CHPPC Module 22, Section 6.3: Radiation Oncology, Wound Care, and Other Specialty Services
MODULE 22: THE HOSPITAL ECOSYSTEM

Section 6.3: Radiation Oncology, Wound Care, and Other Specialty Services

Complete your navigational map by mastering the pharmacist’s role in the critical support services that are integral to comprehensive patient care.

SECTION 6.3

Radiation Oncology, Wound Care, and Other Specialty Services

The essential cogs in the hospital machine.

The “Why”: The Web of Supportive Care

A modern hospital is far more than just a collection of inpatient beds and operating rooms. It is a complex, interconnected web of highly specialized ancillary and supportive services that are essential for providing comprehensive, start-to-finish patient care. The “Why” of these specialty services is to provide focused expertise and technology that complements the work being done on the main inpatient units. While patients may not “live” in these departments, their journey through the hospital will almost inevitably involve an interaction with one or more of them. A cancer patient may see their medical oncologist on the inpatient floor, but they walk over to the Radiation Oncology center every day for their treatment. A diabetic patient may be admitted to a Med-Surg floor for a foot infection, but they are seen daily by the specialized Wound Care team.

As a pharmacist, your reach and responsibility extend into every one of these areas. Your expertise is the common thread that ensures medication safety and efficacy as patients transition between these different care environments. You may be called by a radiologist to help manage a contrast reaction, consulted by a wound care nurse on the selection of a topical enzymatic debrider, or asked by a pain specialist to design a complex lidocaine infusion. This final section of our navigational guide will provide a masterclass on these critical specialty services, ensuring that no corner of the hospital ecosystem is a mystery and that you are prepared to be an effective medication expert, no matter where in the hospital your expertise is needed.

Retail Pharmacist Analogy: The “Behind-the-Counter” and Consulting Expert

Think of your pharmacy’s primary workflow as the inpatient units—this is where the main action of dispensing and counseling happens. But you have other, highly specialized roles as well. The Radiation Oncology center is like your immunization clinic; it’s a specialized service with its own protocols and consent forms where you are the expert on managing local injection site reactions and rare allergic responses.

The Wound Care clinic is your comprehensive “behind-the-counter” section. Patients don’t just grab a bandage; they come to you for a formal consultation. You assess their needs and recommend a specific, advanced wound dressing or a specialty ostomy product. The Diagnostic Imaging department is your DUR system; you are the one who flags the potential for a “drug-disease” interaction (e.g., metformin and IV contrast) before it happens. In each of these roles, you are leveraging your core pharmacology knowledge and applying it in a focused, consultative manner to support the main dispensing workflow. This is precisely how you will function in relation to the hospital’s specialty outpatient services.

Deep Dive 1: The Radiation Oncology Center

Managing the side effects of targeted therapy.

Radiation therapy is a cornerstone of cancer treatment that uses high-energy particles or waves to destroy or damage cancer cells. While chemotherapy is a systemic treatment, radiation is a targeted, local treatment. However, the radiation beam must pass through healthy tissue to reach the tumor, and this “collateral damage” is the source of the acute side effects that you, as the pharmacist, will be called upon to manage.

Your Role: The Symptom Management Expert for Radiation-Induced Toxicities

Your primary role is to anticipate and manage the predictable, location-specific side effects of radiation therapy. The side effects depend entirely on what part of the body is being irradiated.

Radiation Site Common Acute Toxicity The “Why” / Pathophysiology Your Pharmacologic Toolkit & Counseling Pearls
Head & Neck Oral Mucositis & Xerostomia Radiation damages the rapidly dividing cells of the oral mucosa and the salivary glands. • Magic Mouthwash: You will be the expert on your institution’s formulation. A common one is Lidocaine/Diphenhydramine/Maalox. Counsel patient to “swish and spit” before meals.
• Pain Control: Topical analgesics may not be enough. Requires scheduled systemic opioids.
• Saliva Substitutes: Biotene, pilocarpine for severe xerostomia.
• Prevention: Excellent oral hygiene is key. Palifermin may be used for high-risk patients.
Chest / Mediastinum Esophagitis Radiation to the chest area (e.g., for lung cancer or lymphoma) inflames the esophageal lining. • Viscous Lidocaine: To numb the esophagus and allow swallowing.
• Sucralfate Slurry: Can help coat and protect the inflamed tissue.
• PPIs/H2RAs: To reduce acid reflux which can worsen the pain.
• Opioids: Severe cases require IV opioids and often a feeding tube for nutrition.
Breast / Chest Wall Radiation Dermatitis Similar to a severe sunburn. The skin becomes red, painful, and can sometimes peel or blister (“desquamation”). • Moisturizers: Hydrophilic, non-irritating creams (e.g., Aquaphor, Biafine) are the mainstay of prevention and treatment.
• Topical Steroids: Low-potency steroids (e.g., hydrocortisone 1%) can help with itching and inflammation.
• Silver Sulfadiazine (SSD): Reserved for areas of moist desquamation to prevent infection.
Abdomen / Pelvis Diarrhea & Nausea Radiation damages the rapidly dividing cells of the intestinal lining. • Antidiarrheals: Loperamide is first-line. For severe, refractory diarrhea, octreotide may be needed.
• Antiemetics: Prophylactic 5-HT3 antagonists (ondansetron) are often given 30-60 minutes before each radiation treatment.

