Health care systems throughout the world have been put under enormous pressure in the last years. The COVID-19 pandemic has put a large strain on all health care professionals, and the after effects have not been resolved as yet. Facing shortages in staff, equipment, and medicines, pharmacists from both hospitals and community pharmacies have struggled to keep patient care up and running.[1,2] Especially in the field of cancer care, where disruption of treatment can have detrimental effects, keeping pharmaceutical care going is pivotal.
The European Society of Oncology Pharmacy (ESOP) has nearly 4000 members from 66 countries. Its aim is to support optimal treatment for patients with cancer. While this aim has remained unequivocally important since ESOPs foundation in 2000 in Prague, the field in which to strive for this aim has evolved. Unfortunately, cancer incidence still rises.[3,4] This is a result of multiple factors, such as growing and aging populations, sedentary lifestyles, use of tobacco and alcohol, an increase in early preventative examinations, and exposure to environmental factors such as pollutants and ultraviolet radiation. At the same time, survival rates and treatment options are also on the rise, the latter including advanced medicinal therapy products, targeted therapies, immune-oncological checkpoint inhibitors, and other sophisticated biotechnological modalities. While these innovative therapeutic options offer hope for patients with cancer, they also come with ever increasing costs.[5,6] Already existing inequalities between high-income and low-income or middle-income regions are inevitably worsened. Hence, pharmaceutical care for patients with cancer is becoming more complex, and cost-effectiveness is becoming more important. At the same time, staffing is a challenge in many areas around the globe. The WHO has estimated that by 2030, there will be a shortfall of 18 million health workers. In the field of oncology, this basically means that more work will have to be done by less or at best, the same number of staff members as currently available. Finally, availability of medicines is no longer self-evident. Reports of shortages of medicinal products, including essential ones for the treatment of oncological disease, are abundant,[9,10] causing weekly or even daily disturbance of regular pharmaceutical dispensing services. In short, the work field of oncology pharmacy is subject to change. Therefore, the professional society ESOP, in which oncology pharmacists are united, has to periodically investigate the needs and forecasts of its members. The outcomes can then be used to update the Societies' advocacy work, knowledge exchange, and scientific and educational programs.
To map the needs but also the expectations of the oncology pharmacy workers, ESOP has performed extensive surveys among its members. The collated results of these will be provided in this article, which is a follow-up of the previous investigation into the future of oncology pharmacy.
All countries that have delegates or liaisons in the delegate assembly of ESOP are asked on a yearly basis whether national meetings on the topic of oncology pharmacy are planned. If so, the delegate or liaison was asked if a survey could be held during this national event on the future of oncology pharmacy using the online real-time survey tool Mentimeter (Mentimeter, Stockholm, Sweden) in 2019. Each time, the Mentimeter asked the same 11 questions (Appendix 1, https://links.lww.com/EJOP/A5) to allow for good comparability, sometimes translated into the national language, if necessary. The questions were drawn up by the board of ESOP. Participation was voluntary and anonymous. The ESOP delegates from the participating countries were also asked some questions on the practice of oncology pharmacy in their country.
Subsequently, in 2022, all members of ESOP were asked to register their interests in different areas of oncology pharmacy through another online survey, which was set up in LamaPoll (LamaPoll, Berlin, Germany). The different areas of oncology pharmacy named in this survey were derived from the different chapters of ESOPs quality standards Quapos. Again, participation was voluntary. Participants were asked to enter their name and country of residence because this survey was also intended to be able to approach individual members for working groups or special interest groups of ESOP.
3.1. Country surveys
The Mentimeter survey was completed in 12 countries from 3 continents in the first 6 months of 2019 (Table 1). In total, this yielded 595 individual respondents. Five independent questions regarded the evolving role of technology for the oncology pharmacy profession. Most homogeneity was found in the answers to the questions: “Do you think that technological developments will lead to significant changes in pharmaceutical services?” (95% on average said yes, and country averages ranged between 85-100%), “Do you think the number of biological drugs will increase?” (94% answered yes, countries ranging between 63-100%), and “Will the increase in technology decrease the need for pharmacists? (80% answered no, with a range between 64 and 90%). More diverse answers came to the questions “Do you think that the compounding of anti-cancer medications will be completely automated?” and “Will increasing technology in the pharmacy reduce the workload of pharmacists?” (Figure 1). Of note, those countries where more respondents believed that compounding would not be completely automated (Germany, Spain, and Italy) are countries where automation of compounding has been implemented in multiple centers, whereas countries that had a relatively large number of respondents who believed that indeed compounding would be completely automated (Algeria, Ethiopia, and the Republic of Northern Macedonia) do not have compounding robots within their pharmacies yet, nor do they have centralized clean rooms where pharmacy personnel executes all the compounding.
