Pharmacists Play a Vital Role in Addressing Patient Leakage in the Precision Medicine Care Continuum

Pharmacy Times^® interviewed Edward Kim, MD, MBA, physician-in-chief at City of Hope Orange County and vice physician-in-chief at City of Hope National Medical Center in California, on his presentation at the Precision Medicine World Conference 2025 titled: Overcoming Practice Gaps in Precision Medicine: Addressing Patient Leakage. Kim discussed the critical points where patient leakage occurs across the precision medicine continuum, including screening, diagnosis, genomic testing, treatment initiation, and survivorship.

Inefficiencies, such as delays in scheduling biopsies, obtaining genomic results, and coordinating specialist consultations, can significantly prolong the time to treatment, creating anxiety and potential care gaps for patients with cancer or high cancer risk, according to Kim. Institutions such as City of Hope, with integrated resources and expertise, are well equipped to streamline this process, but smaller systems often struggle, leading to delays, incomplete information, and errors.

Kim emphasized the vital role of pharmacy teams in minimizing patient leakage by actively participating in multidisciplinary care. Pharmacists are essential in conducting medication assessments, simplifying regimens, adjusting doses, managing adverse effects (AEs), and addressing symptoms such as pain or gastrointestinal issues caused by treatments. Additionally, their expertise in new targeted therapies and advancements in precision medicine is invaluable to the care team.

Pharmacy Times: What are the most critical points in the care continuum where patient leakage occurs?

Edward S. Kim, MD, MBA: This whole continuum of precision medicine, from the screening all the way up to the diagnosis to the staging to the treatment and the survivorship--I'm lucky [as] I've worked in several places that are dedicated cancer centers. City of Hope is a top 5 nationally ranked cancer center, and this is what we do. We don't deliver babies. We don't fix hips or backs. We focus on those people who are either at risk for cancer, have cancer, or survive cancer. So we have those resources in place to do the screening, to do the diagnosis, to get the genomic information, to discuss among experts the genomic information and what is perhaps the best treatment to move forward with, know about the treatment and have knowledge about the [AEs], how you should modify dosing if complications occur, how long to give that treatment for, when to switch treatments if it's not working, and then finally, how to help people live with their disease and their treatment as they live years and years now, and hopefully one day cured, so that we can help them in their post-cancer life as well.

Artificial intelligence depicts a precision drug delivery system. Image Credit: © Creator88 - stock.adobe.com

Any one of these areas, one can see that there could be leakage for smaller hospitals or systems that don't carry these types of services. Sometimes referring out to other groups to get the biopsy—you think about that's going to take a couple weeks to get, the first appointment takes another week to schedule, the biopsy takes another week to then get the results. Now you have to send that for genomic testing, which can take 2 more weeks on top of that, and then back to another teammate to then discuss those genomic results. We've already gone 8 weeks in this process, and we're still not talking about treatment.

Many patients describe this where it can take months before they get all the information and they're ready to start treatment. Again, this is a patient in my world that's been diagnosed with cancer or has a high suspicion of cancer. This is code red, panic alert, DEFCON 5. There is a huge amount of urgency on this, and this is where sometimes shortcuts or mistakes can occur. Because there's so much pressure to just start treatment, we see this where some of this information is not gathered and used at the time of treatment. So, treatment started, then you get your genomics later. This is where, again, leakage can occur if there's too long of a time period, and you're handing off the different testing or duties for your care team. That's hard, and I can definitely see where that can be frustrating. That's not even talking about how there could be bumps in between with scheduling, getting time off from work, transportation, and then even talking to insurance companies about what can and can't be covered.

There are a lot of reasons why we are going to see this type of leakage occur, especially in this precision medicine continuum, and it's tough to have all of that in one place. So, again, I feel blessed to be at a place like City of Hope that is a dedicated cancer center where we have all these resources, and we can really treat patients at the speed of life. But again, we're lucky that way, and how best can institutions like us support those people in the community to help that patient journey occur. That's really part of our job as well.

Pharmacy Times: How can pharmacy teams support efforts to minimize patient leakage, such as through patient education or navigation?

Kim: I'm a huge supporter of pharmacists, and I'm not just saying that because I'm talking to you all today. I believe that they're truly providers, and they are an integral part of the provider team, and that's different than just being drug dispensers.

So, believing that our pharmacists are an important part of our multidisciplinary team, that they can actually help manage patients, their medications, what types of drugs they're taking, and their [AEs] and titration, I have personally found pharmacists invaluable as part of the team.

So yes, there is that first part of doing a medication assessment. Sometimes patients come in and they've seen multiple different providers, and they have this whole laundry list of medications, just another thing to be complicated about. First thing we do is, let's clear the cupboard. Let's simplify it, making sure that you're on the right medication and you're not confused.

The second then is that I expect my pharmacist to actively manage those medications, to make sure that they're following up with the patients, that in fact, if the dose is not enough, they can increase it. If it's too much, they can decrease it. Again, when you are giving opioids or pain medicine, for instance, you have to be cognizant that you're not causing constipation or other symptoms, and who best than a medication expert—the pharmacist—to be able to have that type of broad knowledge to make sure holistically, we're looking at the patient and how they're being treated.

Then again, I find pharmacists invaluable in knowing the latest and greatest drugs, just like the doctors, they also are very educated on the new targeted therapies, the new precision medicine techniques, and it's really important to have that interaction with the pharmacist, with the [advance practice practitioner], with the nurse, and with your scheduler.

So as long as the patient feels like they're being taken care of by a team approach. That our quarterback has 5 heads. That's what they want, that's what they need, and that's where they'll feel safe. They'll feel trust in the system. They'll feel like we're taking care of them, and that we're not just managing them on the visits, that there is appropriate follow up in between the visits, so that you don't want them sitting at home in pain or not being able to eat or other things like that. This is what's so important to engage our multidisciplinary team, which absolutely includes our pharmacy teams, to make sure this whole care throughout this continuum of precision medicine works effectively for the patients, and more importantly, we can control their disease, control their symptoms, and help improve their overall quality of life.