Closing the Cancer Divide in Tanzania: The Role of Global Oncology Pharmacy Randy Hurley MD, cTrop Med, BS Pharmacy HealthPartners and Regions Cancer Care Centers Foundation for Cancer Care in Tanzania

Acknowledgements: Mary Cooke Pharm D Jill Strykowski MS, RPh, BCPS Monique Giordana Pharm D, BCOP I have no conflicts of interest

Global Oncology Pharmacy The evolving role of Oncology Pharmacy professionals Role of Oncology Pharmacy in resource-constrained settings Pharmacy practice in Tanzania Visions for the future

Inpatient Oncology Pharmacy, University of Wisconsin Hospital, 1982 Technician med administration Drug order MAR transcription Admission & discharge counseling Care team rounding TPN monitoring Pharmacokinetics Chemotherapy administration

Scope of Oncology Pharmacy Practice Clinical skills and therapeutic management Generation, interpretation and dissemination of information Guidelines, policies and standards Public health and advocacy HOPA Scope of Hematology/Oncology Pharmacy Practice 2013 Mary Cooke Pharm D, Pathways to advance oncology pharmacy practice globally. 13th annual HOPA meeting April 2017

HealthPartners Cancer Care Centers Scope of Oncology Pharmacy Practice Supervise all aspects of chemotherapy EHR order sets Double checks Policy/procedures Quality assurance Patient counseling MTM Inpatient rounding Monique Giordana Pharm D, BCOP Regions Cancer Care Center

International Society of Oncology Pharmacy Practitioners Education Advocacy Annual meeting Journal of Oncology Pharmacy Practice

Recommendations for oncology pharmacy in resource-constrained settings Procurement Storage Preparation and dispensing Disposal Training Cost containment Stother M. JOPP 2012

Drug procurement in resource-constrained settings Essential medicines list Bulk purchasing Reputable suppliers Personnel on procurement board of hospitals SOP for drug purchasing WHO essential medicine list WHO cost effectiveness analysis: guide to 700 procedures

Drug storage in resource constrained settings Physical security of storage location Refrigerator hooked to back up generator SOP for drug inventories and management of discrepancies Drug diversion since expensive

Preparation and dispensing in resource-constrained settings Physical infrastructure to limit exposure Sterile products hood PPE and changing room Fixed dose rounding Pre-printed order sets Sterile products hood Exam tables Chairs Wste disposal GHM shipping container

Safe drug disposal in resource-limited settings SOPs for chemotherapy waste Disposal collection containers Functional incinerator

Personnel training for resource-constrained cancer centers Safe handling Safe disposal Chemotherapy spills Administration Extravasation Infusion reaction kits 1979 lancet article: mutagens found in urine of nurses administering chemotherapy 1985 study: nursing handling chemotherapy had increased miscarriges

Cost containment Bulk purchasing Dose rounding and fixed-dosing Defined cost-effective treatment protocols: an “NCCN” for resource-constrained areas Disease guidelines and priorities Health economics, Pharmacology, Pharmacogenetics, Acceptable toxicity Nutritional status, Intercurrent illness

Tanzania Pharmacy Workforce: Education Pharmaceutical Assistant: 2 year certificate Pharmaceutical Technician: 3 year diploma Education focuses on supply chain, calculations, and some clinical Pharmacist: 4 year bachelor degree Clinical pharmacy training Source:, 2009. Ministry of Health of Social Welfare.

Industry & Labor Force Statistics Pharmacies/Dukas in Tanzania: 5241 Pharmacists in Tanzania: 704 Pharmacies per 10,000 population: 1.08-2.61 Pharmacists per10,000 population: 0.01- 1.37 Pharmacist Salaries Source: Assessment of the Pharmaceutical Human Resources in Tanzania, 2009. Ministry of Health of Social Welfare.

Industry & Labor Force Statistics Source: Assessment of the Pharmaceutical Human Resources in Tanzania, 2009. Ministry of Health of Social Welfare.

Ilula District Hospital Pharmacy Services 15 year commitment form Minnesota-based NGO Frank Sanga, Pharmacy technician Annual inter-professional global health elective, UofM College of Pharmacy

Ilula District Hospital Pharmacy Services Frank Sanga, pharmacy technician Procurement officer Dispensing by nurses and midwives Hospital management team QI team

Ilula District Hospital Pharmacy Services Increasing clinical role Retrospective QA “Out of stock” shortages HIV Clinic

Oncology Pharmacy KCMC, Moshi Tanzania Dedicated pharmacist SOPs Secure storage room in clinic Mixing hood Training Fundraising for chemo Rahim Senkondo, Pharmacist

Oncology Pharmacy KCMC, Moshi Tanzania Additional staff Drug shortages PPE shortages Changing room Additional training Rahim Senkondo, Pharmacist

The future of oncology pharmacy at KCMC Education Academic affiliations Society affiliations Expanding clinical role Simulation-based learning chemo administration

Conclusions Oncology pharmacy is a key component of closing the global cancer divide Oncology pharmacy professional societies are beginning to expand their global connections Although professional pharmacy in Tanzania is still evolving, the Cancer Center at KCMC has developed a strong oncology pharmacy program There are exciting opportunities to partner with oncology pharmacy at KCMC