Pharmacists' views on the implementation of therapeutic drug monitoring in oncology

Abstract Background There is increasing interest in the potential benefit of therapeutic drug monitoring (TDM) in oncology. However, uptake in Australian hospitals is limited. Aim This study sought to explore hospital pharmacists' experiences with TDM in oncology, seeking to determine if they could provide insights into barriers and facilitators to its implementation. Method Hospital oncology/haematology pharmacists ( n = 18) from all Australian states participated in semi‐structured interviews. Interviews explored experiences of TDM, and perceived barriers and facilitators to TDM uptake in oncology. Interviews were analysed using an inductive approach to generate themes. Ethical approval was granted by the St. Vincent's Hospital Human Research Ethics Committee (Reference no: 2022/ETH00533) and the study conforms to the Australian National statement on ethical conduct in human research . Informed consent was obtained from all participants via distribution of project information sheets and the completion of written consent forms. Results Most participants provided care in metropolitan tertiary adult hospitals. They reported that TDM was not used routinely to inform therapy for most oncology drugs, but acknowledged potential benefits, particularly when a concentration–effect relationship is established for efficacy or toxicity. Three themes captured the barriers and facilitators to implementation of TDM in oncology: (1) evidence and knowledge translation, (2) logistics and practicalities, and (3) the clinical team. Conclusion Pharmacists are keen to integrate TDM in oncology patients. Key factors perceived to influence TDM uptake are evidence, knowledge, and logistics (assay availability, funding, staff). Standardised guidance, complemented by clinical champions and pharmacokinetic expertise within the multidisciplinary team, is needed to provide confidence in changing dosing practices. Improved access to relevant drug assays will ensure result turnaround times support dosing decisions.