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The Role of the Pharmacist in CLL

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By Tom Henry – Patient 

When most of us think of a pharmacist we think of them primarily in the role of retail pharmacy, the health care professional with whom many of us interact most frequently. However, pharmacy has evolved significantly and there is now a greater degree of specialization in the profession. Specialization in Oncology practice is a major area of growth within pharmacy. 

Traditionally, pharmacists who specialized in oncology practice gained their expertise through years of working in the oncology arena. Today, much like their physician counterparts pharmacists gain specialized training and experience through two-year post graduate residency programs after completion of the six year Doctor of Pharmacy program. Again, like physicians many of these pharmacists then become board certified. Board Certified Oncology Pharmacists (BCOPs) have met rigorous experience requirements of up to four years in oncology practice, passed a comprehensive examination and maintain that certification through extensive continuing education.

Oncology Pharmacists work as part of your treatment team in providing evidence based, patient centered medication therapy management and direct patient care for individuals with CLL and other cancers, including treatment assessment and monitoring for potential adverse drug reactions and drug-drug and drug-food interactions. Oncology pharmacists have the advanced knowledge and experience to manage cancer-related adverse events or clinical situations not encountered in other disease states due to the increasing number and complexity of drug therapies to treat and prevent cancer. Oncology pharmacists are specially trained to recommend, design, implement and modify pharmacotherapeutic plans to optimize outcomes in patients with malignant diseases and to reduce medication errors, and recognize and respond to adverse physical and emotional issues that may arise during treatment including pain, nausea and hair loss. 

A new phenomenon in the practice of pharmacy is the area of specialty pharmacy services. Many drugs are not available through the normal distributive channels and can only be procured through specialty pharmacies. Specialty pharmacies often employ pharmacists who help patients navigate the insurance claims process by facilitating the “prior-approval” process. These pharmacies may also assist patients through the process of obtaining financial assistance through the manufacturer of the products. 

The CLL Society professes the mantra… “Smart Patients Get Smart Care”. Being prepared for each encounter with your care team is a critical element of being a smart patient. This means always having a complete medication history ready to share with your care team. Too many patients fail to include the herbal remedies or supplements on their lists or the over the counter medications they take. Be sure to include the “PRN” or “as-needed” medications you take on your history. As a 17P deletion CLL patient, I was started on Ibrutinib at about 6-months post-diagnosis. Working with the clinical pharmacist specialist at Duke Cancer Center we poured over my medication history and I was advised to stop several supplements that I took because they either had potential drug interactions or they had mild anti-coagulant properties that enhanced the blood thinning properties of Ibrutinib. Despite 35-years in the profession, I failed to recognize the potential harm these potential adverse effects so I walked away with a new higher regard for the oncology specialist.

To be a smart patient you have to be prepared with information about any side-effects you encounter with as much specificity as to date(s), time of day, severity etc. I recommend keeping a diary and paying attention to the messages your body sends you. Be prepared. Ask questions. Read, read, read. I devote no less than 4-hours a week either reading about CLL or because of my professional credentials participating in continuing education programs on CLL. If your hospital or clinic has a patient portal as part of their electronic medical record, utilize this to review your lab results, care notes and in many cases as a means to electronically communicate with your care team between visits. 

My final recommendation on being a smart patient is to be compliant with your recommended course of treatment. Do not stop treatment unilaterally even if you are having horrible side effects; seek out guidance to develop a treatment alternative that may mitigate those side-effects. If you can’t afford your medications seek out information about patient assistance programs that may be available to keep you on your medication.

Thomas Henry is a Registered Pharmacist and CLL Patient. He is President and Senior Consultant for Burlington Consulting Associates, a company that provides consulting services to health systems nationwide. Tom is a CLL Society Medical Advisory Board member and strives to educate other CLL patients through his blog https// He has a forty-two-year career in pharmacy and has served as Chief Pharmacy Officer at two Top-15 Comprehensive Cancer Centers, Moffitt (Tampa, FL) and Roswell Park (Buffalo, NY).

Originally published in The CLL Tribune Q2 2017.

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