Key Responsibilities and Required Skills for Oncology Pharmacist

🎯 Role Definition

An Oncology Pharmacist is a licensed clinical pharmacist specialized in the safe and effective use of antineoplastic agents and supportive care therapies across inpatient, ambulatory infusion, and clinical trial settings. This role combines advanced clinical decision-making, sterile compounding expertise, regulatory compliance, patient counseling, and multidisciplinary collaboration to optimize outcomes for patients with cancer, hematologic malignancies, and those receiving cellular therapies (CAR-T). The Oncology Pharmacist is responsible for chemotherapy order verification, toxicity management, therapeutic drug monitoring, investigational drug services, and quality/safety initiatives, ensuring alignment with USP <797>/<800>, ASHP, and institutional protocols.

📈 Career Progression

Typical Career Path

Entry Point From:

Staff Pharmacist with oncology rotation experience
PGY-2 Oncology Residency graduate or PGY-1 with oncology exposure
Clinical Pharmacist with experience in infusion centers or medical oncology clinics

Advancement To:

Oncology Pharmacy Clinical Specialist / Clinical Coordinator
Pharmacy Manager, Oncology Services
Director of Pharmacy or Director, Cancer Center Pharmacy Services

Lateral Moves:

Ambulatory Care Pharmacist (oncology-focused)
Infusion Center Manager
Clinical Trials Research Pharmacist / Investigational Drug Services (IDS) Lead

Core Responsibilities

Primary Functions

Verify and clinically assess chemotherapy and supportive care medication orders (IV and oral), ensuring dosing accuracy, appropriate regimen selection, renal/hepatic dose adjustments, and adherence to evidence-based oncology protocols and institutional guidelines.
Prepare, compound, and release sterile hazardous and non-hazardous antineoplastic agents under USP <797> and USP <800> standards, including aseptic technique, hazardous drug containment, documentation, and batch record review.
Perform prospective drug utilization review for oncology patients, identify drug–drug interactions, contraindications, overlapping toxicities, and recommend therapeutic modifications to the oncology care team.
Manage and optimize oral oncolytic programs: patient education, adherence monitoring, prescription triage, prior authorization support, and coordination with specialty pharmacies and payers.
Provide direct patient counseling and education on chemotherapy regimens, oral targeted agents, immunotherapies, adverse effect recognition and management (nausea, myelosuppression, hand-foot syndrome), and safe handling/storage of cytotoxic medications.
Conduct medication reconciliation at transitions of care (admission, discharge, clinic visits) for oncology patients to reduce errors, avoid duplications, and ensure continuity of therapy.
Serve as the clinical resource for inpatient and ambulatory oncology teams regarding dosing for special populations (pediatrics, geriatric, renal/hepatic impairment), therapeutic drug monitoring, and pharmacokinetic-based dosing when applicable.
Oversee investigational drug services (IDS) and support oncology clinical trials: review protocols, ensure regulatory compliance, prepare and dispense investigational agents, maintain accountability logs, and coordinate with research staff and IRB requirements.
Provide clinical oversight and order verification for complex cellular therapies (CAR-T): lymphodepleting regimens, bridging therapy, cytokine release syndrome/toxicity mitigation, and documentation of chain-of-custody where required.
Lead or participate in multidisciplinary tumor boards, case conferences, and rounds, offering pharmacotherapy recommendations for regimen selection, sequencing, and supportive care optimization.
Implement, maintain, and update chemotherapy pathways, clinical order sets, evidence-based antiemetic and growth factor protocols, and formulary decisions in collaboration with oncology leadership and pharmacy therapeutics committees.
Conduct medication safety reviews, root cause analyses for chemotherapy-related errors, and lead quality improvement initiatives to reduce adverse drug events and enhance safe handling practices across the cancer center.
Provide education, precepting, and mentorship for pharmacy residents, students, technicians, and nursing staff on oncology pharmacotherapy, compounding safety, and emergency management of chemotherapy toxicities.
Coordinate with outpatient infusion centers and specialty clinics to manage inventory, controlled substances, hazardous drug storage, temperature-sensitive materials, and ordering workflows to prevent treatment delays.
Perform dosing calculations for weight-based, BSA-based, and renal-adjusted chemotherapy regimens, and validate infusion rates, pump settings, and admixture stability against institutional and manufacturer guidance.
Maintain accurate documentation in the electronic medical record (EMR) system (e.g., Epic, Cerner), including chemotherapy plans, medication administration records, clinical interventions, and problem lists for oncology patients.
Develop and execute oncology-focused antimicrobial stewardship interventions when appropriate, and collaborate on febrile neutropenia pathways and prophylaxis strategies.
Participate in formulary management, cost-benefit analyses, and prior authorization escalation for high-cost oncology agents, biosimilars, and immunotherapies to support access and fiscal stewardship.
Monitor and report on key performance indicators (KPIs) for oncology pharmacy services: turnaround times for chemo verification, medication error rates, adherence metrics for oral oncolytics, and patient education completion rates.
Ensure continuous compliance with federal, state, and accrediting bodies' regulations (USP chapters, OSHA, CMS, Joint Commission), and lead preparedness for inspections and audits related to compounding and hazardous drug handling.
Collaborate with specialty pharmacy vendors, home infusion providers, and payers to coordinate transitions to home administration and to troubleshoot medication access and reimbursement issues.
Lead implementation of clinical informatics initiatives related to oncology order sets, clinical decision support, and chemotherapy compounding automation, partnering with pharmacy IT and EMR analysts.
Serve as a liaison to outpatient clinics to develop survivorship medication plans, long-term toxicity monitoring programs, and supportive care pathways for pain, endocrine dysfunction, and psychosocial needs.

