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As cancer therapy becomes more complex, we must enhance our professional standards

Medical therapy for cancers has evolved enormously since the discovery of chemotherapy. Whilst still an important part of the therapeutic armamentarium, the modern cancer therapy toolbox includes biologic therapies with targeted monoclonal antibodies and immunotherapy with immune checkpoint inhibitors, as well as an increasing number of targeted oral therapies in the form of receptor tyrosine kinase inhibitors. This has culminated, in many cases, in a paradigm shift from empiricism to personalised care, under the overarching aim of improving outcomes for patients through individualised care. This evolution of therapy has seen an expansion of drugs available across multiple indications and clinical settings, increasing the complexity of care, and emphasising both the importance of accuracy in prescribing (to minimise medication-related errors) and the importance of appropriate patient education to manage treatment-related toxicities, as well as the follow-up of adverse events. Multidisciplinary care has been championed as integral to good clinical practice in modern cancer medicine; essential to this is the provision of care in accordance with recognised national standards. The updated Society of Hospital Pharmacists of Australia (SHPA) Standard of practice in oncology and haematology by Coutsouvelis et al. outlines the standards for current best practice in the provision of oncology and haematology pharmacy services. They describe the important role of the pharmacist as a member of the multidisciplinary team addressing the professional standards for a pharmacy service within the broader oncology and haematology service, as well as professional standards for these pharmacists’ practice per se. Oncology practice across Australia varies in its delivery from hospital-based services to community practices, with differences also present both across and within states and local health districts. Thus, a uniform optimal practice pathway is difficult to define – however, the principles of such a practice are not. One important principle is good communication between team members and the patient. In oncology prescribing, this highlights the importance of an effective relationship between the pharmacist and the prescribing physician, clinic nurses and/or nurse practitioner. The pharmacist’s role within the multidisciplinary team traverses the cancer therapeutic journey from the prescribing of medications, the provision of education, dispensing to monitoring, involvement in drug intervention clinical trials, and follow-up of anti-cancer therapies (particularly oral therapies). This is even more important in the community setting, with increasing dispensing of oral anti-cancer therapies. Coutsouvelis et al. describe the best practice standards for the pharmacist and the pharmacy service across these different elements. Cancer therapy offers hope for survival and quality of life in patients with cancer. Medication errors in oncology have the potential for serious patient risk due to the nature of the drugs involved, particularly in chemotherapy. A recent review highlights the chemotherapy error rate across the literature to be about one to four per 1000 orders, resulting in 1–3% of adult and paediatric oncology patients being affected. Oral therapies pose a particular risk due to the reliance on the patient or care-givers for compliance. Processes to minimise these errors rely on compliance with administration practice standards and guidelines, audit and review of adverse events against what is expected within the literature, and the recent use of electronic prescribing systems. The establishment of protocols, and adherence to them, is crucial in enabling the safe delivery of anti-cancer therapy. In the Australian context, the Clinical Oncology Society of Australia developed its guidelines for the safe prescribing, dispensing and administration of chemotherapy and related agents in the treatment of cancer, through a multidisciplinary working party involving its member groups: Cancer Pharmacists, Cancer Nurses Society and Medical Oncology Group of Australia. Pharmacy services within oncology units and community practices thus need to maintain a high standard of care. The role of the oncology pharmacist has expanded enormously since the evolution of anti-cancer therapy with chemotherapy, and with roles in inpatient care, outpatient care, clinical trials and community prescribing. The oncology pharmacist plays an important and highly valued role in the management of patients across the whole cancer journey, in public and private settings, and in both hospital-based and community care; they impact on patient outcomes, playing a key role in the quality of cancer therapy delivery, and, recently, in the electronic recording of cancer care. As