Session Descriptions

Hodgkin Lymphoma

Kyla Bailey, BSP, Tom Baker Cancer Centre, Calgary, AB

Hodgkin Lymphoma is one of the most frequent B cell-derived lymphomas, with an annual incidence of 900 new diagnosis in Canada. It accounts for around 0.5 % of all cancers and 15 % of all lymphomas diagnosed. This lymphoid malignancy involves peripheral lymph nodes and can also affect organs such as liver, lung, and bone marrow. About 40% of patients suffer from constitutional symptoms (“B-symptoms”) which can greatly impact daily quality of life.  Fortunately, Hodgkin lymphoma has encouraging response rates and is considered one of the most curable forms of cancer. The landscape of treatment options may include cytotoxic chemotherapy, radiation, stem-cell transplants, and immunotherapy.  Pharmacist can play a vital role in identifying and managing acute and long-term toxicities derived by the different treatment modalities. 

Learning Objectives:

  1. Review disease background including epidemiology, staging, classifications, and risk factors;
  2. Identify clinical features of disease and symptom burden;
  3. Discuss treatment options for both frontline and relapsed or refractory disease; and
  4. Recognizing treatment specific side effects and the role pharmacy practitioners may monitor for long term adverse effects caused by such treatment modalities.

Multiple Myeloma

Tina Crosbie, BSc. (Pharm), ACPR, RPh, The Ottawa Hospital, Ottawa, ON

Myeloma is the second most common blood cancer. In myeloma, abnormal plasma cells (also known as myeloma cells) interfere with the production of normal healthy blood cells in the bone marrow. Plasma cells produce antibodies making them a key component of the body’s immune system. Yet in myeloma, abnormal plasma cells overproduce inactive clones of abnormal antibodies that can negatively affect different parts of the body such as the bones and kidneys. 
Every day nine Canadians are diagnosed with myeloma; people are most often in their early 60’s at diagnosis. Knowing what a patient may experience once diagnosed with myeloma can help the pharmacist be a valued resource when providing care for that patient. Canada has seen a wealth of treatment options improving survival for patients with multiple myeloma. The pharmacist is in a great position to explain the treatment chosen to manage their disease. As a medication expert, the pharmacist can answer questions to optimize the benefit patients receive from their therapy.

Learning Objectives:

  1. Define myeloma and how frequently it occurs in Canada;
  2. Discuss how a patient may appear when needing to start myeloma therapy;
  3. Identify key patient needs and how a 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. 

Hepatocellular Carcinoma

Glenn Myers, BSc(Pharm), ACPR, Dr. Sheldon H Rubin Oncology Clinic, Moncton, NB

Hepatocellular carcinoma (HCC) accounts for the majority of primary liver cancers and carries a high mortality rate in the locally advanced and metastatic setting. HCC majorly affects patients with a history of chronic Hepatitis B or C infection, alcoholic or nonalcoholic fatty liver disease. Prior to 2018, treatment options for transplant ineligible, locally advanced, or metastatic HCC were limited to sorafenib anti-cancer therapy as a 1st line option. Many patients would never receive ≥2nd line therapy due to limited therapeutic options, limited clinical trials, and/or decline in performance status. Evidence for first and second line therapy for HCC have evolved since 2018 to include alternative VEGFR-TKIs (e.g. lenvatinib, cabozantinib, regorafenib), checkpoint immunotherapy (e.g. nivolumab, pembrolizumab), and immunotherapy based combinations (e.g. atezolizumab + bevacizumab, lenvatinib + pembrolizumab). This learning activity aims to provide introductory knowledge of HCC treatment considerations in an effort to optimize pharmaceutical care for your patients. 

Learning Objectives:

  1. Recall the risk factors, epidemiology, and pathophysiology of hepatocellular carcinoma (HCC);
  2. Summarize diagnostic assessment, grading, and prognosis of HCC;
  3. Review management strategies for limited stage HCC;
  4. Discuss the best available evidence and provide overview of treatment algorithms for patients with locally advanced or metastatic HCC; and
  5. Apply supportive care strategies for typical disease related symptoms associated with locally advanced or metastatic HCC.

