Key takeaways
- Community oncology must build the infrastructure, monitoring, and expertise needed to deliver increasingly complex therapies safely.
- A practical approach is to build, buy, and partner - with the strongest emphasis on developing internal teams and external clinical partnerships.
- Oncology pharmacists can bridge clinical and operational workflows, helping with treatment pathways, EMR tools, REMS requirements, patient selection, toxicity management, and education.
- New therapies should be evaluated through quality improvement, including time to treatment, toxicity, hospitalization, local patient retention, and financial sustainability.
- The goal is not to create a new process for every drug, but to build repeatable systems that can support the therapies still coming through the pipeline.
At the Community Oncology Global Congress (COGC 2026), organized by OncoDaily, Brooke Peters, Clinical Pharmacist at American Oncology Network, focused on a challenge that is becoming increasingly difficult to avoid in community oncology: treatments are becoming more sophisticated, but patients still want to receive care close to home.
Oral targeted therapies, antibody-drug conjugates, bispecific antibodies, and CAR T-cell therapies are expanding treatment options, but many also require specialized preparation, monitoring, toxicity management, and rapid intervention.
The question is no longer simply whether community practices can offer these therapies. It is what infrastructure has to be in place to deliver them safely – and how practices can build systems that are ready for the next therapy as well as the one arriving today.
New Therapies Require New Infrastructure
“Our treatment landscape in oncology is rapidly evolving. We have new oncology therapies almost every week, and many increasingly require specialized handling, monitoring, toxicity management, or rapid intervention when toxicity occurs.
Some broad categories driving this evolution include oral targeted therapies, antibody-drug conjugates, bispecific antibodies, and CAR T-cell therapies.
Many of these treatments may have improved tolerability compared with their alternatives, but they can introduce toxicities that are new to our patients, new to us in oncology, or simply new to us in community oncology.
So we need to think about how we operationalize these therapies and build the infrastructure and expertise necessary to keep patients where they prefer to receive treatment – while still using these therapies safely.”
Build, Buy, and Partner
Dr. Peters organized the challenge around three practical strategies:
Build: Develop an interdisciplinary team of physicians, advanced practice providers, nurses, pharmacists, and support staff who understand both the therapies and how to translate them into daily patient care. Build pharmacy expertise, preparation and administration capabilities, monitoring systems, and continuous education.
Buy: Add external tools when they fill a genuine gap, including clinical decision support, care coordination services, and remote patient monitoring.
Partner: Create relationships with other community practices, local hospitals and emergency departments, academic centers, manufacturers, and specialty pharmacies so that complex care does not automatically require moving the patient far from home.
“Build and partner are really the most important pieces.
Continuous education matters because the landscape is not only constantly changing – the way we use individual therapies is changing too.
We continue to learn how to prevent toxicities, how to manage them, how to dose these treatments, and how to monitor patients more effectively.
Partnering is also incredibly important. If we can leverage a local hospital or emergency department for necessary monitoring or toxicity management, we may be able to keep that patient closer to home and continue their treatment in the community.”
The Oncology Pharmacist as an Operational Champion
“The oncology pharmacist is often uniquely positioned, particularly in community oncology, to become an operational champion for implementing modern therapies.
The reason is that pharmacists tend to have a foothold in both the clinical and operational workflows.
We can help develop workflows and standard operating procedures around a new treatment.
- What should the dosing and schedule look like?
- What monitoring parameters are required, and when?
- What happens if toxicity develops? What does the escalation pathway look like?
- Do patients need premedications? Do they need prophylactic medications at home?
Those are clinical questions, but they also have to be translated into a process that the entire practice can actually follow.
Pharmacists often help build treatment plans, flowsheets, and order sets into the EMR.
That means creating tools that can help different members of the interdisciplinary team at different points in the process – whether that is helping the financial team obtain authorization, helping the provider identify supportive medications the patient needs at home, or making sure that REMS enrollment and complianceare complete.
Some therapies may also require several sites of care or visits with multiple specialists. Pharmacists can help coordinate those transitions and communication between sites.
The pharmacist can also help identify the right patient for the right therapy.
That is becoming more complicated. Eligibility may depend on biomarkers, previous therapies, whether the disease was refractory to certain treatments, or other clinical characteristics.
Pharmacists can support that patient identification and then continue to play a role once treatment starts.
We can monitor for toxicities, recommend prophylaxis and supportive care, and support decisions around treatment holds, dose reductions, dose intensification, or infusion interruption.
As these therapies become more complex, toxicity management cannot simply be something we figure out after the toxicity occurs. It needs to be designed into the workflow from the beginning.”
Education Has to Keep Pace With Innovation
“The pharmacist can be a key educator for patients and for the healthcare team.
We can develop drug monographs or quick reference materials that answer the practical questions staff need to know:
- What is this drug?
- Which patients qualify?
- What laboratory values or vital signs need to be monitored?
- How often do we monitor them?
- What medications should the patient be taking at home?
And this education is not only for pharmacy staff. It has to reach nurses, advanced practice providers, physicians, and everyone else involved in delivering the therapy.
The treatment may be new, but the workflow cannot feel new every time a patient walks through the door.
When we introduce a new therapy, we need to look back and ask:
- How are we doing?
- Are we administering this safely?
- Are our patients tolerating it?
- Is there something we need to do differently?
Pharmacists can help lead those quality improvement projects by reviewing the data in the chart, working with providers and interdisciplinary colleagues, and translating what we learn back into the workflow.
They can also support medication access and financial navigation so that we are not only identifying the right drug, but getting that drug to the right patient at the right time.”
How Do You Know the Community Model Is Working?
“Any time we create new infrastructure, new expertise, new workflows, or new standard operating procedures around a therapy, we have to prove to ourselves and to our patients that they can receive that treatment safely in the community – just as they might at an academic or tertiary center.
One thing to measure is time to treatment:
- How long does it take to deliver the therapy once we know the patient needs it?
- Is the delay coming from prior authorization, procurement, or manufacturer approval?
Then we need to look at toxicity outcomes:
- How are patients tolerating treatment?
- Do we need to change prophylaxis or supportive care?
We should look at hospitalization. If we are moving monitoring into the clinic or the home, are patients still ultimately being admitted?
We should measure therapy volume and patients retained locally. How many patients can continue receiving care in the community where they prefer to be treated rather than being referred elsewhere?
And finally, we need to consider financial sustainability and reimbursement, particularly for therapies such as CAR T-cell therapy. If the model is not financially sustainable, the practice will not be able to continue providing that care.”
Build for the Next Therapy, Not Just the Current One
“The complexity of oncology therapies is increasing, and community practices have to evolve with it.
Treatments that may once have been reserved for academic centers because of their toxicity or monitoring requirements are increasingly moving into the community.
The pharmacy team can bridge the clinical and operational gap and serve as an operational champion in that transition.
But we also have to think beyond one treatment at a time.
We cannot build a completely new workflow, SOP, and order set every time another drug is FDA approved.
We need infrastructure and repeatable systems that can accommodate the therapies still in the pipeline.
As we create those workflows today, we need to have the future in mind – so that the next therapy can be incorporated with greater efficiency and consistency for the healthcare team and, most importantly, for the patient.”
Written by Eliz Baloyan, MD, Features Writer and Editor at OncoDaily and CancerWorld
