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How I Became a Clinical Oncology Pharmacist

Oct 27, 2021

Alison Palumbo, PharmD, MPH, BCOP, is a clinical oncology pharmacist at Oregon Health and Science University, a role she has held for 7 years. Her primary area of practice is solid tumors. She joined the institution after completing her pharmacy practice residency at the University of Michigan Health System and her oncology pharmacy residency at the University of Washington Medicine.
Dr. Palumbo serves on the ASCO Membership Advisory Committee. Her special interests include breast cancer, supportive care, and global health. She also enjoys traveling, hanging out with her dog, Ghost, and Crossfit. Follow her on Twitter
How did you initially choose your current career path? Were there any unexpected detours along the way?
AP: I knew I wanted to be a pharmacist from the time I was in high school. I had several mentors growing up who were pharmacists, so it seemed like the best route for me. I originally thought I wanted to specialize in infectious disease because it was such an interesting topic, but during pharmacy school my friend’s teenage sister developed cancer. Watching my friend and his family deal with this devastating diagnosis, I wanted to help, but I realized I did not yet have the tools to be effective. This motivated me to take oncology clinical rotations and learn more about cancer in general. What I found is that I really enjoyed learning about oncology and the act of helping patients through their cancer treatment was very rewarding. Needless to say, I changed my career path at that point.
Are there any particular experiences that shaped your career and led you to where you are today?
AP: One event that really shaped my career path was obtaining my Masters in Public Health. I obtained this degree simultaneously with my Doctor of Pharmacy degree. At the time, I thought it would be most helpful for teaching me sound study methodology and design so that I could become a strong researcher, but it taught me so much more than that. Obtaining my MPH really taught me the importance of prevention, primary care, and universal health care to benefit the population as a whole. Having this 10,000-foot perspective on health care overall has really shaped the way I think about oncology, the research I conduct, and the research that is being done in this field.
Describe your typical work day.
AP: I work in our community oncology clinics focusing on oral chemotherapy. In a typical day, I will call several patients who have started oral chemotherapy and help them manage their side effects. We work closely with physicians to optimize dosing, supportive care, and other issues surrounding oral chemotherapy. We are currently piloting a Collaborative Drug Therapy Management program where we manage certain side effects (such as constipation and nausea) on behalf of providers. We also precept pharmacy students and residents on oncology clinical rotations, teaching them about cancer and its treatment. In my downtime, I also work on several research projects with pharmacy students and residents.
If you have to pick one aspect, what part of your job is your favorite? What part is the most challenging or frustrating?
AP: My favorite aspect of my work is teaching learners about oncology and clinical trials. I really enjoy journal clubs and digging into the nitty gritty details of oncology studies. I also really enjoy talking to patients because it helps me to see the human side of cancer treatment. It is truly an honor to have the time to spend discussing side effects with patients in depth. Most patients just want to be listened to and I am grateful that we can help provide an ear for them.
Perhaps the most frustrating, though necessary, part of my job is the operations piece (troubleshooting the electronic medical record, working with insurance, etc.). This may include working with our existing systems to make them work better for our needs or developing cost-saving initiatives. The reason this can be frustrating is that it does take time away from patient care and teaching. Most go into oncology pharmacy to read papers, talk to patients, and do clinical work, but the unfortunate truth is that it is not realistic for us to spend our time on these activities alone. Pharmacists may be tasked with justifying our positions rather than doing the work we are trained to do.
What do you wish you had known before you chose your career path?
AP: I wish I had learned that it’s ok to say “no” before choosing this career path. As an oncology pharmacist in an academic setting, you are often pulled in many different directions, and though each opportunity can sound fun and exciting, after awhile you may have no room left to give yourself and your family. It is often a recipe for early burnout and exploitation, so I have learned over the years to pass on some opportunities. I teach this to my learners as well, so that they learn to make and set boundaries early for better work-life balance.
Why would you recommend this career to someone starting out in medicine?
AP: I very much love my job and could not see myself leaving it. I love the ever-changing landscape of oncology and that it always keeps me on my toes. I am learning every day. I also love our patients and would miss having the opportunity to support them through their treatment if I ever changed roles.
What kind of person thrives in this professional environment?
AP: Pharmacy is definitely a profession for the detail-oriented as focusing on the details is such an integral part of our job. I would also say it is a wonderful place for someone who considers themselves a lifelong learner because oncology is constantly changing at a rapid and exciting pace. Unfortunately, oncology pharmacy is not for everyone, as we can grow very close to our patients only to lose them to their disease. It takes a big heart to face loss on a day-to-day basis.
What advice would you give to trainee and early-career oncologists about working effectively with pharmacists?
AP: Pharmacists are your friends! Please don’t be afraid to use us for your drug needs as we have a vast awareness of medication side effects, drug interactions, dosages, etc. Additionally, most oncology pharmacists complete 2 years of additional residency training where we specialize in hematology/oncology, or have spent many years in this field, so we understand the ins and outs of oncology treatment very well. We can often assist in chemotherapy order entry (which can be a steep learning curve for new oncologists) and side effect management, and many of us love collaborating on projects with our physician colleagues.

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