Hi ,

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

Last time you learned 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

This week you'll learn about seizing opportunity, QTc prolongation with arsenic, and a community conversation about paclitaxel titration

Have a great week!

Kelley

PS - please go vote today!

🧠 IPS (Insight, Pearl, Sundry)

Insight

“An opportunity is something you seize, not receive”

Oncology is pretty terrifying to step into cold, with limited experience

That’s what a lot of my clients have done - there was an opening and they jumped into the deep end DESPITE not knowing how to swim 🏊

I’m in awe of them

Many people complain about their career but don’t do anything to bring about change - they wait for opportunity to smack them in the face and are surprised (or annoyed) when it doesn’t

My clients are the type of people that raise their hand 🙋‍♀️ when opportunity knocks on their door, even if that hand is shaking while they do it

They are scared, and do it anyway

What does it take to become that kind of person?

You have to have self-confidence that you CAN do hard things. And I bet if you look around, you can find evidence to support that.

We don’t track the hard things we have done very often and when time passes, we forget what was involved in accomplishing them, which makes it seem less impressive - but it IS impressive

Do more to remind yourself that you are capable

If you learned anything from pharmacy school, it was to be a self-learner. To question everything. To find evidence to back you up. Do this with your life and career goals too.

You can do anything you want. You just have to be willing to do the hard work to get it done.

Pearl

When I first learned that we use arsenic in cancer treatment it immediately brought back the memory of reading Flowers in the Attic by V.C. Andrews as a teenager where arsenic poisoning played a pivotal (and unsettling) role in the plot

Arsenic is a critical drug used in the treatment of APL (acute promyelocytic leukemia), a highly curable acute leukemia. However, it poses a significant challenge due to its toxicity.

One of the common toxicities we monitor closely is QTc prolongation, as it can lead to dose delays that may negatively impact cure rates

QTc prolongation is associated with many drugs in oncology. While not inherently dangerous on its own, prolonged QTc can lead to Torsades de Pointes and sudden cardiac arrest.

To mitigate these risks, we typically hold an arsenic dose if the QTc exceeds 500 msec

Most EMRs report QTc using the Bazett formula, but the Lo Coco protocol uses the Framingham correction, which may require manual calculation to ensure precise arsenic dosing

The Framingham correction often yields a lower QTc than the Bazett formula, allowing patients to receive more doses of arsenic and thereby improving their chances of remission in this highly curable disease

Reading EKGs and calculating QTc intervals is not something pharmacists are trained to do but if you work with acute leukemias, it would be a beneficial skill to develop to ensure your patient’s treatment is optimized

Sundry

Our ELO Collaborative community had a great conversation recently that brought out some valuable insights

The discussion started with a question about titrating the first dose of paclitaxel to prevent infusion reactions

Several members shared their experiences, noting that most centers don’t titrate, while one does. This highlighted a common assumption - that our way of doing things must be the standard elsewhere. From experience, I can tell you that practice vary widely!

Another key point was how quickly we often react to incidents

When something goes wrong, it’s tempting to jump into “fix-it” mode to prevent a recurrence. Sometimes, that approach is justified if there’s a clear cause-and-effect relationship. But more often, reactive changes aren’t the best strategy, even if driven by good intentions.

If you encounter a similar issue in your practice, start by checking published data (and be cautious with retrospective analyses). If reliable data is lacking, as with this specific question, consider reviewing your own internal data.

This kind of quality initiative not only helps you better understand how frequently an issue occurs in your setting but may also support your center’s accreditation requirements.

Discussions like these underscore the power of community in oncology. Although we work in different places, we face similar challenges - and by sharing experiences, we can all work more effectively.

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