Secondary Functions

Participate in development and delivery of continuing education for physicians, nurses, and allied health staff on new oncology agents, immunotherapy toxicities, and best practices in chemotherapy safety.
Support pharmacy leadership with budgeting for oncology drug spend, forecasting high-cost therapy usage, and evaluating biosimilar adoption strategies.
Contribute to research initiatives by supporting protocol feasibility, medication-related endpoints, adverse event documentation, and potential investigator-initiated studies.
Assist with recruitment and training of pharmacy technicians and infusion staff to scale oncology services and maintain high standards of compounding and dispensing accuracy.
Lead or participate in committees (Pharmacy & Therapeutics, Oncology Operations, Safety Committee) to influence policy, improve workflows, and standardize oncology medication processes.
Support outreach and patient navigation efforts to improve treatment adherence, manage side effects, and facilitate timely access to supportive services (nutrition, social work, financial counseling).

Required Skills & Competencies

Hard Skills (Technical)

Advanced knowledge of oncology pharmacotherapy, including cytotoxic chemotherapy, targeted agents, hormonal therapies, immunotherapies, and supportive care medications.
Sterile compounding and hazardous drug handling expertise aligned with USP <797> and USP <800> standards; experience in cleanroom operations and gowning procedures.
Chemotherapy regimen review and verification skills, including body surface area (BSA) and weight-based dosing, dose capping, and dose modification protocols for organ dysfunction.
Familiarity with cellular therapy processes (CAR-T) and management of immune effector cell–associated toxicities (ICANS, CRS).
Experience with investigational drug services (IDS), clinical trial pharmacy procedures, and regulatory documentation (protocols, accountability logs, IND/IDE coordination).
Proficiency with major electronic medical record (EMR) systems (Epic, Cerner, Aria) and chemotherapy ordering modules, including building and maintaining order sets and clinical decision support.
Strong medication safety and quality improvement skills: root cause analysis, FMEA, incident reporting, and implementation of corrective actions.
Knowledge of oncology supportive care protocols: antiemetic guidelines (ASCO/ NCCN), growth factor use (G-CSF), infection prophylaxis, and pain management.
Ability to perform pharmacokinetic-based dosing and therapeutic drug monitoring when applicable, and interpret lab results in the oncology context.
Experience with formulary management, prior authorization workflows, and strategies to optimize access to high-cost oncology medications.
Competency in inventory control for biologics, refrigerated/temperature-sensitive products, and controlled substances used in oncology.
Familiarity with accreditation, regulatory, and safety standards (Joint Commission, state boards, OSHA) related to oncology pharmacy practice.

Soft Skills

Excellent verbal and written communication for patient counseling, interdisciplinary team discussions, and documentation in the medical record.
Strong clinical judgment and decision-making under time-sensitive conditions, particularly in managing chemotherapy reactions and oncologic emergencies.
Collaborative mindset to work effectively in multidisciplinary cancer care teams (oncologists, nurses, social workers, research staff).
Leadership and mentorship skills for precepting residents, training technicians, and leading quality initiatives.
Attention to detail and meticulous documentation practices to ensure safe compounding, dispensing, and administration of chemotherapy.
Empathy and patient-centered approach to educate and support patients and families through complex treatment regimens and side effects.
Time management and organizational skills to balance clinical verification, rounding responsibilities, and administrative tasks.
Problem-solving orientation with the ability to analyze workflow inefficiencies and implement process improvements.

Education & Experience

Educational Background

Minimum Education:

Doctor of Pharmacy (PharmD) degree and active state pharmacist license.

Preferred Education:

Completion of a PGY-1 residency plus PGY-2 oncology specialty residency or equivalent oncology residency experience.
Board certification in oncology pharmacy (BCOP) or eligibility.
Additional certifications: immunization, chemotherapy/Biotherapy certification, or sterile compounding credentialing.

Relevant Fields of Study:

Pharmacy (PharmD)
Clinical Pharmacology
Pharmaceutical Sciences

Experience Requirements

Typical Experience Range:

2–5 years of clinical pharmacy experience with at least 1–2 years focused in oncology/hematology, infusion services, or investigational drug services.

Preferred:

3+ years of dedicated oncology pharmacy experience, experience in a comprehensive cancer center, demonstrated competency in USP <797>/<800> sterile compounding, experience supporting clinical trials and CAR-T programs, and prior precepting or leadership responsibilities.