Despite the UK’s highly skilled oncology pharmacy workforce, staff shortages mean the sector is having to look at different ways of working to meet increasing demand on cancer services. Professor Shereen Nabhani-Gebara tells Katherine Price how her research and work with the British Oncology Pharmacy Association is helping equip oncology pharmacy teams with the skills to use emerging technologies efficiently and establishing nationwide standards to ensure all patients can access equitable cancer care.
Professor Shereen Nabhani-Gebara says it was a fascination with new and emerging cancer treatments that drew her to oncology as a specialism.
‘I was in America, and I had my eye on either oncology or cardiology,’ she recalls. ‘I had a chat with my mentor, and he said, “oncology is always going to be growing at a very fast rate with these new classes of drugs… So, if you have a speciality in it, that’ll always give you that edge.” And that was phenomenal advice, because look at all the treatments that have been approved in the past five years, let alone 10 years.’
Now an oncology pharmacist, professor of oncology at Kingston University London, and vice chair of the British Oncology Pharmacy Association (BOPA), Professor Nabhani-Gebara was ‘astonished’ at how progressive UK oncology pharmacy was when she came to the UK and joined Kingston nearly 17 years ago.
‘We’re one of the only countries in the world where oncology pharmacists prescribe systemic anti-cancer therapies (SACTs). Pharmacists lead their own clinics, they see and assess patients, order the required scans and blood tests, oversee the treatment, follow up with patients’ side effects,’ she explains.
‘The traditional role of the pharmacist only being in the hospital pharmacy or responsible for delivering or checking the medicines or preparing the IV – that’s all in the past for us. The clinical role for cancer pharmacists has grown phenomenally.’
Meeting increasing demand on cancer services
Pharmacist prescribing is firmly established in the UK and all pharmacists will be licensed prescribers at registration from 2026 onwards.
However, UK healthcare staffing shortages are proving a challenge when there were nearly 3.5 million doses of SACT delivered in England between April 2021 and March 2022, thought to be increasing at 6-8% per annum.
‘If you look at the number of approvals coming through on a yearly basis, it’s phenomenal. The development and innovation in oncology is growing astronomically, which means people are living longer, there are new treatments on the horizon. But that also means an increase in demand on our cancer services,’ says Professor Nabhani-Gebara.
‘Our infrastructures and workforce are not increasing at the same time, so that means we really need to do things differently to be able to deliver quality and timely treatment to our patients.’
Although early cancer diagnosis in England has reached its highest level, with most recent data indicating 58.7% of the most common cancers were identified at an early stage, it’s still some way from the ambition of the 2019 NHS Long Term Plan for 75% of people to be diagnosed at stage one or two by 2028.
To tackle backlogs and bottlenecks in the referral and treatment pipeline, pilots are evaluating the opportunities for direct referrals by community pharmacy to secondary care and utilising the wider healthcare community, particularly those who can provide care closer to patients’ homes.
Providing inclusive cancer care
To support this, BOPA is developing SACT protocols to standardise cancer care across the UK. For it to be equitable, however, a focus of Professor Nabhani-Gebara’s research is how to ensure inclusive cancer care. This includes, for example, addressing disparities across the cancer care pathway for people from minority ethnic groups.
‘One size really does not fit all,’ she explains. People think that if we’re offering the same thing for everyone, that should be okay. But actually, even though it’s equal, it’s not equitable, and that means a lot of people miss out because you are not offering what they need.’
‘You can do little tweaks in your approach as a clinician and make a huge difference to somebody’s life and whether they continue with their treatment or not,’ she says. One such example is making translators available to patients whose first language is not English.
Last year, in collaboration with OUTpatients – the UK’s only cancer charity supporting the LGBTIQ+ community – BOPA produced the first resource on safe and supportive prescribing for transgender and non-binary patients with cancer, which Professor Nabhani-Gebara was involved in. One of her co-authors, Mariachiara D’Elia, has since published further research on the role of pharmacists in supporting transgender and gender-diverse patients with cancer.
While inclusive care is an increasing part of the pharmacy undergraduate curricula and efforts are focused on training ‘our future workforce to look out for opportunities to be more inclusive in their practice’, Professor Nabhani-Gebara notes that ‘we still have to upskill the existing workforce’.
While there are ‘pockets of excellence’, inclusive cancer care is not being offered uniformly across the country, she says.
As such, part of her research is exploring what standards could be introduced to ensure equitable healthcare for patients without putting undue pressure on healthcare professionals.
Technology-enabled care
Professor Nabhani-Gebara’s research interests also extend to the opportunities in telehealth and artificial intelligence (AI) in supporting cancer imaging. She sees great potential in enhanced machine learning clinical decision support systems for pharmacy oncology prescription verification.
‘If we can use AI to streamline the checking of [SACT] orders, it can free up a lot of workforce that can then do more complex services,’ she says. ‘And that should be close because the technology is ready, it’s mature.’
She feels there is a responsibility of professional organisations such as the Royal Pharmaceutical Society and BOPA to support the pharmacy workforce to be AI-ready, quoting futurist Bertalan Meskó, who said: ‘AI will not replace a healthcare professional, but AI will replace a healthcare professional who can’t use AI.’
Professor Nabhani-Gebara stresses that every healthcare professional needs to understand what technology is being used within their organisation, the training they need to use it, and how they can use it to be more efficient.
‘In the near future, we will all need to use AI to enhance our productivity, our effectiveness,’ she says. ‘You need to be able to take advantage of what technology can offer so that you can be a better healthcare professional.’
BOPA’s plans for 2025 and beyond
As well as an Equity, Diversity, and Inclusion committee to steer the development of inclusive cancer care standards, BOPA has created an AI Specialist Advisory Group. This will guide its AI strategy, assess the preparedness of the UK oncology pharmacy workforce to use AI, identify what upskilling may be needed, and develop relevant training resources. BOPA is also launching a patient and public involvement committee in May, ‘so that our work is informed by the patient voice’, explains Professor Nabhani-Gebara.
Meanwhile, BOPA’s updated digital SACT Verification Passport, launched in 2023, is expanding and receiving international interest. It was intended to allow cancer care pharmacists and pharmacy technicians to move between organisations without requiring re-training and validation due to the accreditation record being held by an individual rather than the hiring organisation.
These developments are all intended to support a workforce under pressure from a globally increasing cancer burden and ensure the varying needs of cancer patients are met.
In addition, Professor Nabhani-Gebara says that cancer should be covered in the undergraduate training of all healthcare professionals, so that the entire multidisciplinary community can care for the growing number of patients living with cancer and with healthcare needs outside of those met by cancer services.
‘We need that level of understanding from all healthcare professionals so that they know what to do if a patient is on hormonal treatment and needs an antibiotic,’ she explains.
It’s about being able to integrate a patient’s cancer profile when treating ‘the regular aches and pains and infections’ these patients will have like any other, to ensure they receive appropriate care at a primary as well as secondary level.
