Pharmacist-led cancer clinic is a 'lifesaver' as oral therapies surge

A new pharmacist-led clinic in Waterloo, Ont. is shifting how oncology patients are treated as a growing number of people are taking oral anticancer drugs, staff from the local health network said during a webinar Wednesday.The session, hosted by the University of Waterloo—"Better care, same team: Inside a pharmacist-led model changing cancer care"—outlined how the Waterloo Regional Health Network’s new Medication Assessment by Pharmacist (MAP) clinic embeds pharmacists directly into oncology care, rather than positioning them on the sidelines.The clinic, first announced in August 2025, supports patients receiving oral anticancer therapy through a shared-care model, where pharmacists and oncologists jointly manage treatment from the outset.Its opening comes at a time when cancer care is rapidly changing, said the network’s director of pharmacy services Anthony Amadio. According to him, more than half of oncology drugs in development are now oral formulations, driving a rapid increase in patients who require close monitoring outside hospital settings.In Waterloo’s region alone, he said there were roughly 160,000 cancer patient visits in 2024—a number that continues to climb.“There’s simply not enough hours in the day for our previous—or current—[healthcare] model to be able to follow up consistently with these patients,” Amadio said.The MAP clinic is designed to absorb that pressure, said clinical oncology pharmacist Jackie Diebold, who broke down how the clinic works.Patients begin with a joint visit involving both their oncologist and a pharmacist, where they receive a full medication review, counselling and baseline assessment. From there, follow-ups are split between the two providers on a structured schedule. Pharmacists help monitor side effects, manage drug interactions and review lab results, while oncologists focus on physical assessments and imaging.“We have a different pathway for the patient depending on what medication they’re on,” Diebold said. “Currently, we are following patients who are receiving an oral anti-cancer agent for early breast cancer, and we’re also managing patients who are receiving oral anti-cancer agents for CLL [chronic lymphocytic leukemia], which is a hematologic oncology population.”That care can be intensive, especially early on, she said. “We only see those patients in the ramp-up stage of the drug,” she said. “That entails eight visits with the pharmacist, including lab work, within a four-week time frame.”But the results have been positive, Diebold said, with staff already reporting eased pressure on care teams. Early signs suggest much of the medication-related workload is shifting away from nursing and hematology staff.For oncologists like Dr. Mary DeCarolis, that redistribution of labour has been critical.“To be honest, it’s a lifesaver,” she said. “I don’t know how I could service all the patients in the clinic without it.”The model hinges on clearly defined roles and a high degree of trust between providers, staff said, with pharmacists operating under clinical algorithms developed with physicians. It allows pharmacists to manage many issues independently while escalating more complex cases.That doesn’t mean the program is without challenges. One of the biggest barriers remains funding. In Ontario, pharmacists still cannot bill OHIP for many clinical services, limiting how widely programs like MAP can expand.But even so, the team sees potential for the model beyond oncology, potentially in clinics also dealing with chronic conditions where medication management is complex and time-intensive.For now, the MAP clinic is evolving in real time—adapting to more complex patients, refining workflows and expanding its scope step by step.“It’s a nice work environment,” said Dr. DeCarolis. “It’s good for the patients to see that other care providers can also take responsibility for their care, that it doesn’t have to just be the doctor. I think it’s been a win-win for me.”

Pharmacist-led cancer clinic is a 'lifesaver' as oral therapies surge

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