The Association of Community Cancer Centers released the results of their 2020 ACCC IO survey that showed how oncology professionals are looking to understand and take advantage of the growing immunotherapy treatment landscape.
By the middle of 2020 the number of actively investigated immune-oncology agents increased by 22% compared to 2019. Moreover, there are now over 60 approved immunotherapy indications with more on the way, according to the Association of Community Cancer Centers (ACCC).1
Over the course of the summer of 2020, the ACCC IO center collected 39 complete responses from a representative sample of their membership. Most of these responses were from community cancer programs that use immunotherapies to treat and average of 21-50 patients a week.
The survey found that community oncologists are now familiar with established immune checkpoint inhibitors and combination regimens that utilize immunotherapy but that they are less familiar with emerging therapies that include bispecific antibody therapies, cancer vaccines, and CAR T-cell therapies. This shows there is to grow in education and adoption of these treatments. However, 87% of respondents cited that 1 of the main barriers to treatment was communicating with sub-specialists to coordinated care. Moreover, they cited financial toxicity as extremely challenging to implementing this care in patients with cancer.
These challenges also were impacting survivorship care for patients on immunotherapy, according to respondents from the survey. Eighty-one percent of respondents said that knowing when to stop immunotherapy treatment, and coordinate with sub specialists to help with that that decision, was “very challenging” and 77% said it was “extremely challenging”. Seventy-eight percent indicated that they wanted more clinical and operational support to alleviate these concerns with treatment coordination and payment around the use of immunotherapies, a barrier to treatment that remains a challenge for practices not aligned with bigger institutes. Some of the key areas that respondents identified they wanted more help in along with coordinating with sub-specialties included learning about associated molecular testing with immunotherapy and easing patient and program financial strain.
The survey responses also highlighted 3 top priorities for oncologists looking to utilize immunotherapy treatment and they were reimbursement for appropriate off-label immunotherapy use, collecting patient-reported outcomes, and having access to immunotherapy-inclusive clinical trials. These priorities, however, shifted in importance among different oncology professionals. For example, 67% of medical oncologists would prioritize having specific immunotherapy treatment information available, compared to 71% of nurse managers who prioritized having the ability to work directly with payers to explain the unique aspects of immunotherapy to themselves and patients. Oncology pharmacists emphasized the importance of having access to experts for consultation on clinical issues.
According to respondents these issues were exacerbated by the nature of the COVID-19 pandemic and managing risk of the virus for patients on immunotherapy who had an increase of severe COVID-19 symptoms, prior to their vaccination status. While many respondents found challenging patients adverse effects (AEs) from immunotherapy treatment via telemedicine visits to be challenging, the adoption of the technology now appears to be a permeant fixture of care. One that oncologists are looking for more resources to navigate.
“While this year’s report is different because of the impact of COVID-19 on all areas of cancer care, what we found to be encouraging about immuno-oncology is how the pandemic actually revealed strategies that will forever change care,” said Sigrun Hallmeyer, MD, chair of the ACCC Immuno-Oncology Institute Executive Committee, in a press release. “For example, the rapid utilization of telemedicine revealed the potential for effectively monitoring patients under IO treatment. An incredibly tragic pandemic did not slow down the speed of development, approval, or adoption of immunotherapy.”
Other immunotherapy related challenges that respondents highlighted were 51% of respondents had practice operations issues and found the use of immunotherapy agents in combination with other drugs to be somewhat challenging. Moreover, managing patients demands, expectations, and educating patients on immunotherapy remain challenges for oncologists to work through. Fifty-four percent of respondents said that differentiating chemotherapy side effects from the immunotherapy side effects remained a challenge. Among other survivorship challenges respondents cited no standard in recommendations and keeping up to date with drug specific side effects.
With education of both clinicians and patients being a key part of identifying and overcoming challenges to the use of immunotherapy ACCC released different resources for survivorship planning and for building out an infrastructure within a community practice. These ranged from webinars that oncology professionals can attend to advice on multispecialty coordination.
“In 2021, ACCC launched the education program, Bringing CAR T-Cell Therapies to Community Oncology, to help community cancer programs and practices obtain the education and tools
necessary to identify their patients who may be eligible for CAR T-cell therapy and coordinate with local cancer centers that can deliver that care close to patients’ homes,” ACCC wrote in the report about their ongoing efforts to help with immunotherapy adoption in community practices. “As part of this program, ACCC will be conducting a series of focus groups and publishing effective practices guide and additional resources related to identifying patient candidates for CAR T-cell therapy and coordinating their care.”