Overview of the PRN

The Hematology/Oncology PRN was established in 1994 to improve professional collaboration among clinical pharmacists who practice in hematology and oncology settings. As of April 2020, the PRN has 686 members, and trainees make up almost 50% of its membership. The PRN focuses on developing and promoting the growth of the hematology/oncology clinical pharmacy profession involving hematology/oncology clinical pharmacists, students, residents, and fellows in their education, projects, and initiatives. The PRN also supports the Frontiers Fund with annual donations.

Opportunities for Resident and Fellow PRN Members

The Hematology/Oncology PRN supports travel to ACCP Annual Meetings for hematology/oncology residents and pharmacy students. Annually, the PRN offers students and residents the opportunity to apply for travel grant awards, seeking to foster research and general engagement with the oncology specialty. The pharmacy residents and students who receive travel support to the ACCP Annual Meeting are invited to present a research project at the PRN business meetings and networking forums. Recently, the PRN developed four advisory committees to help lead various initiatives and generate opportunities for all members – the Membership & Operations, Research, Communications, and Learners’ committees. The Learners’ Committee was specifically developed to ensure that the PRN focuses on the engagement of learner members and is primarily composed of learners, including those who represent this perspective in other committees. All the committees are composed of both practicing pharmacists and learners, allowing students, residents, and fellows to interact regularly with specialist mentors to drive forward the PRN’s goals.

Other activities that learners, students, residents, and fellows have engaged in have included the PRN’s mentored newsletter articles and virtual rotations, held for the first time this past December. These newsletters, which put together and released twice a year, consist of various articles on topics of interest to the authors. Learners are encouraged to reach out to local hematology/oncology pharmacists for mentorship in writing (the PRN can facilitate these with limited options). The virtual rotations this past year were fun and educational for all involved. Students, PGY1s, and fellows were invited to participate in a bleeding disorders/factor stewardship virtual rotation. PGY2s participated in a bone marrow transplant and cellular therapy virtual rotation. Both opportunities were led by specialists in these areas, and the PRN offered abbreviated experiences, largely topic discussion and journal club based, in specialized disease states that may not be seen at all institutions. Overall, learners are encouraged to express interest in continued and further PRN involvement and to look forward to additional opportunities for ongoing engagement.

Current Clinical Issue

Cancer Mortality Declines at an Unprecedented Rate

By Adwoa Nyame, Virginia Commonwealth University School of Pharmacy, Pharm.D. Candidate (Class of 2021)

Mentor: Erin Hickey, Pharm.D., BCOP

(an excerpt from the Hematology/Oncology PRN Spring 2020 Newsletter)

Over the past 2 decades, overall cancer mortality has declined. The American Cancer Society (ACS), which annually compiles pooled incidence and mortality data, reports that overall cancer mortality decreased by an average of 1.5% per year during 2008–2017.¹ In its most recent report, ACS announced the single largest yearly decline to date, a 2.2% decrease from 2016 to 2017.

The falling cancer mortality rate in the United States has been exciting news for patients and providers alike. In 2016, there was a 27% decline in cancer mortality from 1991 – the peak in cancer mortality – which is an indicator of how far the field of oncology has progressed.² Although the ACS report cannot determine causal relationships between factors affecting mortality, there is debate on who deserves the credit. One point of discussion is whether the decreased mortality should be attributed to advances in cancer pharmacotherapy. Because the declining rate is driven by a decrease in lung cancer mortality, many experts speculate that advances in treatment, including the introduction of precision and immunotherapy-based drugs, are now displaying large-scale progress.

Critics of the ACS report are a reminder that several other factors may have more heavily influenced the decline in mortality. These include reduced smoking rates among both the male and female sexes, improved supportive care, multimodal therapy (i.e., surgery and radiation techniques), and screening practices. For example, the incidence of tobacco use for men and women has decreased from 20.9% to 15.1% since 2005.³ This decline in tobacco use in both men and women could be an integral part of the decline in cancer mortality because statistics show that the risk of developing lung cancer is 15–30 times higher in lifelong smokers than in nonsmokers.⁴ Furthermore, it is unlikely that the anti-EGFR tyrosine kinase inhibitors approved in the early- to mid-2000s (i.e., erlotinib, crizotinib) or the immune checkpoint inhibitors in later lines of therapy for advanced disease are producing this improved decline. It remains to be seen whether the survival benefit of next-generation targeted therapies or first-line combination chemoimmunotherapy will be reflected in the mortality rates of future reports.⁵

Although the cancer mortality rate is declining faster than ever, the causal relationship is difficult to determine. As an oncology pharmacy community, we can carry this message to continue developing and expanding the pharmacist’s role to further decrease cancer mortality by optimizing pharmacotherapy as well as using the appropriate screening techniques. Regardless of what caused the decline, cancer mortality is declining at an unprecedented rate – a victory that should be celebrated in the oncology field.

References:

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020;70:7-30. doi: 10.3322/caac.21590.
2. American Cancer Society (ACS). Facts & Figures 2019: US Cancer Death Rate Has Dropped 27% in 25 Years. doi: 10.3322/caac.21551.
3. Ward EM, Sherman RL, Henley SJ, et al. Annual report to the nation on the status of cancer, featuring cancer in men and women age 20–49 years. J Natl Cancer Inst 2019;111:1279-97.
4. Centers for Disease Control and Prevention (CDC). 2019. What Are the Risk Factors for Lung Cancer? Available at https://www.cdc.gov/cancer/lung/basic_info/risk_factors.htm. Accessed February 10, 2020.
5. Desai A, Gyawali B. Fall in US cancer death rates: time to pop the champagne? EClinicalMedicine 2020;19:100279. doi: 10.1016/j.eclinm.2020.100279.