CAPhO Oncology Fundamentals Day Saturday, October 1, 2016

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1 The Canadian Association of Pharmacy in Oncology Presents CAPhO Oncology Fundamentals Day #OFD16 [Type here]

2 Accreditation CAPhO Oncology Fundamentals Day is accredited by the Canadian Council on Continuing Education in Pharmacy (CCCEP) for 6.67 continuing education credits (CEUs). Participation on October 1 st is required to receive a letter of participation. CCCEP Number: C-P Program at a Glance Click on the session title or presenter name to go directly to the session description or presenter biography. Note: All times indicated are Eastern Daylight Times (EDT).The program below is subject to change. Time Session 09:30 09:40 Welcome Remarks 09:40 11:50 Fundamentals of Hematologic Cancer 09:40 10:20 Lymphoma - Kyla Marien, Tom Baker Cancer Clinic, Calgary, AB 10:25 11:05 Chronic Leukemias - Danica Wasney, CancerCare Manitoba, Winnipeg, MB 11:10 11:50 Multiple Myeloma - Tina Crosbie, The Ottawa Hospital, Ottawa, ON 11:50 12:30 Break 12:30 14:55 Fundamentals of Solid Tumours 12:30 13:15 Breast Cancer - Melanie Danilak, Alberta Health Services, Edmonton, AB 13:20 14:05 Colorectal Cancer - Tom McFarlane, University of Waterloo, Kitchener, ON 14:10 14:55 Lung Cancer - Jason Wentzell, The Ottawa Hospital, Ottawa, ON 14:55 15:20 Break 15:20 18:00 Chemotherapy Toxicity Management 15:20 16:00 16:05 16:45 16:50 17:20 Chemotherapy Induced Nausea and Vomiting - Sally Waignein, BC Cancer Agency, Vancouver, BC Other Gastro-Intestinal Toxicities - Glenn Myers, Horizon Health Network, Moncton, NB Febrile Neutropenia - Tara Leslie, Tom Baker Cancer Centre/University of Alberta, Calgary, AB 17:25 18:00 Skin, Nail and Hair Toxicities Lynn Hartery, Eastern Health, St. John s, NL 18:00 18:10 Closing Remarks Page 2 #OFD16

3 Session Descriptions and Presenter Biographies Fundamentals of Hematologic Cancers Lymphoma - Kyla Marien, Tom Baker Cancer Clinic, Calgary, AB Lymphomas are a heterogeneous group of over 40 different malignancies originating from T cells and B cells in the lymphatic system. Within this group of diseases there are similarities and differences within the pathophysiology, natural history, and prognosis. As treatment options differ dependent on the specific disease, the adverse effects patients experience can be diverse. Pharmacists are well positioned to assist in monitoring lymphoma patients for therapy toxicities and optimizing supportive care measures. 1. Appreciate the numerous types of lymphoma and gain understanding in the differences between Hodgkin and Non-Hodgkin, indolent and aggressive, and B- cell versus T-cell lymphoma; 2. Discuss the incidence, pathophysiology, typical presentation, and prognostic factors for lymphomas; 3. Describe some common treatment regimens, associated side effects, and monitoring parameters for common types of lymphoma; and 4. Explore the role of CD20 monoclonal antibodies in lymphoma and discuss the associated supportive care requirements. Kyla Marien graduated from University of Saskatchewan in 2003 and currently works for Alberta Health Services at the Tom Baker Cancer Centre as clinical hematology pharmacist. Over the past 13 years she has practiced in many diverse settings, including community, geriatrics, hospital outpatient, and oncology. Kyla truly believes each setting provided her with different skills and knowledge to allow her to practice today in oncology with an appreciation for a patient s experiences both in the center and in the community. Before joining the hematology clinical pharmacy team, Kyla developed her oncology clinical skills with the oral chemotherapy management clinic. Kyla is a proud CAPhO member. Page 3 #OFD16

