Hi ,

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

Last time you learned about hypertension with anti-VEGF therapies, the unique-ness of belzutifan in kidney cancer, and losing yourself

This week you'll learn about patient overwhelm, sexual dysfunction after prostate cancer treatment, and why you should hone your sales skills

Have a great week!

Kelley

🧠 IPS (Insight, Pearl, Sundry)

Insight

If you’ve ever been overwhelmed learning oncology, you can appreciate what our patients go through when faced with a cancer diagnosis

Consider Zane, a 68 year man with newly diagnosed, metastatic, castration-sensitive prostate cancer

His oncologist spoke carefully to him, explaining the diagnosis, the treatment options, and what the journey ahead might look like

But the words sounded foreign, like a new language he had to learn overnight

At home, Zane and his partner have handouts and notes spread across the kitchen table and are trying to remember what the doctor said

What drug is he starting? When does it start? How is he going to feel when taking it?

Patients at the beginning of their cancer treatment are in over their heads so ensuring they have written information that specifically outlines the medications they will receive and when/how to take them, how long they will taking them, and common side effects can help them feel more prepared

Following up with them during the chemotherapy infusions and/or within the first 2-4 weeks of starting non-infusion medications can help field any early toxicities and provide some piece of mind that they have an ally

Pearl

Sexual dysfunction is a common and distressing side effect for patients undergoing treatment for prostate cancer that, in my experience, is not discussed as often as it needs to be

More than 95% of patients treated for prostate cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial reported sexual dysfunction

95% 😳

Patients can experience erectile dysfunction, reduced libido, dysfunction with ejaculation and orgasm, and psychologic effects related to the disease and treatment

There are several mechanisms tied to the sexual dysfunction side effects of prostate cancer treatment: 

1. Anatomical and Neurological Factors:

   • The area around the prostate is full of nerves - even with nerve-sparing techniques and a highly skilled surgeon, many patients experience erectile dysfunction (and urinary incontinence) following a radical prostatectomy
   • Radiation can cause damage to surrounding nerves and blood vessels, leading to delayed and often permanent sexual dysfunction
2. Hormonal Changes:
   • By suppressing testosterone, androgen deprivation therapy (ADT) causes reduced libido and other changes such as loss of penile size or testicular atrophy. Even after discontinuation, testosterone recovery may take months or years.
3. Vascular and Ejaculatory Dysfunction:
   • Treatments can disrupt blood flow and ejaculation mechanisms, resulting in painful or impaired ejaculation
4. Psychological and Relational Impacts:
   • Body image concerns, stress from the cancer diagnosis, and lack of communication with partners can exacerbate sexual dysfunction

Since there are many causes of sexual dysfunction, a thorough assessment is needed to identify the best treatment option

And there are treatment options, including:

• PDE-5 inhibitors
• Intraurethral alprostadil
• Intracavernosal injections
• Vacuum erection devices (VED)
• Penile vibrator
• Penile implants
• Pelvic floor exercises
• Psychosexual counseling
• Sex therapy

Despite its prevalence, sexual dysfunction remains a topic many clinicians avoid. Many patients enter treatment believing they will maintain normal sexual function, but few are fully informed about the risks or have access to robust sexual health support; very few cancer centers even have a dedicated sexual health clinic.

ASCO’s prostate cancer survivorship guidelines recommends discussing sexual function with patients, monitoring erectile function over time, treating erectile dysfunction, and referring men to sexual health specialists. They also encourage patients and their partners to discuss sexual intimacy and to seek out counseling and support services when needed.

Pharmacists, while not traditionally seen as primary providers for addressing sexual health, can often be an accessible clinician for these conversations. For those interested, this area presents an opportunity to carve out a niche in survivorship care.

Sundry

We are all in sales

Yes, even you as a pharmacist is in sales

Sales has a bad reputation but at it’s core it’s really just problem solving

When you have a problem you want solved, you seek out solutions

When some friendly neighborhood honey bees 🐝 moved into my house, I wanted to be sold a solution, and FAST!

I also like to think about sales as a transfer of enthusiasm

We are all in sales because we are all selling ourselves in our work

We do this in job interviews, applying for promotions, applying to be on a committee, submitting to be a speaker at a conference, making LinkedIn connection requests…

We’re selling our skills, our experience, our background, our ability to create a desirable outcome

If you haven’t thought about improving your selling skills as a professional development strategy, now is the time

Wondering where to start?

Follow your curiosity and ask questions! Find out what the other person’s pain point is, hear their story, and ask them if they’d be open to hearing your ideas for a solution.

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

Learn with others in the Enjoy Learning Oncology (ELO) program

The ELO Collaborative is my signature oncology pharmacy membership community that was created for pharmacists working in oncology and trying to learn on the job. It combines a curated curriculum with access to expert oncology pharmacists to walk through case studies and answer questions.

Learn on your own with digital products

Prepare for BCOP with over 425 questions in the Oncology Pharmacy Question Bank (you can also add on example patient cases!)

Learn about breast, lung, prostate, and other cancers with our individual disease courses