March 29, 2019

Cazenovia, NY – The National Community Oncology Dispensing Association, Inc. (NCODA)is pleased to announce the addition of three new members to the Executive Council. Randy Erickson, RN, BSN, MBA, James Gilmore, PharmD, and Kirollos Hanna, PharmD, BCPS, BCOP joined the Council in March.

Randy Erickson currently serves as Chief Executive Officer at Utah Cancer Specialists in Salt Lake City, UT. He is a skilled healthcare professional with over 20 years of clinical experience. In his current role as CEO, Randy helps set the strategic course for the practice. Utah Cancer Specialists is the largest community-based oncology and hematology treatment practice in Utah, with physicians providing medical oncology, hematology, radiation oncology, and imaging services. ”Cancer care has become increasingly complex and with more oral therapies available, providing high quality care to our patients has never been more important. The overall patient experience is enhanced when physicians are able to dispense these medications within their own practices. NCODA is the perfect partner in helping practices improve pharmacy operations and enhance patient care,” said Randy. 

James Gilmore is the Executive Vice President at Georgia Cancer Specialists (GCS). GCS is a national leader in advanced cancer treatment and research. Their 50 physicians provide care in 26 Northside Hospital Cancer Institute locations across Metro Atlanta, and North and Central Georgia. ”I am very honored to serve on the Executive Council of NCODA. It has become one of the most important organizations in the oncology space. I look forward to helping NCODA to continue to grow and to ensure that our patients have access to live-saving therapies for years to come”, said Gilmore. 

Kirollos Hanna is board certified by the Board of Pharmacy Specialties in Oncology Pharmacy and Pharmacotherapy. He is currently an Assistant Professor of Pharmacy at the Mayo Clinic College of Medicine. He primarily practices Hematology/Oncology pharmacy at the University of Minnesota Medical Center and Mayo Clinic. ”It is an honor and privilege to serve patients through NCODA. The rapid growths in oral oncology therapeutics and practices have created large gaps in optimizing care and streamlining dispensing. As a firm believer in the NCODA mission of a patient-centered, medically-integrated dispensing model, I will continue to advocate for patients and best-practice initiatives”, said Hanna. Kirollos is an active member in NCODA committees and initiatives. He serves on the advisory board for the Treatment Support Kit (TSK) initiative, he is editor for the Positive Quality Intervention (PQI) initiative, he is serves on the oral chemotherapy education (OCE) steering committee, and he also serves as part of the editorial board for NCODA’s publication, Oncolytics Today.

“Over the last month we have added three highly skilled and well-respected oncology professionals to our Executive Council!” said Jim Schwartz, NCODA President and Executive Council Chair. “Randy, James, and Kirollos are well positioned to help us continue executing on our mission.”

For more information about NCODA’s Executive Council and general updates visit

See the Full Press Release HERE

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Natasha Khrystolubova is one of the lead author of the Journal of Oncology Pharmacy Practice article, Pharmacist-led patient education and adverse event management in patients with non-small cell lung cancer receiving afatinib in a community-based, real-world clinical setting.

An NCODA practice working to make a difference in the pharmacy to positively impact patient care. Florida Cancer Specialists (FCL) have taken an active role in patient care and adherence.

Going Beyond the First Fill gives every patient the monitoring and follow-up to improve care at the pharmacy level through best practices. These are challenges real community-based pharmacies are facing. FCS gives patients the support needed through health education and resources. “The FCS program was designed specifically to manage AEs that occurred during use of afatinib, but many of the principles and approaches could be implemented for patients treated with other types of medication. ” Read More.

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Written by: Latha Radhakrishnan, PharmD, BCPS, BCOP
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Description of PQI:

The Granisetron Transdermal System (Sustol) is a 5-HT3 Receptor Antagonist (5-HT3 RA) that allows for an alternate medication delivery compared to oral or parenteral administration.  The purpose of this PQI is to review appropriate patient identification and discuss clinical considerations for the use of granisetron. 


The Granisetron Transdermal System is approved for the prevention of nausea and vomiting in patients receiving moderately and/or highly emetogenic chemotherapy (MEC and/or HEC) for up to 5 consecutive days1.  Current practice guideline include granisetron transdermal system/patch as a 5-HT3 RA option for use in the prevention of acute and delayed intravenous MEC and HEC chemotherapy.  It is also a choice in high to moderate chemotherapy emesis prevention2. The pharmacokinetic profile of the formulation reveals continuous delivery of granisetron through the skin for over 6 days3

PQI Process: 

Based on clinical practice experience, consider using the granisetron transdermal system in the following patient situations:

  1. Moderate to highly emetogenic multi-day chemotherapy
  2. Difficulty swallowing tablets due to oral mucositis, tumor location, vomiting, etc.
  3. Combination radiation + chemotherapy (head and neck regimens, etc.)
  4. No intravenous access
  5. Limited gut motility and absorption due to opioids or tumor location
  6. Difficulty remembering to take oral medications
  7. Refractory nausea and vomiting despite receiving appropriate preventative anti-emetics
    • Place patch on patients on the last day of multi-day intravenous chemotherapy

Upon receipt of an order for granisetron transdermal system:

  • Ensure appropriateness of use in either MEC/HEC intravenous or high to moderate oral chemotherapy
  • Check start date of chemotherapy cycle
    • Apply 1 patch (3.1mg) 24-48 hours on clean, dry, intact skin on the upper outer arm prior to the start of c hemotherapy to the upper arm (do not cut)
    • Wear throughout chemotherapy treatment up to 7 days total
    • Remove at least 1 day (24 hours) after chemotherapy completed
  • Discuss the use of surgical bandages or medical adhesive tape at the edges of the transdermal system to keep it in place
  • Provide a prescription for a rescue medication (i.e. prochlorperazine, metoclopramide, etc.) to assist with breakthrough nausea and vomiting. Other 5-HT3 RA such as ondansetron should not be used as rescue medications to avoid QT prolongation, constipation, and headache.

 Patient Centered Activities:

  • Application Instructions
    • Ensure that patients understand where to apply the patch
    • Educate on avoiding sunlight and heating sources (heating pads, tanning beds)
  • Patient Education
    • Review common side effects which include constipation and headache
      • Constipation – provide recommendations for a stimulant laxative (bisacodyl, sennosides, etc.) PLUS a stool softener
    • Explain when to apply and remove the patch – a calendar would assist
    • Remind to keep patch area covered under clothing and for another 10 days after the patch is removed to avoid potential skin reactions from natural or artificial sunlight

 Financial Assistance

    • Patient Rx Solutions ( or 1-800-676-5884)
      • Coverage option for uninsured patients
      • Co-pay Assistance Cards
      • Sancuso Patch Replacement Program – If chemotherapy is delayed or reschedule


  1. Sancuso [package insert, Bedminster, NJ: ProStrakan, Inc.; 2015.
  2. National Comprehensive Cancer Network. Antiemesis (Version 3.2018). January 3, 2018.
  3. Howell J, Smeets J, Drenth H, et al. Pharmacokinetics of a granisetron transdermal system for the treatment of chemotherapy-induced nausea and vomiting. J Oncol Pharm Practice. 2009; 15: 223 – 231.
  4. Boccia RV, Gordan LN, Clark G et al. Efficacy and tolerability of transdermal granisetron for the control of chemotherapy-induced nausea and vomiting associated with moderately and highly emetogenic multi-day chemotherapy: a randomized, double-blind, phase III study. Support Care Cancer. 2011; 19: 1609-1617.
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