Hi ,

Welcome back to the Oncology Insights Newsletter which helps you learn oncology, and other nuggets, as you progress in your oncology career. 

Last week you learned about the downsides of being digitally dead, VTE risk in cancer, and got a sneak peek into an oncology-related memoir.

This week, you'll learn about how to quickly access glucarpidase when you need it, ifosfamide-induced neurotoxicity, and the consequences of hesitating.

Have a great week!

Kelley

🧠 IPS (Insight, Pearl, Sundry)

Insight

Life's guarantees: death, taxes, and toxic methotrexate levels on Friday nights 😳

MAP chemotherapy for osteosarcoma, which includes cisplatin, can be harsh on the kidneys, and the whopping methotrexate dose of 12 grams/m2 puts patients at risk for a potentially toxic methotrexate level

On a Friday at 5 pm, the rush to determine if glucarpidase is needed, the optimal dosage, and how to procure it is stressful 🤯

Glucarpidase is used to rapidly lower methotrexate levels in patients experiencing renal dysfunction and delayed methotrexate clearance, which can lead to severe toxicity

With a drug costing as much as a house 🏠, making an informed and swift decision is crucial for patient safety and your institution’s financials

Save yourself the stress: establish glucarpidase treatment criteria and ordering procedures ahead of time to avoid last-minute confusion.

One thing you can do is to establish an inter-hospital sharing agreement

These agreements enable hospitals to access glucarpidase from nearby facilities that stock it, thereby ensuring rapid availability of the medication when urgently needed without requiring each hospital to maintain its own costly supply

For effective implementation, it's essential to coordinate with regional pharmacy networks and hospital alliances to set up protocols for requesting and transferring glucarpidase - this is where processes can fall apart when you need the drug urgently so plan out the details in advance!

Protocols should include clear communication channels, transportation logistics, and reimbursement processes

This collaboration not only helps in managing costs but also improves patient care by ensuring timely access to a potentially life-saving treatment

Pearl

Ifosfamide, a cytotoxic agent used for treating sarcomas and some other cancers, is known to cause neurotoxicity, which can manifest as encephalopathy in as many as 30% of patients 🧠

Patients get a lot of hydration and mesna (2-MercaptoEthane Sulfonate Na) with ifosfamide, and although mesna helps to prevent hemorrhagic cystitis, it does not prevent neurotoxicity 🙁

To mitigate the risk of ifosfamide-induced encephalopathy, we monitor serum electrolytes, especially sodium levels, because ifosfamide can cause inappropriate antidiuretic hormone secretion (SIADH)

Patients experiencing neurotoxicity may present with confusion, hallucinations, or somnolence and need prompt intervention. It is common for infusion centers to use a neurotoxicity checklist to assess patients daily.

If neurotoxicity occurs, ifosfamide is stopped and methylene blue may be given, depending on the severity and clinical context. We don’t know the mechanism of why methylene blue works, but it’s thought to prevent the accumulation of the toxic metabolite, chloroethylamine.

Sundry

While driving to the gym last week, there was a squirrel 🐿️ in the middle of the road

Usually, squirrels make a quick decision to run one way or another - and as long as they choose fast, it doesn’t matter what the decision was, it will get them out of the path of an oncoming car

But when they hesitate for a second too long, things get dicey - this squirrel hesitated and almost met with dire consequences 😳

There’s a good life lesson there

If you don’t make a decision (no matter which direction it takes you), you’ll likely to get hit

It doesn’t matter what the decision is, just make one and move on

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When you're ready, here are ways to get help

Learn oncology

The Enjoy Learning Oncology (ELO) program was created for pharmacists working in oncology and trying to learn on the job. It helps you develop your baseline knowledge of the important diseases and concepts that will help you be successful in any type of oncology role. 

✔️ The ELO Certificate tier is the closest you'll get to a residency experience without taking a $50,000+ pay cut. It pairs you with an experienced oncology pharmacist mentor to help you smash your professional goals and reach that next level you've been striving for. It also comes with accountability calls with me and everything in the ELO Collaborative. Book a call to see if this is the right fit for you.

✔️ The ELO Collaborative is the signature oncology pharmacy membership community. It combines curated content in 24 weekly lessons with access to expert oncology pharmacists to walk through case studies and answer questions, both on monthly live calls and asynchronously in the community, a question bank, cases, professional development workshops, and more!

✔️ The ELO Blueprint is the self-led tier of ELO to help you deepen your oncology knowledge. It includes the 24 weekly lessons of curated content so you learn where all the great resources are, in addition to the question bank and cases. 

Other Resources

✔️ Practice questions are a great way to study for the BCOP exam and assess your oncology knowledge. Purchase access to the question bank for as little as $297. All 350+ questions are created and reviewed by expert oncology pharmacists in each specialty area and have answer explanations. Plus you have the opportunity to add on practice cases!

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