Neuroendocrine Tumors

Stephanie Lovering, BSc(Hon), BScPharm, PharmD, ACPR, The Ottawa Hospital, Ottawa, ON

Neuroendocrine tumors (NETs) encompass a heterogeneous group of neoplasias that develop from a variety of anatomic sites. They can secrete a range of bioactive products, which have the potential to result in a secretory syndrome. There are several therapeutic interventions that can be considered for the treatment of NETs including surgical, loco-regional, pharmacologic, and nuclear. This presentation will review the basics of the main classifications and staging systems of NETs and will focus on pharmacologic alternatives for the treatment of NETs.

Learning Objectives:

  1. Describe the classification and staging systems of neuroendocrine tumors (NETs);
  2. Explain carcinoid syndrome and common clinical manifestations; and
  3. Compare and contrast the mechanism of action, efficacy, and safety of pharmacologic treatment options for NETs.

Introduction to Reviewing Oncology Specific Literature

Bianca Au, Cross Cancer Institute, Edmonton, AB

Reviewing literature is a crucial and challenging part of our jobs as healthcare practitioners. This presentation will provide an introduction to reviewing oncology specific literature. There are several different types of studies one may encounter while reviewing oncology literature, including randomized controlled trials. We will review what a randomized controlled trial is, it’s place in the hierarchy of evidence, look at some common terms / language one may encounter while reviewing oncology literature, and work through an example of how to review a randomized controlled trial. We will explore those topics from an oncology perspective to highlight how it differs from a non-oncology viewpoint.

Learning Objectives:

  1. Define oncology specific literature;
  2. Review the different types of literature in oncology with a focus on randomized controlled trials;
  3. Discuss a step wise approach to critically appraising a randomized control trial; and
  4. Examine the different points to consider when reviewing an oncology specific study compared to a non-oncology study.

Thrombosis in the Setting of Cancer - A Pharmacy Perspective  

Tom McFarlane, BScPhm PharmD RPh, University of Waterloo / Sunnybrook Health Sciences, Toronto, ON

Oncology patients present a unique challenge in anticoagulation, since they have a propensity to both clot and bleed easily and are often on multiple medications that can interact with anticoagulants. This presentation will summarize best practices for management of patients with VTE, and give some guidance on how to manage drug interactions that can occur in this setting. Topics covered will include use of LMWH, guidelines for use of DOACs, new evidence for prophylaxis in the ambulatory setting, and common concerns with CYP metabolized agents.

Learning Objectives:

  1. Review thrombogenesis in oncology;
  2. Review primary and secondary prophylaxis of VTE in cancer patients; and
  3. Examine possible drug interactions with DOACs in the cancer population.

Cancer Care in the Community: Tips & Tricks for Frontline Pharmacists

Jason Wentzell, BScPharm, RPh, ACPR, BCOP, MHM, Extend Pharmacy, Ottawa, ON

The recent pandemic has highlighted the value of the frontline pharmacist in providing timely, accessible and accurate health care and advice within our communities. As contemporary cancer care rapidly evolves through a widening use of immunotherapy and targeted oral oncolytics, CAPhO members are in a unique position to highlight important teaching and monitoring points to help our frontline care providers identify and prevent potential issues surrounding cancer care in our communities. This session serves to provide a very brief, practical update into key recent and emerging oncology practice changes for frontline pharmacists and to raise awareness of common medication errors for all involved pharmacists as our patients transition from specialized oncology services to receiving care in the community.

Learning Objectives:

  1. Briefly review recent advancements in therapeutics and practical monitoring for key oncology practice areas pertinent to frontline pharmacists;
  2. Review and raise awareness of several common oncology medication errors that can occur at transition points from specialized oncology service to frontline care; and
  3. Briefly introduce several accessible and reliable references frontline pharmacists can use to help answer day-to-day oncology medication questions that arise in practice.