From Pill Counter to Cancer Partner: Inside City of Hope’s Push to Make Pharmacists Central to Precision Oncology

Cancer care has become increasingly complex—precision drugs, genetic profiling, and targeted therapies now define treatment pathways. Yet despite these advances, systems worldwide still struggle with fragmented coordination, inconsistent adherence, and the rising costs of innovation. For Wafa Samara, Vice President and Chief Pharmacy Officer at City of Hope—one of the United States’ leading cancer centers—the solution lies in expanding the pharmacist’s role from a medication gatekeeper to an integrated oncology specialist.

“Decisions driven by data reduce failures and improve outcomes,” Samara said. “It’s about matching the right drug to the right patient at the right time—and ensuring they can take it as intended.” Her approach reflects a growing consensus in oncology: that the future of cancer care depends as much on delivery and management as on discovery itself.

Turning a Challenge Into an Opportunity: The Oncology Pharmacist’s Growing Role

As oncology care grows more complex—with more targeted drugs, narrower safety margins, rising costs, and an explosion of real-world data—the system still struggles to match the right therapy to the right patient, sustain adherence, and curb “financial toxicity.”

At leading cancer centers, one clear solution is taking shape: move pharmacists from the sidelines to the core of oncology decision-making, and equip them with the data, reimbursement models, and authority to act. “Decisions driven by data reduce failures and improve outcomes,” said Samara. “It’s about getting the right drug to the right patient at the right time—and making sure they can actually take it as intended.” 

At City of Hope, pharmacists play an integral role across the care continuum. They join tumor boards, tailor dosing, monitor toxicity, and coordinate transitions between inpatient and outpatient settings. Their involvement has consistently improved safety, adherence, and patient satisfaction. “We’ve shown through multiple projects that when pharmacists manage medications, outcomes improve,” Samara said. “That evidence opened doors—not just in oncology, but in infectious disease and clinical workflow design.”

This evolution demonstrates a broader shift across cancer care: as therapies become more complex, pharmacists are emerging as essential medication strategists—ensuring precision, safety, and continuity at every stage of treatment.

Designing for Use: Where Pharmacy Meets Industry

For Samara, pharmacists also play a critical role in how cancer therapies are designed and delivered. Their perspective provides a reality check for manufacturers and regulators working to bring new treatments to market. “Before you launch, ask the people who work directly with patients,” she said. “Pharmacists are the bridge between the lab and the lived experience.”

This insight has shaped product design across several categories. One example she shared involved a self-mix injectable cancer therapy. “The company wanted patients to mix and inject the drug themselves. From a pharmacist’s standpoint, that’s unrealistic. Simplifying it into an auto-injector pen not only improves safety but also adherence.” This approach—designing for usability rather than just efficacy—has become increasingly relevant as more treatments move from hospitals to the home setting.

Data and AI: Freeing Experts for Higher-Value Work

As oncology produces vast amounts of clinical and research data, pharmacists are taking on a new analytical role. At City of Hope, technology now supports—not replaces—their clinical expertise. The center’s proprietary AI platform, Hope LLM, integrates lab results, physician notes, and research databases into a unified dashboard that supports real-time decisions. “For a new cancer patient, it can instantly identify the best therapy or clinical trial,” Samara said. “By automating data collection, pharmacists can focus on interpretation and care.”

Machine learning also automates the routine work—monitoring compliance, tracking controlled substances, and flagging anomalies—freeing pharmacists to spend more time with patients. “Technology lets pharmacists work at the top of license,” Samara said. “It moves them from tracking to treating.”

How is technology changing what it means to practice oncology pharmacy? The answer lies in how automation clears the administrative burden and returns clinical time to its highest purpose—decision-making, patient care, and interdisciplinary work at the point of treatment. Essentially, it’s shifting the focus back to what matters most—people, not paperwork. By taking over the repetitive, behind-the-scenes work, automation gives pharmacists the bandwidth to think, collaborate, and act. Instead of chasing data or managing inventories, they’re interpreting results, guiding treatment choices, and staying present with patients when it counts.

Addressing Financial Toxicity—And What That Means at City of Hope

Financial toxicity—the economic burden of cancer treatment—has become a defining challenge. “We don’t want patients deciding between paying their mortgage or paying for their drugs. If a patient meets criteria and cannot afford their medication, we help them get it. Innovation means nothing if it doesn’t reach every patient,” she emphasized.

By treating affordability as a clinical variable, not an afterthought, City of Hope integrates financial assessments into its pharmacy workflow to identify at-risk patients early and connect them to assistance programs. Pharmacists also maintain direct communication with patients between treatment cycles. “Our team checks if they’re taking their medication, refilling on time, and managing side effects,” Samara noted. 

However, this expanded role wasn’t easy to achieve. Early on, Samara encountered resistance from physicians. “When I suggested adding oncology pharmacists to oncology teams, one chief medical officer asked me, ‘If your pharmacists are going to take care of patients, what am I going to do?’”

