Remote clinical pharmacy services in oncology have demonstrated substantial cost savings while expanding pharmacists' roles in patient care, according to presentations at the 2025 Oncology Pharmacists Connect meeting in Austin, Texas. The findings highlight how oncology pharmacists are adapting to new technologies and addressing critical challenges in cancer care delivery.
Remote Pharmacy Services Generate Millions in Savings
A comprehensive study evaluating remote clinical pharmacy services showed remarkable financial impact, with 7 remote clinical specialists achieving $8.9 million in total cost savings while serving 5,600 patients from July 2023 to December 2024. The interventions included dose adjustments, therapeutic interchanges, and drug selection optimization, with a notably high acceptance rate of 93% from clinicians.
The most significant cost-saving interventions included dose banding for pembrolizumab (Keytruda; Merck & Co) and adjustments in zoledronic acid usage. Eugene Przespolewski, PharmD, BCOP, DPLA, clinical pharmacist specialist at Roswell Park Comprehensive Cancer Center, noted that many of these interventions involved "basic clinical interventions—things like dose rounding, banding, ensuring indications were appropriate, and biosimilar interchanges."
However, questions remain about the long-term sustainability of these savings and whether similar results could be achieved through enhanced electronic medical records systems. Scott Soefje, PharmD, MBA, BCOP, director of pharmacy at Mayo Clinic, emphasized that while remote pharmacist interventions are beneficial, their cost-effectiveness might be limited unless they result in tangible improvements in patient outcomes such as overall survival or progression-free survival.
Intensive Medication Reconciliation Reveals Hidden Complexities
A pharmacist-led medication reconciliation project spanning 82 clinical trials and 525 patients demonstrated the critical but resource-intensive nature of comprehensive medication reviews in phase 1 trials. The process required an average of 45 minutes per patient, with an additional 18 minutes dedicated to phone consultations.
Patients reported an average of 12 medications, ranging from 2 to 42 medications per patient. During reconciliation, pharmacists added an average of 3 medications, made 2 medication changes, and discontinued 3 medications per patient. Notably, cannabis and over-the-counter herbals were frequently underreported by patients but successfully identified through the pharmacist-led process.
"The challenge with doing med rec processes is ultimately the time that's required. It's a really labor-intensive process," Przespolewski explained. He recommended utilizing team members including technicians, interns, students, and residents to help streamline the process while maintaining pharmacist oversight for accuracy and completeness.
Remote Monitoring Reduces Clinic Burden
A randomized clinical trial involving 196 patients compared usual in-clinic care with remote supportive care management for patients undergoing curative-intent cancer therapies. While the study showed no significant difference in emergency department visits or hospitalizations between groups, remote monitoring significantly reduced urgent clinic visits.
The remote care model involved daily reporting of symptoms, vital signs, body weight, and structured communication with the oncology team. Additionally, remote care improved quality of life in some patients, particularly in activities of daily living and symptom assessments.
Przespolewski interpreted these results positively, noting that while there was no statistically significant reduction in hospitalizations, there also wasn't an increase despite more intense remote monitoring. "The reduction in urgent follow-up visits and clinic appointments is another significant benefit. It frees up appointment slots for patients who need urgent care and helps streamline the process for new patients," he said.
AI Shows Promise but Limitations Persist
The integration of artificial intelligence in oncology practice revealed both potential and current limitations. A study comparing ChatGPT performance with expert oncologists in answering questions about hematologic malignancies found that expert responses were preferred in 75% of cases, though AI achieved 90% accuracy in identifying correct answers.
"The gap between human and AI responses narrowed significantly. It was still easy to identify which responses came from AI, but the quality was close, and in some cases, AI responses were preferred," Przespolewski observed. However, panelists agreed that AI cannot yet replace human expertise, particularly for nuanced decision-making and clinical judgment application.
Patient acceptance of AI varies significantly by demographics and application. A survey of 330 patients at an urban academic medical center found that patients younger than 65 years and those with higher distrust in healthcare systems expressed more skepticism about AI. Patients were more comfortable with AI for low-risk aspects of care like cancer screening or lifestyle recommendations but remained hesitant about AI involvement in diagnosis and treatment planning.
Drug Shortages Force Treatment Adaptations
The impact of drug shortages on oncology practice was highlighted through a study examining cisplatin and carboplatin shortages in lung cancer treatment. These shortages led to shifts toward immunotherapy use, particularly in metastatic cancer cases.
Soefje explained that his institution's approach involves collaboration between pharmacists and clinicians to develop contingency plans, though he acknowledged that current practices remain largely reactive. "Being able to modify and manage therapy during shortages is part of our role, and we also serve as a bridge between procurement, administration, and clinical teams—translating the situation and criteria to ensure everyone's aligned," Przespolewski added.
The presentations emphasized that oncology pharmacists must continue evolving to meet changing healthcare demands. As Przespolewski concluded, "The future of oncology pharmacy will require greater collaboration across health care teams, the integration of new technologies, and a focus on improving patient outcomes."