Table 1 -
Surveys on the future of oncology pharmacy by country
||Date of survey
||Number of participants
||February 19, 2019
||June 8, 2019
||June 2, 2019
||May 4, 2019
||May 15, 2019
||June 22, 2019
||June 7, 2019
||September 10, 2019
||January 8, 2019
|Rep. North. Macedonia
||May 31, 2019
||June 18, 2019
||March 7, 2019
Another subset of questions related to clinical oncology pharmacy and multiprofessional care. The question “Do you think that more communication between pharmacists and physicians will be required?” yielded overwhelming affirmative responses: 95% of respondents answered yes. The question “Are hospital pharmacists going to spend most of their working hours in the wards instead of pharmacies?” gave divergent answers; overall 42% answered yes, 19% said no, and 39% said maybe. To the question “Do you consider yourself competent in patient education, interviewing clinicians, and pharmaceutical communication techniques?” most “yes” answers came from Ethiopia, Spain, and Chile (95, 71, and 61%, respectively), while most “no” answers came from Algeria, Germany, and Poland (49, 49, and 48%, respectively). In Germany and Poland, regular counseling of patients by clinical pharmacists has not been widely implemented thus far. The final question of the Mentimeter asked participants to choose one or two topics that they believed would be the focus of the profession in the future from a list of four options: (1) New pharmaceuticals, (2) Improved clinical management of cancer patients, (3) Implementation of multidisciplinary working groups, and (4) Technological advances. By far, multidisciplinary working was chosen most (424 times) ruling number one overall and in 8 individual countries (Algeria, Chile, Czech Republic, Germany, Italy, the Netherlands, Poland, and Spain). Second came improved clinical management of patients with cancer (328 times) followed by technological advances (232 times) and new pharmaceuticals (216 times).
3.2. Individual interest survey
In the individual member survey, 757 of our members responded (response rate 22%) out of 53 different countries. In total, they entered that a specific topic was of interest to them 1706 times (Table 2). Clinical pharmacy and continuous education in oncology pharmacy were the topics that were ticked most often by the respondents. To analyze the extend of participation in correlation with the numbers of active oncology pharmacists per country, we calculated what percentage of the members of national societies had completed the survey. The results showed a large variability, as is visualized in Figure 2. Overall, the average of respondents of the 53 countries was 39% (range: 2%–100%). We performed a geographic analysis to see whether different regions of the world had a different distribution of topics of interest. We divided Europe into Eastern Europe and Western Europe because of the attention of the Beating Cancer plan into potential East-West divides in Europe. The results of this analysis are visualized in Figure 3. As can be seen, in general, Western European respondents had less interests to advance in topics overall as compared with Eastern European respondents, but the distribution over the different topics did not show large disparities. Colleagues from Asia showed a relative large interest in robotics and automation as well as in clinical pharmacy checking prescriptions and pharmacovigilance. Colleagues from America showed a large interest in continuous education and colleagues from Africa in research.
Table 2 -
Interest of ESOP members in different areas of oncology pharmacy
||Number of members indicating an interest in the topic
|Development of quality standards (QuapoS)
|Safe working and occupational exposure (MASHA)
|Compounding and GMP
|Automation and robotics
|Oncology continuous education (EUSOP)
|Supportive care for patients with cancer
|eHealth in oncology
|Clinical pharmacy (1): patient counseling
|Clinical pharmacy (2): checking prescriptions (medication reconciliation, drug-drug interactions) (pharmacovigilance)
|Pharmacokinetics and therapeutic drug monitoring
|Oral anticancer drugs
The last years have shown several shifts in oncology care, some of them a result of the COVID-19 pandemic, such as the increasing number of drug and equipment shortages and more focus on telemedicine and teleconsultation and others more a result of advancing technologies such as personalized medicine, advanced treatment modalities, and automation and robotics. In this shifting landscape, the endeavors of ESOP to always support optimal treatment for patients with cancer, remain standing but are adapting to the latest developments. Our two surveys combined point us in the directions where we can best support our members. On the one hand, the traditional tasks of pharmacists, such as checking prescriptions and screening for drug-drug interactions as well as preparation and dispensing of anticancer drugs, will and should not be forgotten. The survey result show us that we must continue to periodically update our quality standard (Quapos), adding new guidelines on upcoming treatments while revising the existing ones to incorporate the latest knowledge. On the other hand, novel areas of the profession, such as eHealth and robotics and in some countries, radio pharmacy, must be moved forward to ensure optimal care for patients in the future as well. Overarching all areas of oncology pharmacy is the need for continuous education to enable members to stay up to date in their knowledge. This pivotal issue is well recognized by the ESOP members, as shown by the large number of respondents indicating this particular topic in their response.
To the best of our knowledge, this is the biggest global survey of the oncology pharmacy workforce to date. One previous survey with 81 respondents, mainly from the United States, identified activities of clinically working oncology pharmacists, but did not specifically question their interests or needs. Another small survey, with 62 respondents, investigated educational needs of oncology pharmacists. The two most sought after areas for education were pharmacotherapy and research. Our survey is thus by far the most extensive one, but some limitations to it still exist. First, participation was voluntary, and members who are more active in the Society or more interested in its future might therefore be over-represented, potentially biasing the results. Second, most respondents came from Europe, so global representation is not evenly distributed in the results. Therefore, we advise that future surveys specifically promote participation of members located in the regions where the current ones had lesser respondents.
In response to the challenges of the past years and combined with anticipated changes in the near future, the membership surveys of ESOP will guide the ESOP presidium and the ESOP special interest groups to leverage the expertise of oncology pharmacists in those areas that are of greatest interest. This will ensure that we keep evolving our profession with the aims to optimize care and outcomes for our patients.
Design of the study: M. Crul, K. Meier; Analyses of the results: M. Crul, C. Meier, K. Meier; Preparation of the manuscript: M. Crul.
The authors would like to express their gratitude to all members of ESOP who participated in one or both surveys.
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