It took persistence and proof. By demonstrating safer care, fewer side effects, and improved adherence, pharmacists gradually won trust. “Once outcomes improved, the pushback faded. The value was undeniable.”

Reimbursement, Recognition, and the Road to Provider Status

Even as pharmacists prove their clinical value, structural and financial barriers still limit how far their role can go. Across much of the world, pharmacists remain underrecognized in health policy and undercompensated in practice. “If hospitals must choose between hiring a doctor who generates revenue or a pharmacist who doesn’t, the choice is obvious,” states Samara. “Until pharmacists are recognized as reimbursable providers, the model will always face limitations.”

She argues that reimbursement is not only about pay—it’s about sustainability. Without financial recognition, hospitals have little incentive to embed pharmacists in oncology teams, even when data clearly show improved outcomes. “We take on the work that helps doctors and patients alike—managing toxicity, coordinating care, ensuring adherence—but the system still doesn’t reimburse those efforts,” she noted.

Samara sees encouraging signs abroad. In Taiwan, for example, new reimbursement models now cover pharmacists in critical care and ambulatory oncology clinics, allowing them to consult directly with patients, adjust regimens, and collaborate with physicians. “That’s a sign that advocacy works,” she said, “but recognition must continue globally.”

At City of Hope, Samara’s team continues to advocate for parity. She believes pharmacists should be measured—and compensated—for the outcomes they directly influence: fewer adverse events, better adherence, and lower hospitalization rates. With cancer therapies growing more complex and health systems shifting toward value-based care, she argues that pharmacists’ roles are no longer auxiliary but essential. “We’ve shown that when pharmacists manage medications, outcomes improve,” Samara said. “The next step is making sure policy and payment catch up to the evidence.”

Implementation Priorities for Hospital and Industry Leaders

For hospitals, integrating pharmacists into oncology leadership requires policy and structure. Tumor boards should include pharmacy specialists with defined authority to adjust therapy, initiate supportive care, and order monitoring tests. Hospitals should also embed financial screening into pharmacy operations, automate inventory and compliance tracking, and publish post-implementation outcomes to support sustainability.

For industry, closer integration with pharmacists can prevent costly usability issues. Manufacturers gain real-world feedback on delivery, dosing, and patient experience—key factors driving market adoption. Collaborating with clinical pharmacy teams also supports real-world evidence generation and patient-support design while meeting post-market transparency requirements. Strengthening hospital–industry partnerships is only part of the solution. To sustain progress, the field must invest in training future oncology pharmacists with modern skills and global vision.

Fewer students now enter oncology pharmacy, and more move to industry. Samara sees this as both a challenge and an opportunity to close the gap between innovation and patient care. “We must train pharmacists in analytics, oncology, and automation,” Samara emphasized. At City of Hope, new residency programs integrate AI, automation, and medication-safety design. These initiatives produce clinicians fluent in both data and biology—professionals who can translate complex science into practical care.

She believes global collaboration is key to sustaining that momentum. Through partnerships such as the one between City of Hope and Taipei Medical University (TMU), institutions share data, validate AI models, and align training frameworks across populations. “Collaboration expands the role of pharmacists and strengthens the evidence behind every decision,” Samara said. Together, these efforts aim to build a global network of oncology pharmacists who connect research, technology, and care to deliver smarter, more equitable treatment.

A Roadmap for Oncology Pharmacy

To solidify pharmacy’s role within oncology, Samara outlined key actions for the field:

1. Integrate pharmacists into all oncology decision loops, from tumor boards to formulary design.
2. Establish provider recognition and reimbursement for clinical pharmacy services.
3. Expand training programs that merge clinical expertise with data literacy.
4. Use AI and automation to streamline administrative burdens and enhance patient focus.
5. Build international frameworks to validate outcomes across diverse populations.

Finishing the Equation: Policy, Payment, and the Path to Routine Precision Care

Pharmacy’s role in oncology is shifting from support to leadership. Pharmacists now influence every stage—from protocol design and patient education to market access and data analytics. “We use data to position the right therapy and organize care so patients can stay on it,” Samara said. “When pharmacists operate at the center of oncology, outcomes improve, and costs make more sense.”

The message is clear: in modern cancer care, pharmacists are not just participants—they are architects of precision, safety, and access. As health systems worldwide move toward personalized and value-based care, the pharmacist’s seat at the oncology table is no longer optional. It is fundamental to making every new discovery count where it matters most—in the patient’s outcome.

City of Hope began in 1913 as a small two-tent facility outside Los Angeles, treating tuberculosis and critically ill patients. Over a century later, it has evolved into a National Cancer Institute–designated system with major centers across California, Arizona, Georgia, and Illinois—where Wafa Samara oversees nationwide pharmacy operations. Image: GeneOnline

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Author

Bernice Lottering