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A forward-thinking new clinic at Waterloo Regional Health Network (WRHN) is changing the face of breast cancer care locally by integrating pharmacists more deeply into oncology treatment.
Focused on supporting patients receiving oral anticancer treatment, this new model is improving care efficiency, maximizing healthcare providers’ scope of practice, and delivering patient-centred, timely care more than ever before.
The pilot program at the WRHN Regional Cancer Centre is a collaborative, shared-care model between WRHN’s pharmacists and oncology physicians. Currently, patients diagnosed with early-stage breast cancer receiving adjuvant treatment with CDK4/6 inhibitors (abemaciclib and ribociclib) are provided care through this new clinic.
In this model, patients begin with an extended first visit with their oncologist and pharmacist team. The patient’s follow-up appointments are then structured on a rotational schedule between the oncologist and clinical pharmacist. Pharmacists continue each care journey with the patient, spending additional time to assess drug side effects, manage potential interactions, and evaluate lab work. Patients continue to be seen at appropriate time points with their oncologist for physical assessment and radiologic evaluation.
“The addition of our Medication Assessment by Pharmacist (MAP) clinic highlights our commitment to transforming patient care.” says Anthony Amadio, Interim Director of Pharmacy at WRHN. “Through the creation of this clinic and integration of a dedicated clinical pharmacist, we are providing patients with safe, seamless, and optimized care during their cancer journey. This collaborative approach reflects our focus on innovation and ensures patients receive the most comprehensive, personalized care possible.”
Inspired by oncology models in British Columbia and the Maritimes, the WRHN team developed a made-in-Ontario framework to address challenges, such as the intensive monitoring of each patient required during the early treatment cycles. Due to the success of the program to date, the clinic will expand this fall to include monitoring for patients on venetoclax for Chronic Lymphocytic Leukemia, and plans to include oral agents for ovarian and prostate cancer in the future.
“This initiative represents a pivotal step in both patient care and our practice,” says Dr. Shelley Kuang Medical Oncologist at WRHN. “The collaborative approach between the pharmacists and physicians at the Waterloo Regional Cancer Centre has allowed patients to feel better supported when starting new oral anticancer medications, preparing them for potential side effects and optimal management strategies.”
This is not just a new workflow, it’s a shift in how care is provided. Pharmacists, working alongside algorithm-based guidance documents co-developed with oncologists, are empowered to manage therapy independently. This includes ordering lab work and diagnostics (e.g. ECG) appropriate for the medication being monitored and holding therapy or making dose adjustments as required. When necessary, care is escalated to involve a physician for further assessment and management.
“This clinic gives us the opportunity to practice at our full scope,” says Jackie Diebold, Clinical Oncology Pharmacist at WRHN. “It’s about supporting the patient through safe, comprehensive care while reducing the burden on physicians and the system. We’re using our knowledge and unique skill set to make a significant impact.”
Diebold adds that another benefit to patients through this novel clinic is a reduction in the time patients spend waiting for medications: “Patients are then supported through their treatment journey by retail pharmacy partners, who are prepped in advance by the clinic team, significantly reducing wait times and improving access.”
Patients on a CDK4/6 inhibitor are seen by the Pharmacy Team at WRHN every two weeks during their first two treatment cycles, an intense schedule that is made more manageable through the pharmacy-led approach, providing wraparound care. The time between visits is then extended based on the tolerability of the medication and stability of the patient.
Far from being reluctant, physicians are embracing and advocating for the model. They help triage eligible patients and refer those best suited to pharmacist-led monitoring, ensuring a good clinical fit. Patients, in turn, must consent to join the clinic, which builds trust and reinforces a sense of agency.
By taking on stable, lower-risk patients, the clinic is freeing up oncologists’ schedules to focus on more complex cases and new patient intake, increasing capacity and reducing delays in cancer care.