4 Chronic Leukemias - Danica Wasney, CancerCare Manitoba, Winnipeg, MB Systemic therapy for both Chronic Lymphocytic Leukemia (CLL) and Chronic Myelogenous Leukemia (CML) has evolved significantly over the past years. Systemic therapy for both CLL and CML is complex due to both the regimens used and the patient populations, as patients often present with comorbidities and multiple medications. Pharmacists are well equipped to optimize clinical outcomes for patients with CLL and CML through education, monitoring, symptom management, and medication management. For CLL, selection of systemic therapy is based on a variety of patient and disease factors, including staging, patient performance/functional status, and genetic markers. Systemic therapy regimens for CLL are complex, consisting of both oral and parenteral anticancer agents in addition to crucial supportive care agents. In addition, these regimens require careful attention with regards to drug interactions and medication adherence. Pharmacists can play a key role in optimizing care for patients with CLL. For CML, the introduction of targeted therapies has resulted in significant advances in patient survival and outcomes. Treatment selection is based on a variety of patient and disease factors, including CML phase, patient performance/functional status, and genetic markers. Since systemic therapies used to manage CML are usually orally administered on an outpatient basis, pharmacists are positioned to support patients with CML through management of drug interactions, symptom management, and medication adherence. After this presentation, participants should be able to: 1. Discuss the incidence, prevalence, pathophysiology, and staging for Chronic Lymphocytic Leukemia (CLL); 2. Discuss the incidence, prevalence, pathophysiology, and staging (phases) for Chronic Myelogenous Leukemia (CML); 3. Describe systemic treatment selection, monitoring parameters, and expected outcomes for patients with CLL and CML; and 4. Explain common supportive care issues for patients with CLL and CML. Danica Wasney is a Clinical Pharmacist for the Provincial Oncology Drug Program at CancerCare Manitoba. In this role, she participates in the provincial oncology drug review process including the management of the provincial oncology drug formulary. She is a member of the Expert Review Committee for the pan-canadian Oncology Drug Review (pcodr) at the Canadian Agency for Drugs and Technologies in Health (CADTH). Danica has clinical experience in breast, colorectal, thoracic and gynecologic cancers, neuro-oncology, and hematologic malignancies. Page 4 #OFD16

5 Danica graduated from the Faculty of Pharmacy at University of Manitoba and completed an Accredited Hospital Pharmacy Residency at The Ottawa Hospital. She is a Board Certified Oncology Pharmacist, a member of the CAPhO Research Committee, and a past member of the CAPhO Education Committee. Page 5 #OFD16

6 Multiple Myeloma - Tina Crosbie, The Ottawa Hospital, Ottawa, ON Multiple Myeloma is the second most common blood cancer. Every day, seven Canadians are diagnosed with myeloma; most commonly people are in their early 60 s at diagnosis. Myeloma can affect other parts of a person s body including the kidneys and bones. Knowing what a patient can expect when diagnosed with myeloma can help the pharmacist be a valued resource when providing care to that patient has seen a wealth of treatment options for patients with multiple myeloma. The pharmacist is in a great position to explain the treatment chosen to manage the disease and answer questions so the patient can benefit from their therapy. 1. Define myeloma and how frequently it occurs in Canada; 2. Discuss how a patient may appear when ready to start myeloma therapy; 3. Identify key patient needs and how the pharmacist can assist their patient with myeloma; and 4. Review what treatment combinations are available for patients with newly diagnosed and for patients with relapsed myeloma. Tina Crosbie holds a Bachelor of Science in Pharmacy from Memorial University of Newfoundland and completed her hospital pharmacy residency at The Ottawa Hospital. She has over 20 years experience in hospital and retail pharmacy practice in Newfoundland and Ontario. For the last 17 years Tina has been part of the hematology team at The Ottawa Hospital. Currently, she is the clinical pharmacist for the ambulatory hematology chem unit. Here she oversees patients with lymphoma, multiple myeloma and chronic lymphocytic leukemia who are receiving care on an outpatient basis. Tina has written educational materials and has given presentations on numerous topics in hematology. She also enjoys being a peer reviewer for the Canadian Council on Continuing Education in Pharmacy (CCCEP), and is a proud member of CAPhO. Page 6 #OFD16

7 Fundamentals of Solid Tumours Breast Cancer - Melanie Danilak, Alberta Health Services, Edmonton, AB This presentation will provide the pharmacist with an introduction to the treatment of breast cancers, with a focus on the early breast cancer setting. 1. Recommend appropriate screening for breast cancer to patients in the community; 2. Describe the methods used to detect and classify breast cancer; 3. Differentiate between the main treatment options offered to patients with breast cancer, including surgery, radiation therapy, chemotherapy, targeted therapy, and endocrine therapy; 4. Describe common or significant toxicities that arise from systemic breast cancer treatments; 5. Evaluate common drug interactions involving breast cancer treatments; 6. Identify resources available to health professionals and patients about breast cancer treatment; and 7. Recognize the role of the pharmacist in providing care to patients with breast cancer. Melanie Danilak obtained her BSc. in Pharmacy in 2004 and Master of Education in Health Sciences Education in 2016 from the University of Alberta. She has completed an accredited pharmacy residency with a focus in oncology at the Cross Cancer Institute and has obtained additional prescribing authorization from the Alberta College of Pharmacists. Melanie is currently a Clinical Practice Leader and Residency Coordinator with Alberta Health Services. Her clinical practice is focused on breast cancer endocrine therapy. She is also a clinical adjunct professor with the Faculty of Pharmacy & Pharmaceutical Sciences at the University of Alberta. Page 7 #OFD16

