Alexandra Shillingburg

Alex Shillingburg, PharmD BCOP, was the winner of HOPA’s 2018 New Practitioner Award, which recognizes an early-career HOPA member who has made a significant contribution to developing or supporting clinical hematology/oncology pharmacy services. Dr. Shillingburg is a clinical pharmacy coordinator at Levine Cancer Institute, Atrium Health, Charlotte, NC, where she specializes in malignant hematology and hematopoietic stem cell transplant in both inpatient and outpatient settings.

Early in her career, Dr. Shillingburg developed the role of a clinical pharmacist in the malignant hematology and stem cell transplant outpatient clinics at West Virginia University (WVU). Because of her innovative perspective and leadership skills, she quickly was asked to assume the post of director of the stem-cell collection and apheresis program. Dr. Shillingburg has continued to advance pharmacy practice at her new position with Atrium Health. She has identified several opportunities for patient care improvement and optimization. She is also highly dedicated to teaching and mentoring students and residents in the field of oncology and has recently become the PGY-2 Oncology Pharmacy Program Director at Atrium Health. She has served on a number of HOPA committees and has also spoken at HOPA’s annual conferences in the last several years. In November 2018, we asked Dr. Shillingburg to share some thoughts on her career and what winning the New Practitioner Award has meant to her.

In what practice setting do you work? Do you specialize in a specific tumor type? Briefly tell us about the type and number of patients that you see in your practice.
I currently practice at the Levine Cancer Institute (LCI) and Carolinas Medical Center (CMC), both part of the Atrium Health hospital network. CMC is a large public nonprofit hospital licensed for 874 beds, with a dedicated oncology unit and stem cell transplant unit, together comprising 52 beds. The Levine Cancer Institute is a comprehensive cancer care center with 25 regional facilities. The main building, where the majority of the 200 oncologists practice, consists of 68 infusion chairs (the number will increase to more than 100 in spring 2019) and offers numerous clinic and supportive services.

I specialize in malignant hematology and stem cell transplantation, along with five other pharmacists in my group. The six of us rotate monthly between the outpatient clinics (leukemia, lymphoma, myeloma, and posttransplant) and the two inpatient service teams. Because we are a tertiary referral center, many patients with rare and highly refractory diseases are referred to us, and because we are the only stem cell transplant facility within a 75-mile radius, most patients with leukemia are referred to our care. On average, each of us cares for 20–30 patients daily.

How long have you been a member of HOPA, and how have you been involved during that time?
I became a member of HOPA as a PGY-1 resident in 2012 when I was planning to apply for PGY-2 residencies in oncology and wanted to become more involved in the leading oncology pharmacist organization. After joining, I was immediately incorporated into the Publications Committee and served as a member for 2 years. During that time, I authored several articles for HOPA News. I also proposed initiating “The Resident’s Cubicle” column, which would focus on issues relating to residents and residency programs. I wrote the three inaugural columns and have been thrilled to see its continued inclusion in HOPA News.

In 2014, I spoke at both HOPA’s Practice Management meeting and the Annual Conference on topics related to my experience at the WVU Cancer Institute when the institute was seeking Quality Oncology Practice Initiative (QOPI) certification from the American Society of Clinical Oncology (ASCO).

In 2015, I sat on the BCOP Updates Course Committee for one term and worked with the group to develop the topics, review the content, and organize the review course program.

Early in 2018, I had the opportunity to join the Leadership Development Committee. I am really enjoying being involved with the numerous initiatives that group has planned, including launching the Mentorship Pilot Program and focusing on issues related to women in pharmacy leadership.

What have you done to improve oncology pharmacy care at your places of employment that may have contributed to your winning this award?
In my first position as a clinical specialist at WVU, I instituted and developed the outpatient clinical pharmacist’s role in the malignant hematology and stem cell transplant clinics. I instituted a pharmacist-run tacrolimus monitoring program for all patients after allogeneic transplant, revised the posttransplant immunization process, and implemented processes for monitoring many posttransplant complications. I was also asked to direct the stem-cell collection program and work with the nursing, physician, and stem-cell processing technicians to coordinate care of our healthy donor collections, autologous collections, and extracorporeal photopheresis patients.

