Rotation 9: From Avastin to Zytiga

Posted by Emily at Tuesday, April 19, 2016

I absolutely cannot believe P4 year is nearly over and graduation is just a few days away!  I ended my APPE experiences on a high note, working with the Oral Oncolytic Program here at UMHS under the guidance of Dr. Shawna Kraft.  After five weeks of working at home for my DI rotation, I was very happy to be back in an office/hospital work environment.  Working from home may be an ideal situation for some, but I had a hard time staying focused and was starting to go a little stir crazy by the end of it!

This rotation qualified as ambulatory care, and as such, I had more direct patient interaction on this rotation than I’d had on any other.  Rotation hours were 0800 – 1630, and I spent the majority of my time calling patients as part of the Oral Oncolytic Program.  Through this program, patients who are scheduled to begin oral chemotherapy are flagged for contact.  My responsibilities included calling these patients on the phone prior to the start of their new medication in order to counsel them on appropriate administration, potential side effects, and adherence, and to complete a full medication reconciliation to make sure our records were up to date and that there were no drug-drug interactions with their new chemo agent.  We would then follow up a week later to see how the patient was tolerating their treatment and to answer any questions.  Dr. Kraft really let me fly solo for a  lot of this rotation, and while I was a little nervous at first, it was exhilarating to finally begin feeling like a competent, independent practitioner.  (And just in time, right?)  All the phone interactions were also good practice for my fellowship, where instead of staffing by verifying orders, I’ll be staffing the poison center hotline, taking calls from patients seeking advice on potentially toxic ingestions.

I provided even more direct direct patient care on Mondays when I worked with the Symptom Management Clinic team.  This clinic sees patients who need additional assistance managing symptoms and side effects of their cancer (e.g. pain, fatigue, nausea, anxiety, etc.)  I would complete med recs for each patient and translate the information I gathered from patient interviews into a well-organized medication summary table listing the indication, drug name/strength/dosage form, directions for use, and times of administration for each of their medications.  I would also include notes about the medication changes that had been made as a result of their appointment at the bottom, and then print a copy of the medication summary for the patient to take home.

Direct patient care is one of the scariest and most rewarding parts of rotation.  The College of Pharmacy does their best to train us and prepare us for these kinds of interactions, but nothing is quite like truly being put on the spot with a question and KNOWING THE ANSWER, or seeing the gratitude on a patient’s face when you provide them with information that no one else had taken the time to discuss with them.  For example, I had the opportunity to meet with a couple oral chemo patients and their spouses in person in the Cancer Center while they were here for other appointments because they requested to talk face-to-face rather than over the phone.  I was happy to take this extra step in order to do what was best for the patients, and they really appreciated the service provided by the Oral Oncolytic Program.

In addition to these activities, I had the opportunity to shadow an infusion pharmacist and an anemia clinic pharmacist.  I also participated in topic discussions on nausea and vomiting, neuropathic pain, new oral chemotherapy agents, renal cell carcinoma, multiple myeloma, thyroid cancer, and breast cancer, and a journal watch with one of the PGY2 oncology residents.  Finally, I prepared a presentation on venetoclax, a new oral chemotherapy agent for the treatment of chronic lymphocytic leukemia.

It was clearly a busy month, but I was grateful for that because it made the last rotation go by quickly!  It has been a pleasure recapping my rotation experiences for this blog, and once again, I can’t believe that the Class of 2016 has nearly reached the finish line.  I know my classmates and I are all excitedly looking to the future, and I know that we will be well-equipped to face whatever professional challenges and opportunities lie ahead thanks to the exceptional training we received at Michigan.  Go Blue!