8 Colorectal Cancer - Tom McFarlane, University of Waterloo, Kitchener, ON Colorectal cancer is one of the most prevalent types of cancer in Canada, with nearly 25,000 cases diagnosed in 2014 and over 9,000 deaths attributed to the disease. It is 90% curable if detected at an early stage, yet unfortunately screening is still not done optimally. Treatments for colorectal cancer are advancing, and patients are living longer, thus creating a need for management as a chronic disease. This presentation is intended to give the pharmacy practitioner a basic understanding of the pathogenesis of the disease, basic workup, treatment options, and management of adverse effects. After attending, participants will be able to: 1. Understand the etiology, pathogenesis, and prevalence of colorectal cancer; 2. Apply screening guidelines for colorectal cancer to patients; 3. Outline agents used to treat colorectal cancer in the curative, neoadjuvant, and adjuvant settings; and 4. Detail the management of adverse effects related to colorectal cancer treatments. Tom McFarlane received his Bachelor of Science in Pharmacy degree from the University of Toronto in 1996 and his Doctor of Pharmacy degree from Idaho State University in He is currently a Clinical Lecturer and researcher at the UW School of Pharmacy in Kitchener, Ontario, where he created, coordinates, and teaches the oncology curriculum in the Doctor of Pharmacy program. He also holds memberships in CPhA, CAPhO, and ISOPP and is Chair of the CAPhO Research Committee as well as being a member of the CAPhO Executive and Education Committees. Page 8 #OFD16

9 Lung Cancer - Jason Wentzell, The Ottawa Hospital, Ottawa, ON The changing therapeutics of lung cancer is becoming more complex and requires an understanding of management principles by the primary care pharmacist in order to identify and resolve drug therapy issues and optimize the care of patients with lung cancer. This session will focus on the provision of information pertinent to pharmacy practitioners involved in the care of patients with various types of lung cancer. A brief overview highlighting the demographic, genetic, therapeutic and prognostic differences between small cell lung cancer and non-small cell lung cancers will be provided. The predominant focus of the session will be to review common therapeutic agents used in the treatment of lung cancers. Particular emphasis will be given to current and emerging oral anticancer therapies that participants may see in clinical practice, including information on identifying and managing potential drug interactions. In addition, a summary and strategy will be provided to front-line pharmacy care providers on how to identify, manage or refer toxicity caused by immune-related anticancer therapies. Lastly, some practical information on managing anticancer therapy related adverse effects and reiterating the importance of smoking cessation where applicable will be provided. 1. Participants will learn the basic demographic, genetic, and prognostic differences between small cell lung cancer and non-small cell lung cancers; 2. Participants will learn about the indications, pharmacology, schedules and toxicities of current anti-cancer therapies for respective lung cancer types; and 3. Participants will be provided with practical information on the identification and management of anti-cancer therapy related toxicities and drug-drug interactions that can be incorporated into daily practice. Jason Wentzell completed his pharmacy degree at Dalhousie University and his Pharmacy Residency at The Ottawa Hospital. He has been practicing as an inpatient Medical Oncology pharmacist for 5 years and has recently received his Board Certification as an Oncology Pharmacist. Jason is the pharmacist representative in the Ottawa Hospital Cardio-Oncology clinic and is involved in research in the areas of cardio-oncology, adverse drug reaction reporting, simulation education and oral anticancer therapy. He is currently serving as a Regional Clinical Coordinator for the University of Waterloo PharmD program. Page 9 #OFD16

10 Chemotherapy Toxicity Management Chemotherapy Induced Nausea and Vomiting - Sally Waignein, BC Cancer Agency, Vancouver, BC Chemotherapy-induced nausea and vomiting (CINV) is one of the most distressing, yet manageable toxicities associated with chemotherapy treatment. Appropriate prevention strategies can minimize the risk of CINV, and thus, the potential complications of CINV. This presentation will briefly review the generally management strategies of acute, delayed and anticipatory CINV, and highlight the unique role that pharmacists can play in optimizing CINV management in cancer patients. Upon completion of this program, participants will be able to: 1. Define the 3 types of CINV, and their associated onset and duration of symptoms; 2. Identify the chemotherapy agents commonly associated with CINV; 3. Describe the general pharmacologic approach to the prevention and management of CINV; and 4. Recognize the role of the pharmacist in helping to prevent and manage CINV in cancer patients. Sally Waignein obtained her Bachelor of Pharmaceutical Sciences from the University of British Columbia (UBC) in 2006, completed a Pharmacy Residency at Fraser Health, BC in 2007, and obtained her Doctor of Pharmacy degree from UBC in She is currently the Residency Coordinator and Provincial Pharmacy Education Coordinator at the BC Cancer Agency. Her clinical practice is focused in breast cancer and drug information, and she is also involved in the Agency s Priorities and Evaluations Committee. Sally is actively involved in the training of undergraduate Pharmacy students and residents, and is a Clinical Instructor with the UBC Faculty of Pharmaceutical Sciences. She holds membership in CAPhO and CSHP, and is an active member of the CAPhO Pharmacist Education Committee. Page 10 #OFD16

