caused by a multitude of different infections. Management of these patients, including transitioning these patients to the ambulatory setting while still on treatment, remains a major challenge for oncology pharmacists and the multidisciplinary health care team. In this presentation, I will review febrile neutropenia as an infectious syndrome, and discuss central line infections, lower respiratory tract infections (focusing on fungal pneumonia), and CMV mucositis as infections commonly seen in this patient population.

Learning Objectives:

1. Identify reasons why malignant hematology patients are at risk for infectious complications;
2. Review Febrile Neutropenia as an infectious syndrome commonly seen in malignant hematology patients;
3. Describe the management of central line infections, lower respiratory tract infections, and CMV mucositis; and
4. Discuss difficulties and potential risks of infection management in the malignant hematology patient transitioning to the ambulatory setting.

As the prevalence of cancer increases, now affecting one in two Canadians, so does the frequency of adverse events relate to anti-cancer therapies. Oncology protocols have evolved, which has led to an improvement in patient prognosis and overall survival. However, those treatments are associated with adverse cutaneous side effects, which can impair a patient’s quality of life and result in dose reductions or discontinuations that could be detrimental for the outcome of the patient. Studies confirm that appropriate management is therefore necessary. 

Proper adjunctive management and palliative care can lead to an improvement in patient quality of life for patients experiencing skin toxicities from oncology treatments. 
 

The future of how real world evidence (RWE) can be used to inform clinical practice, drive more rigorous HC and health technology assessment, and provide patient’s perspective on the value of oncology medicines.

Learning Objectives:

1. To understand the current landscape and future framework for the use of RWE in Health Canada (HC) and Health Technology Assessment (HTA) for oncology medicines;
2. To discuss how the future frame work incorporating RWE will impact patient treatment and management; and
3. To discuss specifically how real-world derived patient/caregiver reported quality of life (QoL) and other outcomes should be incorporated into HC and HTA decisions and patient management.

The role for immunotherapy in cancer treatment continues to expand. We will review the changes, challenges, and opportunities that immunotherapy presents in our oncology practice. Recent evidence for the use of checkpoint inhibitors includes:

• atezolizumab in combination with bevacizumab in hepatocellular carcinoma
• ipilimumab plus nivolumab in combination with chemotherapy in non-small cell lung carcinoma
• nivolumab as adjuvant therapy in resected esophageal or gastroesophageal junction cancer.

With an increase in the use of checkpoint inhibitors, we will discuss on-going challenges in managing immune-related adverse events. We will also look towards future opportunities for immunotherapy being studied in oncology.

Learning Objectives:

1. Describe the expanding role of immunotherapy in cancer treatment;
2. Recognize challenges in managing immune-related adverse events; and
3. Understand future opportunities for use of immunotherapy being studied in Oncology:
   • As tumour agnostic therapy
   • In combination with radiation therapy (abscopal effect).

To view the AGM Agenda, last year's AGM minutes and Committee reports go to the Community Centre and click on 'Upcoming Events' then 'CAPhO 2021 AGM'. 

To fully understand how a pharmacy technician can benefit and aid in interdisciplinary settings, we must first dive into the history and making of the registered pharmacy technician’s scope of practice. Who we are, what we can do, and where we are doing it, is the focus of this presentation. Together will peer into the world of a clinical technician and see what how their tools can help unburden your everyday clinical practice.

Learning Objectives:

1. To summarize the evolving evidence for the regulated pharmacy technician advancement into clinical roles;
2. Identify efficiency contributions technicians make to a pharmacy and multidisciplinary team; and
3. To brainstorm future opportunities for utilizing regulated pharmacy technicians.

Canadians have a long standing interest in using plant derived cannabinoids (cannabis) for medical purposes. Despite the lack of evidence, cancer patients have a desire to use cannabis for cancer and treatment related symptoms as well as an anticancer strategy.

This presentation will review the current legislative framework for cannabis use, explore reasons for use by cancer patients and summarize the current evidence supporting cannabis use in oncology. To better meet patient needs we have established a Pharmacist run cannabis consultation service (CCS). The rationale for the CCS, principles by which it operates, challenges and lessoned learned will be discussed.

Learning Objectives:

At the end of this presentation you will be able to discuss the:

1. Canadian legislative framework governing cannabis use for medical purposes;
2. components of the endocannabinoid system;
3. evidence for the use of cannabis in oncology symptom management;
4. cancer patient’s perspective on using cannabis for medical purposes; and
5. role of pharmacists in managing cancer patients taking medical cannabis.
    

The presentation will provide a general overview of acute lymphocytic leukemia (ALL), treatment principles of ALL and provide an overview of the new therapies incorporated into practice over the last 2 years.

