Hi ,

Welcome back to the Oncology Insights Newsletter which fosters your continuous growth in oncology pharmacy practice

Last time you learned about raising your floor, biomarker-directed therapy in metastatic colon cancer, and a renovation update

This week you'll learn about how oncology pharmacy is similar to the Secret Service, the difference between Child-Pugh and MELD in hepatocellular carcinoma, and my first NCODA meeting.

Have a great week!

Kelley

🧠 IPS (Insight, Pearl, Sundry)

Insight

There has been a mass exodus of agents from the Secret Service - long shifts, outdated facilities, high pressure/stress, fast paced, poor management, training requirements

Does some of this sound familiar? 🤔

It reminds me a lot about the hemorrhaging of oncology pharmacists from patient care in the past few years - completely unrelated industries with a lot of similarities

The Secret Service lost 18% of their workforce over 2 years (1400 people)

We don’t track the numbers on how many we’ve lost in oncology but anecdotally, we all know it’s a lot. We see the constant stream of LinkedIn updates about new roles or experience it first hand with our colleagues.

Less Secret Service agents means a less safe environment for those they protect. And fewer oncology pharmacists means a less safe environment for patients with cancer.

The Secret Service has been focused on hiring, but training someone to potentially take a bullet for the president is not something accomplished in a 90 day onboarding 🫤

And oncology has a similarly long onboarding process. Sure, you can get some basics down when you start but it takes years to reach your potential as it does a Secret Service agent.

We all need to be thinking of the big picture with our workforce. Almost every oncology pharmacist I meet loves taking care of patients so there must be a way to retain them better than we have been.

What do you think are the keys to retention?

Pearl

Throughout hepatocellular carcinoma (HCC) literature, you may notice two different scoring systems: Child-Pugh (CP) and the Model for End-Stage Liver Disease (MELD)

While both systems assess liver function and disease severity, they serve different purposes and use distinct criteria.

• Child-Pugh (CP) Score: This system evaluates the severity of chronic liver disease and classifies patients into one of three categories (A, B, or C), with Class C indicating higher mortality rates. The CP score is commonly used in clinical practice to guide treatment decisions for HCC.

• MELD Score: Primarily used to determine eligibility and priority on the liver transplant list, the MELD score quantifies the severity of end-stage liver disease. Higher MELD scores indicate more severe disease. MELD scores can be recalculated periodically to monitor changes in a patient’s condition.

When choosing treatments for patients with advanced or unresectable HCC, the CP score is most appropriate for guiding therapy selection

Knowing your patient’s CP score is also important for applying clinical trial data, as many HCC studies included only patients with CP-A scores. In real-world practice, most patients with HCC do not have a CP-A score, which presents challenges when translating trial results to broader patient populations.

Sundry

Last week, I attended my first NCODA (National Community Oncology Dispensing Association) conference, and it was an experience!

I go to a lot of conferences (13 last year), but this was my first time at NCODA because it's members-only, and membership is exclusive to those working directly in dispensing practices. NCODA covers travel costs for a set number of members, covering hotel and flight without a registration fee. Pretty incredible, right?

Fortunately, the NCODA team made a special exception for my attendance this year, and I’m grateful for the chance to participate!

For context, if you’re already tallying up your last conference costs, the registration for ASHP Midyear alone is often higher than a typical domestic flight.

So, how does NCODA make it work? They fund it through sponsorships from industry, creating an opportunity for those who might otherwise not attend, especially technicians, who often face financial barriers to professional development.

Of course, covering travel costs for about 700 attendees isn’t trivial - likely close to $840,000 based on the expenses for my flight and hotel alone. While sponsorships make this feasible, the sheer scale and logistics are impressive, though it’s also a reminder of the financial strain this puts on the healthcare system.

It raises the question: how else could industry spend close to a million dollars?  Perhaps lowering drug costs...🤔

I enjoyed the conference and was able to meet some clients face-to-face and connect with colleagues from my ELO Collaborative community, including one of our experts who spoke at the event. I also reconnected with friends and met many new people - some of whom follow me on LinkedIn or here on this newsletter and seemed surprised that I’m a real person (yes, it’s me, Kelley 👋).

Overall, it had the energy and excitement of other oncology conferences but with a focus on practical challenges in dispensing practices and content suited for those newer to oncology. It may not cover BCOP exam prep, but for many, NCODA opens doors to grow your career in oncology.

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