Although payers are moving cautiously with respect to I/O drugs, patients are embracing these new agents, and this also is a reason for concern, the ICLIO paper said. With the advancing tide of information about I/O drugs, patients have become more assertive about requesting them. This means that physicians are spending more time discussing treatment options with physicians, the paper said. Oncology specialists worry that advertising has the potential to mislead patients and add to the difficulty of guiding them along the optimal treatment paths. “Patients may incorrectly interpret direct-to-consumer (DTC) advertising content to mean that a particular immunotherapy has benefit for all patients. This misinterpretation can lead to complex discussions with providers about patient eligibility for a particular therapy.”
The paper called for strategies to improve patient and provider education—for the selection of appropriate treatment and for understanding how to manage that treatment successfully. “In addition to educating patients about whether immuno-oncology is right for their particular circumstances, the real-time implementation of immunotherapy in community settings requires strategies to support the recognition and management of responses to treatment, pseudoprogression, and the unique characteristics of immune-related adverse events (irAEs).”
The educational component of implementing I/O therapies requires oncology practices to spend money and dedicate other resources toward the effort. This will be a challenge for some of the less-well funded and equipped practices in the United States, especially those in rural areas, the paper said. “Immuno-oncology drugs are not only expensive to purchase but their administration requires specialist personnel and highly educated staff (such as immuno-oncology dedicated pharmacists), thereby generating additional costs.”
To help solve some of these problems for practices so that they can offer immuno-oncology to their patients, the ICLIO in January 2017 launched a Visiting Experts program, through which members of the Association of Community Cancer Centers will dispatch a team of immuno-oncology experts to conduct one-day workshops at individual practices. The team includes a nurse, clinician, administrator, and a pharmacist, who will provide actionable strategies and “engage with participants on the nuances and complexities of immuno-oncology effective practices.” Providers are also taught how to optimize patient care and overcome payment challenges, in sessions that are tailored to the specific needs of the practice that is hosting the workshop.
The paper said that nurses can play a larger role in the expansion of I/O treatment at practices. One way is to enable them to develop localized expertise by establishing distinct immunotherapy treatment space within infusion centers, with dedicated I/O resources and nursing staff. “Implementation of immuno-oncology in real-time, as therapies are approved, will require ongoing nursing education on immunotherapies, especially in relation to the prevention, recognition, mitigation, and management of immuno-oncology related toxicities and immune-related adverse events,” the paper said. In addition, the spread of telehealth and clinical trial opportunities may also represent means of expanding access to immunotherapy, the paper said.
In the coming year, oncology practices will have to learn more about how to optimize clinical response using immunotherapy, develop team approaches to using this medication, find ways to understand the value of immunotherapy, and break through the access barrier so that more of their patients can benefit, the authors wrote.
Institute for Clinical Immuno-Oncology. Immuno-oncology: there’s more to discover. http://accc-iclio.org/. Published January 17, 2017. Accessed January 27, 2017.