11 Other Gastro-Intestinal Toxicities - Glenn Myers, Horizon Health Network, Moncton, NB The presentation will briefly outline non-cinv related toxicities of chemotherapy, targeted anti-cancer and immunotherapy that affect both the upper and low gastro-intestinal (GI) tract. This will specifically include mucositis, diarrhea, constipation, and enterocolitis. 1. Identify the specific chemo-, targeted and/or immune-therapies responsible for causing diarrhea, constipation, mucositis and enterocolitis; 2. Compare and contrast the clinical presentation and timeline of each GI toxicity as it relates to their respective chemo-, targeted or immunotherapies; 3. Apply the CTCAE guidelines when grading each of the respective GI toxicities in order to guide appropriate treatment; and 4. Discuss the general non-pharmacologic and pharmacologic treatment strategies for GI toxicities and identify when these strategies may differ depending on the causative agent. Glenn Myers is a clinical pharmacist in outpatient oncology and emergency medicine at The Moncton Hospital in Moncton, New Brunswick. Glenn completed a BSc (Pharmacy) at Dalhousie University in 2011 and subsequently went on to complete his hospital residency at the Saint John Regional Hospital in Saint John, NB. Glenn has been in oncology for 4 years and specializes in assessment and management of chemotherapy and immune related adverse effects. Page 11 #OFD16

12 Febrile Neutropenia - Tara Leslie, Tom Baker Cancer Centre/University of Alberta, Calgary, AB Febrile neutropenia is a common complication for patients receiving treatment for cancer. It is considered a medical and oncologic emergency with a mortality rate estimated between 5-20%. Timely recognition of symptoms, assessment, and initiation of empiric treatment is critical. In select patients, prophylaxis of febrile neutropenia and/or infection is indicated. Within this session, we will discuss febrile neutropenia patient education, monitoring, prophylaxis, and treatment. Upon completion of this program, participants will be able to: 1. Define febrile neutropenia (FN) and appreciate the urgency and implications of this oncologic emergency; 2. Discuss the importance of patient education and self monitoring for fevers; 3. Understand primary and secondary prophylaxis of FN and the roles of filgrastim and peg-filgrastim; and 4. Describe the stepped approach to antibiotic therapy of FN. Tara Leslie attained her Bachelor of Science in Pharmacy (BSP) degree from the University of Saskatchewan in 1997, obtained her Board Certification in Oncology Pharmacy (BCOP) in 2010, and acquired her Additional Prescribing Authority (APA) in She is a Clinical Pharmacist at the Tom Baker Cancer Centre in Calgary and Clinical Assistant Professor with Experiential Education at the Faculty of Pharmacy, University of Alberta. Tara maintains a clinical practice within the ambulatory lymphoma and chronic leukemia clinics and is actively involved with student education as a preceptor and instructor for malignant hematology and oncology complications. She is an active member of CAPhO and ISOPP serving as Chair of the CAPhO Pharmacist Education Committee and Co-Chair of the ISOPP 2017 Symposium Annual Program Task Force. Page 12 #OFD16

13 Skin, Nail and Hair Toxicities Lynn Hartery, Eastern Health, St. John s, NL Provide a general overview of dermatological toxicities (skin, nail and alopecia) associated with chemotherapy treatment. Upon completion of this program, participants will be able to: 1. List potential dermatological toxicities of chemotherapy, including list of causative agents, and briefly describe what causes them; 2. Discuss skin toxicities, including dry skin/pruritis, macular rash, papulopustular EGFR/targeted therapy rash, hand/foot reaction, and management of these reactions; 3. Discuss nail changes and management; 4. Discuss alopecia and management; and 5. Recognize the role of pharmacists in counselling and monitoring patients on dermatological toxicities of chemotherapy agents. Lynn Hartery is a Clinical Pharmacist II at Eastern Health Pharmacy Services, St. John s, NL. She graduated from Memorial University of Newfoundland School of Pharmacy with BScPharm in In 2005, Lynn moved to Eastern Health and in 2006 began clinical duties as Oncology Pharmacist at Dr. H. Bliss Murphy Cancer Center. Lynn still continues to spend part of her time in the Pharmacy Department where she has a lead role in the chemotherapy preparation room. As part of the oncology team, she performs patient assessments and medication reviews, counsels patients on chemotherapy and performs patient toxicity assessments. Page 13 #OFD16