Dr Postow on Practical Steps to Improve Multidisciplinary Care Coordination in Melanoma

“Trying to get all these people [on a multidisciplinary care team] aligned is a little bit of a challenge. But [using] some electronic health records that are bringing people together and using common communication platforms [is helping to] improve [those gaps in care coordination].”

Michael A. Postow, MD, chief of the Melanoma Service at Memorial Sloan Kettering Cancer Center, discussed the level of multidisciplinary coordination that is required to optimize survivorship care for patients with melanoma who have been previously treated with immune checkpoint inhibitors.

As the population of long-term cancer survivors who received immunotherapy continues to grow in melanoma, the gaps in care coordination that exist across specialties and health systems are becoming increasingly consequential, Postow noted. One of the central challenges is that clinicians across different disciplines tend to operate within the boundaries of their own areas of expertise, Postow said. Oncologists, for instance, may default to evaluating whether disease progression is driving a patient's symptoms, and once active cancer is ruled out, may not immediately consider chronic or delayed immune-related adverse effects (irAEs) as the underlying cause. At the same time, non-oncology providers who have cared for a patient long before a cancer diagnosis, such as primary care physicians, rheumatologists, and cardiologists may not recognize that an immune checkpoint inhibitor the patient received months or years earlier could be contributing to a current presentation. Bridging this awareness gap across all members of a patient's care team is a foundational step toward better survivorship care.

The coordination challenge is further intensified when patients receive care across multiple, disconnected health systems. A patient may see an oncologist at one institution, a primary care physician at another, and a rheumatologist managing joint pain from immunotherapy at a third, with limited ability for those providers to access each other's notes or communicate in real time. These structural barriers can delay recognition of late-onset irAEs and fragment the management of complex, overlapping conditions, Postow added.

Emerging electronic health record platforms and shared communication tools are beginning to ease some of these logistical burdens, and continued investment in health information technology will be essential. In the interim, institutions are encouraged to proactively foster cross-specialty dialogue, build survivorship-focused care pathways that explicitly account for late-onset irAEs, and cultivate a culture in which providers across disciplines remain vigilant to the long-term immunologic consequences of checkpoint inhibitor therapy.