I was also involved in many quality improvement initiatives and worked with cancer center leaders to maintain American College of Surgeons/Commission on Cancer and Foundation for the Accreditation of Cellular Therapy (FACT) accreditations. When the center was planning to apply for QOPI certification by ASCO in 2014, I was asked by the section chief of oncology to oversee the process. Over the course of a year, I coordinated this massive effort to update and submit the required policies, collate data from chart abstractions, and validate data collection processes; I then oversaw the onsite visits, after which we received our accreditation and an excellent review.

Since transitioning into my role at LCI, I have worked with our group to develop several new chemotherapy order sets, implement criteria for the use of glucarpidase, optimize the administration of high-dose etoposide, and revise the posttransplant immunization standards.

What would you identify as keys to your success so far in your career?
I think the major key to the success I have had so far is that I don’t set limits on where I can be involved. If I have the knowledge and ability to contribute to something and improve the care that we provide, I want to do that. Many of the roles I have taken on have been tasks that are not traditionally considered “pharmacy roles.” I often get surprised looks when I talk about my involvement with the stem-cell collection team or the QOPI certification team because it’s not typical for a pharmacist to fill those roles. I took the time to understand the needs and abilities of each group, I understand the clinical processes, and the rest is just good communication, desire, and effort. Instead of assuming it’s not something we can do, I ask, “Why not?” Be a peer reviewer for a journal as a resident? Why not? Mentor student research projects as a resident? Why not? Teach nursing classes on stem-cell processing? Why not?

What are your areas of interest pertaining to research and education?
My clinical areas of interest are chronic leukemias, growth-factor support, posttransplant complications, and posttransplant immune reconstitution.

My greater passion is the education and development of pharmacy residents. I have always loved being closely involved with residency training, providing professional and personal mentorship and guidance, and helping the residents progress to reach their full potential. Since moving to LCI, I have been extensively involved with both the PGY-1 program and the PGY-2 oncology residency, and I assumed the role of residency program director for the PGY-2 oncology program in July 2018. I have really enjoyed devoting time to improving the program and, most important, to developing my first official resident. I also have kept in touch over the years with several former residents whom I precepted or mentored. Seeing their successes as clinicians, as pharmacy advocates, as organization leaders, and as people is truly my greatest motivator.

What does winning the New Practitioner Award mean to you personally?
Receiving this award was a true honor, and I was incredibly thankful to have been selected from what I can only imagine was a pool of remarkable pharmacists. It feels very gratifying to know that others have recognized and appreciate the effort I have invested into my role as an oncology care team member. As I move forward in my career, I hope to continue to be a role model in the pharmacy profession and practice at a level deserving of this recognition. Being selected by a group of peers for whom I have so much respect and admiration has also given me the desire to inspire other early-career pharmacists to excel and be actively involved in collaborative efforts to improve the care of our cancer patients.

What advice would you offer to other oncology pharmacists who are either just beginning their career or expanding their role in patient care?
My advice is to find something that motivates you, something that drives you to be more involved, something that interests and excites you. Whatever that is, you will need it to inspire you as you wade through the mundane, tedious, and politically sensitive tasks that are part of every job. Don’t let the fact that something may not be a typical role for a pharmacist stop you from jumping in and making a difference. And last, find something outside of your job that grounds you and gives you purpose beyond being a pharmacist. These friendships, hobbies, relationships, sports, charities, churches, and families—or whatever your release may be—allow you to appreciate complexity and gain perspective in life. These things make you a more well-rounded and satisfied person. These things will keep you from burning out and allow you to return to your very important job of improving the lives of our patients with cancer. Treating cancer every day tends either to make us blasé about very serious matters or to be a serious emotional drain. It is crucial to find a respite outside of work in order to stay focused and engaged while at work.

Lisa Cordes, PharmD BCOP BCACP
Oncology Clinical Pharmacy Specialist and Educator
National Cancer Institute
Bethesda, MD

Kasey Jackson, PharmD BCOP
Clinical Pharmacist Specialist, Hematology/Oncology
Medical University of South Carolina Hollings Cancer Center
Charleston, SC