Learning Objectives:

1. Understand treatment principles of ALL;
2. Explain what is meant by the term “minimal residual disease”;
3. Understand the use of blinatumomab and how to manage side effects;
4. Understand the use of inotuzumab ozogamicin and how to manage side effects; and
5. Review the role of CAR T-cell therapy in the treatment of ALL.
    

The pervasive pandemic has challenged healthcare workers in more ways than one. From patient care, to supply continuity, drug shortages, as well as the incredible financial toll it has taken on Canadian hospitals. Join Dr. Alicia Wall in this timely discussion on drug waste minimization strategies, where she will discuss strategies employed at Eastern Health, such as beyond use date extension (i.e., drug vial optimization).

The COVID-19 pandemic has affected many aspects of oncology medical practice, including how clinics are managed. In some cases, new ways of scheduling treatments have emerged that have proven beneficial for patients and may endure post-pandemic. Join us at the CAPhO Virtual Conference 2021 for an interactive symposium guided by two experienced pharmacists who will review strategies as they relate to immunotherapy in the management of various cancers, and will illustrate with patient cases the application to current practice.

The Model Standards for Pharmacy Compounding of Hazardous Sterile Preparations requires hospital pharmacies to implement an IV Compounding Supervisor, who is tasked with developing policies and procedures for training and assessing compounding personnel and overseeing the sterile compounding activities in the pharmacy. The Standards require the Supervisor be evaluated for knowledge and abilities by a third-party evaluator. We will discuss the challenges of achieving this while the world is dealing with COVID-19 restrictions, and steps technicians and pharmacists can take in the meantime. 

With discontinuation of native non-pegylated Asparaginase in Canada, PEG-asparaginase has become the defacto front line asparaginase product.  This discussion will focus on the importance of Asparaginase in the treatment of A.L.L.  and the challenges with delivering it (differing side effect/toxicity profiles, role of TDM) in these populations.

Opportunity to share innovative pharmacy practice implemented during the COVID-19 to support oncology patients.  Discuss the benefits, barriers and impact of changes utilized during this eventful time.

In this informal discussion we will explore palliative care clinical issues that face oncology pharmacists, with a focus on the outpatient setting, as well as looking at some of the hot topics in the realm of palliative care.

We are facing an increased challenge to connect with patients, Health Care Workers, Patient Support Programs, and government agencies during COVID-19 around drug access. We will discuss these challenges and offer shared experiences
on how we have worked to address them.
 

Providing education materials in formats other than printed documentation can really help our diverse and aging patient population, whether it be for patient education, new staff orientation or other reasons.  Historically, considered costly and time consuming, creating videos are not as hard as they used to be! In this roundtable, we will some of the applications that are readily accessible so that you can create your own education or training video.  We'll discuss platforms that can support the dissemination of patient education material and share ideas and initiatives that are in development.

The conference theme of “Change, Challenge, Opportunity” is at the heart of this plenary session. In response to the increase in opioid-related deaths in Canada, national strategies and guidelines have been developed to help support both practitioners and patients in improving opioid use. Unfortunately, these strategies focus on opioid use for chronic non-cancer pain. During this session we will explore:

• the impact of the opioid crisis on patients living with cancer related pain; 
• some of the safety concerns around opioid use in patients with cancer;
• how pharmacy’s unique position and high accessibility within the health care system amplifies its impact when implementing meaningful strategies to better support patients requiring opioids to manage cancer related pain; and
• the current and future direction of research in Canada on this topic and how you can engage with initiatives and practices to best support your patients living with cancer related pain.

We hope you leave this session feeling informed and empowered to collaborate with both your patients and inter-professional health care teams to ensure patients with cancer are receiving the most effective pain control strategies and are supported and educated regarding using these therapies safely. 

Learning Objectives:

1. Describe the current opioid crisis in Canada;
2. Explain the role of opioids in management of cancer-related pain;
3. Develop a monitoring plan (safety and efficacy) for a patient receiving opioids for cancer-related pain;
4. Incorporate the World Health Organization guidelines into your pharmaceutical care process for patients receiving opioids for cancer related pain; and
5. Summarize pharmacy-sensitive practices that you can implement/champion in your practice setting or institution.

This important symposium will feature the first ever HOPE (Honouring Oncology Pharmacy Excellence) award recipients (to be announced), who will showcase their award-winning submissions.
 
You will also learn about a new educational initiative called ABC – Addressing the Basics in Cancer, to be launched later this fall.
 
The speakers will include Flay Charbonneau from Ontario, who will introduce the HOPE Awards, Scott Edwards, from Newfoundland, who will present the ABC program, and Dr. Nirmesh Shah from Apobiologix, who will provide an overview of the APP.