On Pediatric Oncology Practice and Growth Beyond the Clinic

Don S. Dizon                 Susannah Koontz

One of the things I got to do when I came back to Providence was dive in to a new practice- soft tissue sarcoma. Providing multidisciplinary care for those with sarcoma had been a practice gap for quite some time, and I felt it was a cancer type that required the same multidisciplinary focus as other cancer services had. It didn’t take long for someone to help. Dr. Bradley DeNardo stepped up to help me. He is a pediatric oncologist at Hasbro Children’s Hospital and has an interest in sarcoma, so together, we created an adult–pediatric soft tissue sarcoma program here at Brown, and one we are quite proud of.

Meeting Brad brought me closer to the world of pediatric oncology, too. I had never considered it as a specialty, but I knew many who had on social media. One of those who I’ve often chatted with is Susannah Koontz, PharmD, BCOP, FHOPA. She and I have exchanged tweets over the years, so much so that I consider her a twiend. I decided to delve more into her career and her passions, and she graciously agreed to share them with me in this Discussions piece.

Happy Thanksgiving to all, and Brad—you’re next!

What about the patient population motivates you to work with them?

The two things that fuel my passion for working with children with cancer are the indomitable spirit they have during treatment and the impact that we as healthcare providers can have on their care and their subsequent trajectory in life. I’m often asked if working in pediatric oncology is sad or depressing. Of course there are times when patient outcomes are not what we want. However, the zest for life the kids have and the fun—yes fun!—we have on the unit or in the clinic far outweigh the moments of sadness. And knowing that I can attenuate an acute side effect, which allows a child to attend school on a day they receive chemotherapy, or temper the development of a long-term toxicity, which helps kids live healthier lives many years after treatment, is something special.

How has the pharmacist's role on the treatment team changed in oncology? In pediatric oncology?

I’ve been in oncology pharmacy for nearly 25 years and have witnessed great strides in the role of the pharmacist in the care of people with cancer. Pharmacists have become integral members of healthcare teams, not just in academic medical centers but also in community oncology centers, infusion centers, and private practices. We’ve moved from entering physician orders on rounds to entering into collaborative practice agreements (CPAs) with medical staff to perform specific patient care functions (and hopefully, pharmacists will be granted provider status under federal legislation in the near future). While we remain drug information experts, we are also engaging in research as co-PIs, developing pathways and guidelines within multi-disciplinary teams and ensuring the delivery of safe, quality patient care through participation in quality improvement and medication use committees. And, with some of our colleagues transitioning to work in the pharmaceutical industry and government agencies, patients are increasingly benefiting from the expanding reach pharmacists have in oncology care.

More opportunities are available to pharmacists specializing in pediatric oncology. There has been an increase in the number of available positions, many of which are fully dedicated to hematology, oncology, and stem cell transplant patients, as the value of pharmacists has become well-documented. More and more frequently, pediatric oncology pharmacists are involved in the extrapolation of adult data to determine applicable doses of cancer therapies for children and extemporaneous compounding of treatments and supportive care medications

Do you still see patients? When did you stop? What motivated the change in careers?

I shifted roles after working at an academic medical center for a decade. While I thoroughly enjoyed what I was doing—patient care, teaching, clinical research, etc.—I began to realize my professional growth and development was plateauing. At about the same time, my in-laws were experiencing some decline in their health necessitating increased assistance from our family. So, I took the opportunity to try something new—starting a small business—that allowed me flexibility with my time that my relatives needed. Since I no longer see patients in clinic, my current connection to direct patient care is through curbside consults I periodically receive from colleagues who reach out to me for advice or a second opinion on a clinical conundrum.

What do you miss? What do you not miss?

In my current role the thing I miss most is the direct interaction with patients, caregivers, and members of the healthcare team. We’re all human and need social interaction across all aspects of our lives. I really enjoy collaborating with others to develop solutions in response to problems and it’s part of what I do now as a consultant. While I’ve always worked to solve problems we commonly encounter in pediatric oncology—such as determining the optimal therapy for the treatment of a rare pediatric cancer—it’s more satisfying when done in-person with your peers. I also miss the opportunity to work directly with patients and their caregivers to educate them on their medications. I believe that providing people with knowledge and tools to understand their cancer treatments empowers them to be their best advocates in their own care.

I don’t miss the increasing complexities of the electronic health record coupled with a growing administrative burden being placed on healthcare providers. While there’s a need for documentation in healthcare and a role for technology to facilitate it, it shouldn’t come at the sacrifice of the time we spend with patients. I’m also grateful for the variety of work I perform as a consultant. No two weeks are alike for me, and I’m not faced with repetitiveness of tasks that can come while working as a clinical pharmacist.

What would you say to your younger self about making career choices?

One piece of advice I would give to my younger self when any opportunity is presented is to take a closer look at who’s sitting at the table. We are living in a climate having difficult, but necessary and long-overdue, conversations about diversity, equity, and inclusion. I would advise taking a concerted look at the community of which you are invited to be a part, be it a residency program, a job, an institutional committee, a national task force, an organizational board, etc. The research is clear that diverse teams are higher functioning. If everyone at the table is alike, think twice before taking a seat. And if you do take a seat in a group where you are ignored or demeaned for your ideas and observations, then go find another table.

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