Key Opinion Leader: Dr. Emily Mackler's Impact on Oncology
Emily R Mackler, PharmD, BCOP’s research and work aims to improve the effectiveness and quality of care provided to oncology patients through medication. She is a respected member of the medical community, and shares her wealth of knowledge with medical students at the University of Michigan College of Pharmacy.
Education and Early Career
Emily R Mackler, PharmD, BCOP, first attended Drake University where she received her PharmD. She went on to complete her residency experience in Pharmacy Practice and Oncology at the University Hospital in Cincinnati, OH. She became Clinical Oncology Pharmacist with Michigan Medicine in 2002. In 2003 Dr. Mackler founded the Oncology Specialty Residency at the University of Michigan, and she remained the program director up to 2013. She has been an adjunct clinical associate professor at the University of Michigan College of Pharmacy since 2011, and was a clinical assistant professor from 2002 to 2011.
Throughout her career, Mackler has immersed herself in improving oncology quality and safety endeavors. She has been the co-lead and founding developer of the NCCN Chemotherapy Order Templates since 2006, when they were formed. She was also the founding pharmacist for the Cancer Center Symptom Management and Supportive Care Program for the University of Michigan from 2009 to 2012.
In 2012 she became the founding director of the Oral Chemotherapy Program for the University of Michigan. In 2013 she founded MOQC’s Oral Oncolytic Program and became the course director of the Michigan Society of Hematology-Oncology (MSHO) Annual Pharmacist’s Meeting. Since 2017 she has been the HOPA representative with the National Quality Forum. In 2018 she became the Task Force Chair for the HOPA Quality Take Force.
Clinical Trials and Research
The focus of Dr. Mackler’s research and practice is on the management of oncology symptoms, quality of care, chemotherapy safety, medication adherence, and patient-reported outcomes.
Primary care comprehensive medication reviews in cancer patients with comorbid conditions
In this study, 96 cancer patients with select comorbidities went through a comprehensive medication review (CMR) to explore patient characteristics and interventions. Study participants were adults who received both active cancer treatment and primary care at Michigan Medicine who have comorbid conditions such as diabetes (DM), chronic hypertension (HTN), heart failure (HF), depression or anxiety that also completed an intake survey and underwent a CMR performed by a primary care clinical pharmacist.
Recommendations for medications were reviewed with primary care physicians, then implemented in follow-up visits, and finally documented in the patient’s electronic medical record (EMR). Using collaborative practice agreements when needed, patients were referred to pharmacists for diabetes and or HTN management. Of the 31 patients seen by pharmacists, medication profiles were changed for 84% of them. Nearly a quarter of patients were seen for disease management.
Neuropathy was the most bothersome symptom reported by over one in five patients (21%). Patients with low social support might need additional healthcare services to ensure that their needs are met. The majority of patients reported little or no hassle with the frequency of doctor’s appointments required in the study.
In conclusion, the discovery was made that primary care pharmacists have the ability to improve both the coordination of care and clinical outcomes for cancer patients who have comorbid conditions due to 23% of patients requiring added chronic disease management.
Implementation of and Satisfaction with an Outpatient Oral Anticancer Therapy Program
Due to the ongoing development of novel oral anticancer agents, the use of oral medication in the treatment of cancer has increased significantly over the past few years. Opportunities to improve patient care and prescribing practices for patients receiving oral anticancer medications have arisen as a result of new medications being released to the market rapidly.
This study showcased how well patients were able to track and manage their symptoms at home, how comfortable they were with the information received on new medications, and patient ability to access new medications through their pharmacy in relation to the Outpatient Oral Anticancer Therapy Program.
A major factor in patient satisfaction was the ability to receive financial assistance for medications. A follow-up factor in satisfaction was the timeliness of receiving medications. Mackler notes in the audiocast associated with this publication that some medications studied could take up to a month for the patient to receive after being prescribed.
An effective oral anticancer treatment program can be created through cautious arranging with multiple key stakeholders. The program has brought about a high patient and provider fulfillment and self-announced patient education scores. Future investigations will be directed to survey the effect of the program on tolerant adherence, budgetary advantages, and other patient wellbeing and quality results.
Utilization of patient-reported outcomes measures (PROM) to characterize symptom burden and adherence associated with oral oncolytic therapy
The utilization of patient-reported outcome measures (PROMs) to screen malignancy treatment mediocrity has been appeared to decidedly affect results. The motivation behind this examination was to portray the occurrence and seriousness of symptoms, quiet self-administration certainty, and medication adherence in patients getting oral oncolytic treatment. Strategies: This multicenter, cross-sectional, observational examination was led across 6 Michigan oncology rehearses from July 2016-December 2018. Patients were qualified to finish PROMs over the span of their treatment in the event that they were accepting an oral oncolytic medicine (barring endocrine treatment).
In total, 2,252 PROMs were completed across 695 patients, with a median age of 69, and 48% of patients included were female. In 35% of PROMS, a most bothersome symptom (MBS) was indicated by the patient. Fatigue, pain, constitutional symptoms, and nausea/vomiting were the most commonly reported MBSs. In 20% of PROMs, non-adherence was reported by the patient in correlation with symptoms caused by medications.
Patients who are prescribed an oral oncolytic in order to treat cancer experienced a high manifestation of symptoms, with over half encountering a moderate to severe indication. Advancing symptom management and giving patient instruction that expands patient confidence in self-administration may improve medication adherence and patient results.
Social Media Presence
Mackler has a wide presence online, with 148 social media mentions, mostly stemming from her extensive network on LinkedIn. She was recently elected to the Hematology/Oncology Pharmacy Association (HOPA) Board of Directors and received celebration for the honor online.
Awards and Accolades
Directions in Oncology Pharmacy™ Keynote Speaker 2019
Emily Mackler PharmD, BCOP continues to improve the lives of oncology patients through pharmaceutical therapies and follow ups for patients. Her work has proven that the interaction and communication with the pharmacist, doctors, and patients is crucial to patient care and outcomes. H1 thanks her for her contributions in improving the lives of patients.