Pharmacist Contributions to Quality Improvement in Oncology Care: 2025 ASCO Quality Care Symposium

Introduction

At the 2025 ASCO Quality Care Symposium, 12 pharmacist-led posters were presented that highlight the expanding role of pharmacists in quality improvement within cancer care. Three main themes were represented: oral anticancer therapy management, precision oncology, and workflow optimization. Selected posters are highlighted within this article based on their alignment with HOPA’s mission and vision, innovation, relevance to clinical practice and impact on patient care, and demonstration of pharmacists’ value to advancing or improving cancer care.

Impact of Oral Anticancer Agent Management Among Community Oncology Practices¹

As the use of oral anticancer agents (OAA) continues to rise, pharmacists play a central role in ensuring safe and effective therapy through access, patient education, adherence monitoring, adverse effect management, and coordination of care. Pharmacists embedded in the multidisciplinary care team improve patient care by assessing treatment response, identifying drug-drug interactions, managing toxicities, and addressing any identified barriers to adherence.

In this study by Mackler et al., patient outcomes were compared before and after the integration of clinical pharmacists within community oncology practices across Michigan via the Pharmacists Optimizing Oncology Care Excellence in Michigan (POEM) program. Before POEM, patients receiving OAAs were educated and received symptom monitoring by nurses, physician assistants, or nurse practitioners. This was a multicenter, retrospective analysis from January 2019 – January 2024 conducted as a pre- (n=423, control group) and post-implementation (n=463, pharmacist care group) comparison across 3 practice sites.

Demographics were similar between pharmacist care and control groups. More patients in the pharmacist care group received education prior to OAA start (77% vs. 36%, p=0.001) and were assessed for medication adherence (72% vs. 23%, p=0.001). Reasons for OAA discontinuation were similar between groups. There were no differences between groups in all-cause hospitalizations and ED visits at 6 months or in cancer and treatment-related hospitalizations at 6 months. However, there was a decrease in cancer and treatment-related ED visits at 6 months in the pharmacist care group (9.5% vs. 13.7%, p=0.006).

The incorporation of clinical pharmacists within community oncology practices led to increased education and adherence assessments as well as a decrease in cancer- and treatment-related ED visits. By integrating clinical expertise with personalized patient counseling, pharmacist-led oral anticancer clinics enhance continuity of care and support the growing shift toward outpatient, patient-centered cancer treatment.

Reclaiming Oral Cancer Medications to Improve Access: Early Outcomes from a Statewide CDR Network²

The rising cost of oral chemotherapy agents has become a significant challenge in oncology care, often placing a heavy financial burden on patients and their families through high copays, insurance deductibles, and direct cost for uninsured patients. Cancer drug repositories (CDRs) allow individuals to donate eligible, unused cancer medications to be further utilized for patients in need. With CDRs, there is potential to minimize cancer medication waste while improving medication access for patients that face access barriers. The implementation of CDRs across the nation is currently suboptimal. YesRx is a non-profit, charitable service organization that was founded in June 2023 in collaboration with the first three registered CDRs in Michigan to help support healthcare partners in both improving oral chemotherapy access and decreasing waste of high-cost medications. The YesRx Network was formed with nine founding partner sites in August 2023 to improve statewide access to CDR resources, especially for those areas serving vulnerable patients and communities.

With the implementation of the YesRx Network, a recent retrospective analysis was conducted with statewide CDR data from August 2023 – May 2025. CDR donations received by the YesRx Network included donor zip code, medication donated, and quantity donated. Medication dollar value was calculated utilizing the average wholesale price (AWP) of the medication for the year that it was donated or received. During the study period, 1,379 individuals donated unused medication, and 1,000 patients had received an average of a one-month supply of medication via the YesRx Network. Total donations received were valued at $25,012,535 AWP, and prescriptions dispensed at no cost to patients were valued at $15,521,489 AWP. Most medication recipients were aged 65 years or older (53%). Breast cancer (28%) was the most common diagnosis for CDR recipients, followed by leukemia (18%), lung cancer (12%), and prostate cancer (9%). Michiganders in rural zip codes made up 41% of dispenses, and 90% of Michigan counties received CDR resources by the completion of the 22-month period. During this same period, the YesRx Network expanded to 105 sites, including community sites, private practices, and academic centers.

Cancer drug repositories (CDRs) are a valuable resource for improving access to therapy by enabling the donation and redistribution of unused, unexpired oral chemotherapy agents to eligible patients. This reduces medication waste while expanding the availability of treatments for individuals with financial barriers.

Optimizing Cancer Therapies: Pharmacy-Led Innovations in Precision Oncology^3,4,5

Precision oncology increasingly depends on timely, comprehensive biomarker testing and structured clinical decision support. Three recent initiatives presented at the 2025 ASCO Quality Care Symposium illustrate how pharmacist-led workflows and electronic prompting can improve safety, personalize therapy, and close gaps in care across diverse oncology settings.

