Pharmacists help facilitate rigorous treatment plans for kids with cancer

We are committed to a culture of safety at Norton Children’s Cancer Institute. We spent 18 months building chemotherapy protocols into electronic health records, making us one of a small number of medical centers nationally to do so.

Every day at Norton Children’s Cancer Institute, affiliated with the UofL School of Medicine, pharmacists round with the teams. We’re part of the decision-making process for hematology, oncology and stem cell transplant patients. Our goal is to help give these children the best possible outcome and keep them safe.

For many patients, this involves following rigorous treatment plans. Norton Children’s is a member of the Children’s Oncology Group, which develops complex, detailed protocols based on the latest research. These protocols can cover two or three years of treatment and run as many as 500 pages.

A lot of what we do is making sure we are adjusting medications according to the protocol. We also adjust medications to minimize nausea and vomiting, a common side effect. In addition, we ensure infections are treated well, give pain medication when needed and monitor for toxicity.

We are committed to a culture of safety at Norton Children’s Cancer Institute. We spent 18 months building chemotherapy protocols into electronic health records, making us one of a small number of medical centers nationally to do so. This work is never done, as we are continuously updating current protocols and adding the latest protocols to the electronic health record. That means when a physician uses the computerized physician order entry system, the electronic record is populated correctly. The system went live in 2020, significantly reducing the potential for errors.

Many therapies are toxic. To minimize the number of adverse events, we started a chemotherapy safety committee, a multidisciplinary committee to see where we can do better. This safety committee has resulted in improvements in care at Norton Children’s Cancer Institute.

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Over the next decade immunotherapy will become more common, offering exciting new treatments. Already, Norton Children’s Cancer Institute offers CAR-T cell therapy for children and teens with advanced and/or recurrent B-cell acute lymphoblastic leukemia (ALL).

With immunotherapy comes toxicities we’re not used to seeing in children, including the potential for cytokine release syndrome. We have protocols in place on the front end to manage these toxicities so we can ensure the kids receiving immunotherapy are as safe as possible.

Norton Children’s Hospital, which serves as the primary pediatric teaching facility for the University of Louisville School of Medicine, is a leader in education. We have one of only four specialized pediatric oncology pharmacy training programs in the country. The other programs are located at St. Jude Children’s Research Hospital in Memphis, Tennessee; Memorial Sloan Kettering Cancer Center in New York City; and Seattle Children’s Hospital in Washington.

We receive applicants for the yearlong program from all over the country, and our graduates are now becoming the next generation of leaders at places like Children’s Healthcare of Atlanta in Georgia; Riley Hospital for Children in Indianapolis, Indiana; and Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tennessee.

There is a common misconception that pharmacists only receive prescriptions and fill medications. In reality, we are active members of the team, offering an important perspective as we work together to provide better outcomes for our patients.

What motivates me every day is the spirit of our patients. These kids are so resilient. Most of the time they handle treatment with a smile on their face. It’s so rewarding for me to see them come in with a life-altering diagnosis and come out of their treatment able to go on with full lives.

Joshua J. Elder, Pharm.D., BCPS, BCOP, is a clinical specialist with the Norton Children’s Cancer Institute hematology, oncology and stem cell transplant programs and director of the postgraduate year two (PGY2) oncology pharmacy residency at Norton Children’s Hospital.

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