Deep Dive 2: The Wound Care Clinic

The science and art of healing from the outside in.

The wound care team is a multidisciplinary service, led by specialized nurses and physicians, that consults on the management of complex or non-healing wounds throughout the hospital. These can include pressure injuries (bedsores), diabetic foot ulcers, venous stasis ulcers, and complex surgical wounds. As the pharmacist on the team, you are the expert on the vast and often confusing array of topical products used to manage these wounds, as well as the systemic medications needed to support healing.

Your Role: The Topical Therapy and Debridement Expert

Your job is to help the team select the right product for the right wound at the right time. This requires understanding the principles of wound healing (e.g., the need for a moist environment) and the characteristics of the wound bed.

The Wound Bed Preparation Paradigm: TIME

Modern wound care is guided by the “TIME” framework. You should use this to guide your recommendations.

  • T – Tissue Management: Is there non-viable (necrotic) tissue or slough that needs to be removed (debrided)?
  • I – Infection/Inflammation: Are there signs of local or systemic infection that require antimicrobial therapy?
  • M – Moisture Balance: Is the wound too dry (needs a hydrating dressing) or too wet (needs an absorptive dressing)?
  • E – Edge of Wound: Are the wound edges advancing and healing, or are they stalled?

The Pharmacist’s Formulary of Wound Care Products

Product Category Example(s) Mechanism / Use Case Your Clinical Pearls
Enzymatic Debriders Collagenase (Santyl) This is a prescription ointment that contains an enzyme that selectively digests necrotic collagen, helping to “clean” the wound bed. Used for chemical debridement. This is your domain. It’s one of the few prescription drugs for topical wound care. It works best in a moist environment. You must advise against using it with dressings that contain silver or iodine, as these heavy metals can inactivate the enzyme.
Antimicrobial Dressings Silver dressings (Aquacel Ag), Cadexomer Iodine (Iodosorb), Honey (Medihoney) Used for wounds with a high bioburden or signs of local infection. They provide a sustained release of an antimicrobial agent into the wound bed. These should only be used for short periods (e.g., 2 weeks) to control infection, not for long-term use. Overuse can impair healing and lead to resistance. You are the antimicrobial steward for topical agents.
Absorptive Dressings Alginates, Foams Used for wounds with moderate to heavy exudate (drainage). They absorb excess fluid, maintaining a moist-but-not-wet environment. The choice depends on the amount of drainage. Alginates are for heavy drainage, foams are for moderate drainage. These are key for “Moisture Balance.”
Hydrating Dressings Hydrogels, Hydrocolloids Used for dry wounds that need moisture to heal. They donate moisture to the wound bed. A dry wound cannot heal. Hydrogels are excellent for providing moisture to a wound with dry eschar to facilitate debridement.

Deep Dive 3: Other Key Specialty Services

Rounding out your navigational map.

Your expertise will be required in numerous other areas. Here is a brief masterclass on your role in two more vital hubs.

The Diagnostic Imaging Department

Your primary role here is to prevent adverse drug reactions related to imaging procedures, especially those involving iodinated contrast media used for CT scans.

Mastering Contrast-Induced Nephropathy (CIN) Prevention

IV contrast is nephrotoxic. Your job is to identify high-risk patients and ensure a prevention protocol is in place.

High-Risk Patients:

  • Pre-existing CKD (eGFR < 60)
  • Diabetic nephropathy
  • Concurrent use of other nephrotoxins (NSAIDs, aminoglycosides)
  • Volume depletion

Your Recommended Prevention Protocol:

  1. IV Hydration: This is the single most effective intervention. Recommend an infusion of 0.9% Normal Saline at 1-1.5 mL/kg/hr for 3-6 hours before the scan and continuing for 6 hours after.
  2. Hold Metformin: Ensure metformin is held on the day of the procedure and for 48 hours after, until renal function is rechecked and confirmed stable.
  3. Hold NSAIDs: Recommend holding any scheduled NSAIDs for 24 hours before and after the procedure.

The Dialysis Unit (Apheresis)

Whether for chronic ESRD or acute kidney injury, the dialysis unit is a hub of complex medication management, and the pharmacist is a central player.

Your Core Responsibilities in Dialysis Pharmacy
Responsibility Your Key Actions
Medication Dosing This is your number one job. You must know which drugs are removed by dialysis and which are not. You will recommend “post-dialysis” dosing for many drugs (e.g., gabapentin, certain antibiotics) so they are given after the dialysis session to avoid being cleared from the body.
Anemia Management You will be the expert on Erythropoiesis-Stimulating Agents (ESAs) like epoetin alfa and darbepoetin, as well as the IV iron products needed to support red blood cell production. You will manage complex, protocol-driven dosing based on hemoglobin and iron studies.
Bone & Mineral Disease You will manage the phosphate binders (sevelamer, calcium acetate) and the activated Vitamin D analogues (calcitriol) used to control secondary hyperparathyroidism in ESRD patients.