Dana-Farber Cancer Institute (DFCI) instituted an enterprise-wide program for preemptive dihydropyridine dehydrogenase (DPYD) genotyping and genotype-guided dosing supported by electronic health record prompts, pharmacist-led recommendations, and multidisciplinary education. In September 2024, a pharmacist-driven outpatient workflow was launched to operationalize genotype-guided dose initiation, adjustment, and re-escalation. The workflow identifies patients without prior 5-FU/capecitabine exposure, triggers automated DPYD testing orders and closed-loop notifications for abnormal results, and standardizes pharmacist recommendations for dose modification and re-escalation based on established guidelines. Structured documentation, tracking of genotypes and dosing decisions, and targeted training for clinicians were embedded to ensure consistent adoption.

From September 2024 – May 2025, 810 patients underwent DPYD testing; deficiencies were detected in 45 patients (28 receiving 5-FU, 17 receiving capecitabine). Pharmacists issued genotype-guided dose recommendations for all identified patients, with oncologists accepting 40 of 45 recommendations. Among those managed, 14 patients subsequently received dose re-escalation according to clinical tolerability and the standardized algorithm.

These results demonstrate that a pharmacist-led DPYD genotyping workflow is feasible and impactful in the outpatient oncology setting. Oncologist uptake was high, reflecting successful integration into practice. By enabling proactive, personalized fluoropyrimidine dosing and structured re-escalation, the approach has the potential to reduce life-threatening toxicity while minimizing underdosing, thereby improving safety and treatment fidelity.

In parallel, a poster from the Michigan Oncology Quality Consortium (MOQC) assessed real-world biomarker testing in metastatic non-small cell lung cancer (NSCLC) adenocarcinoma across 10 practices. In a retrospective review (January – March 2025), the most recent 10 newly diagnosed metastatic adenocarcinoma patients per site were analyzed using a standardized REDCap form and descriptive statistics. Of the 78 patients, 76 (97%) underwent testing; however, only 62 (79%) received large-panel next-generation sequencing (>50 genes). The remaining 14 had targeted point-mutation assays (n=9), smaller NGS panels (n=4), or underwent testing via an unknown method (n=1). Non-NGS approaches commonly missed NTRK fusions, RET rearrangements, HER2 mutations, and nontraditional EGFR variants. Medical oncologists ordered most tests (n=61, 80%). Actionable biomarkers were found in 43 patients (55%), most commonly KRAS G12C (22%) and EGFR exon 19 deletion/L858R (18%). Notably, of 24 patients with frontline-actionable mutations, 4 (17%) did not receive guideline-recommended targeted therapy. The findings highlight the need for comprehensive testing panels and decision support to ensure guideline-concordant treatment.

A third initiative from McKesson/The US Oncology Network focused on electronic re-prompting for ESR1 mutations in HR-positive, HER2-negative metastatic breast cancer, where ESR1 mutations drive endocrine resistance and became clinically actionable after targeted therapy approvals in January 2023. Clear Value Plus, a decision-support tool, was modified in November 2023 to prompt retesting for ESR1 at disease progression, preceding a February 2024 guideline recommendation. A retrospective analysis of iKnowMed EHR data across more than 2,700 providers at approximately 600 sites (November 2023 – January 2025) evaluated testing coverage, detection, and conversion metrics. Across 8,742 treatment decisions (5,903 first line; 1,808 second line; 1,031 beyond), the proportion with known ESR1 status rose from 37.3% to 44.6%. ESR1 mutations were detected in 12% prior to first-line therapy, 19% prior to second-line, and 27% beyond second-line. Re-prompting converted 9% of unknown decisions to known status, enabling potential targeted therapy for 463 patients. Negative-to-positive conversion was 1%; repeat testing among ESR1-positive patients occurred in 9%; positive-to-negative conversion was under 1%. The strategy improved reporting, provider education, and timely identification of patients eligible for targeted therapies.

Collectively, these initiatives underscore the value of embedding pharmacist expertise and EHR-driven prompts into routine care. They also demonstrate that proactive testing and standardized, genotype-guided recommendations can enhance patient safety, increase mutation detection and reporting, and improve alignment with guideline-directed therapies. Future opportunities include expanded decision support, continuous training, and real-time performance feedback to sustain and scale precision oncology across practices.

Conclusion

Pharmacist-led research at the 2025 ASCO Quality Care Symposium highlights the breadth of pharmacists’ impact on oncology care. From advancing precision medicine through genotype-guided dosing and biomarker testing to expanding patient access through drug repositories and improving clinical outcomes through oral anticancer medication management, these projects demonstrate how pharmacists enhance safety, efficiency, and equity in cancer care.