March 15, 2024

The field of hematology and oncology drew in Tracelyn Freeman '18, with its unique blend of science, empathy, and hope. The courses she took in this area of her undergrad intrigued her, and rotations at the College of Pharmacy only strengthened that connection and appeal. Today, Dr. Freeman, PharmD, BCOP, has built a rewarding career working closely with patients while she advances care in all areas of this field. 


As a specialty pharmacist at the James Cancer Hospital at The Ohio State University, she specializes in myeloid malignancies, including acute leukemia and other disorders of the bone marrow. She provides medication, education, and counseling to patients who are confronting new and life-threatening diagnoses, monitors their ongoing treatment, and weighs in when complications arise. 


In addition to her clinical work, she serves as a preceptor, teaching pharmacy students how to manage, listen to, and counsel this population. She also conducts research that provides new and effective avenues in oncology treatments.


“My interest in oncology was first piqued when I was an undergrad student. I remember being fascinated by the oncology module in a pharmacology course because the science was really interesting, and I thought the role of the pharmacist could be very impactful,” Dr. Freeman recalls. 


Today she definitely finds ways to make an impact, whether working with high-acuity, newly diagnosed patients and starting them on therapy or transitioning patients to other phases of treatment and ongoing care in the outpatient clinic. 


Building relationships with empathic education.


Unfortunately, receiving a cancer diagnosis is incredibly scary. “I think it's challenging at every step because when first diagnosed, patients are overwhelmed. They are receiving a lot of information at one time, maybe without having the time to process it. My main focus has always been to try to meet the patient where they are and see where I can be most helpful to them at the time,” she says. 


She has found that when patients are first starting treatment, this is where she can make the most impact “because the educational piece is so critical.” Recognizing that this is a low point in a patient’s life, Dr. Freeman works to build trusting relationships with her patients — something she finds very rewarding. “I really like to talk with patients and educate them on their treatment regimens, explain things that we're monitoring, and point out adverse effects that they may experience.” 

She knows that patients in this situation are inclined to turn to the Internet for information (as she does herself) and may not be able to tell if what they find is factual. She relishes the ability to be a trusted and expert resource who can sit across from her patients and address their questions “and, hopefully, ease some of those feelings of anxiety.”  

She also sees patients who are admitted for complications or are in intensive parts of their treatment. “This can be a little tougher. Some of the things that patients are dealing with may be commonly experienced with a certain regimen, but others can take us by surprise and can be difficult to navigate.” 

Lastly, her clinical care takes her to the hematology and transplant outpatient clinic, where she works with hematologists and interacts with patients directly through patient counseling. “A bone marrow transplant is the only available cure for AML in many cases, so it’s especially rewarding to work with transplant patients who are at the end of their clinical journey,” she says.

One reason the pharmacist is so important in hematology and oncology is that treatment can lead to side effects that may affect all different parts of the body and can present various complications, including infections. These require additional treatments, and it’s a challenge to balance medications. “It’s important to keep in mind the patient’s goals when embarking on treatment because sometimes some of these complications can, unfortunately, really hinder quality of life. Sometimes, we have to take a step back to ask, what is the bigger picture here? What makes the most sense to do?”

That can involve facilitating a lot of goals-of-care conversations with the patient’s care team while also helping the patient navigate the unknown. It can mean being a resource when unknown complications crop up, and the team needs to try something new or different. And it can mean going the extra mile to explore what options are available to access novel or experimental treatments even when not covered by insurance. “It’s always interesting to see how those situations are navigated as part of the care team. It’s nice to be a part of that process, too,” she says.

Preparing the next generation of pharmacists with soft skills.


She enjoys preparing future pharmacists for this complex role, both through classroom teaching and taking students on rotations. A big part of her work as a preceptor is preparing students to interact with patients who are fighting a potentially terminal disease. The first step, she says, is to make sure the student feels comfortable and confident in their knowledge of the drugs and the patient’s condition. “I think it is even more difficult to talk to someone and carry some information that you yourself may not even feel equipped to carry.”

Then she models those patient conversations, demonstrating how to meet the patient where they are in their understanding of their situation and how to pick up on verbal and nonverbal cues. She reflects, “my empathy and ability to pick up on cues comes from the lifelong influence of my mother, a social worker.” She teaches students to prioritize information, because sometimes patients can’t absorb everything and need time to process. It can be more effective to come back later to follow up with additional or reinforcing information.

“My goal for them is that by the end of the rotation, they are acting independently as the specialty pharmacist on the team. I honestly think that's probably the most rewarding part of it all is being able to start with them from the beginning and walk them through that entire process and see the growth in their knowledge, professionalism, and empathy skills.” 

Drug interaction and dosing research to improve oncology patient side effects.

Her goal is to always improve outcomes for her patients, and that includes precepting resident research and studying the effects of therapies her team uses in practice. Currently, she is studying the use venetoclax and hypomethylating agents in AML and the intricacies that have come to light in practice, including optimal dosing strategies in the presence of antifungals. 

Intensive chemotherapy regimens can be very hard to tolerate, and because AML is typically a disease seen in older patients, they often have comorbidities that lower their tolerance and increase the chance of complications. Because AML patients are at such high risk of infection, they are often prescribed antifungal medications from a class of drugs called azoles. Because of the way venetoclax is metabolized by liver enzymes, there is a major drug interaction with the azoles. 

“As we have gained knowledge using this regimen, some questions have come up regarding the appropriate dose adjustments with the antifungal we use most commonly,” she said. Some trials have found a difference in the degree of inhibition with the two most commonly used antifungal medications, leading to recommended dosage adjustments for Venetoclax.

“We are now conducting a retrospective study to see if there are any differences in safety, the incidence and duration of cytopenias, and efficacy between different doses for venetoclax and a particular antifungal” she says. 

“We are also looking at venetoclax and HMA in combinations with different agents and situations. We’re thinking about patients who have different genetic characteristics and how they perform with this regimen. All of these are unknown questions, and I think we are looking forward to studying more and working to find an answer.”

Her patient relationships fulfill her each day.


This has been such a rewarding career path for Dr. Freeman, and one that she didn’t know was possible with a PharmD degree. Her passion for educating the next generation of specialty pharmacists, love of science, desire to learn and enhance the field, and the space to apply empathetic care to her patients, have led to a career in pharmacy that leaves her fulfilled each day. “I can see the impact I make most days in very big and very little ways, but it’s my patients and learners who inspire me every day,” says Freeman.