The newest frontier in medicine is immuno-oncology (IO), a rapidly evolving field and, perhaps, the most important recent discovery for cancer therapy. This therapy has only been used on patients for a few years. Yet, this revolutionary cancer treatment pioneered by the winners of the 2018 Nobel Prize for Medicine has been hailed as the future of fighting the disease.
Historically, medical oncologists have been in the driver's seat in terms of cancer care, directing the care and making sure patients are receiving appropriate therapies. However, pathologists are now emerging as leaders to actively guide the appropriate use of IO agents and shape treatment decisions.
With new IO drugs and new therapies continually coming into service—there are more than 2,000 IO treatments under development—it is a challenge for clinicians in the oncology community to learn how to use a new drug and understand its side effects. An estimated 80 percent to 90 percent of cancer care is delivered in the community, as opposed to academic settings.1
“IO is radically different from the standard chemotherapy/radiation treatment. It has its own set of mechanisms of actions, toxicities, side effects (immune-related adverse events), monitoring, parameters, etc.,” says Randall Oyer, MD, an oncologist at Lancaster General Health, a community cancer hospital, in Lancaster, PA. “There is still no single standard available for most related biomarker testing.”
To address these challenges, ASCP has developed a comprehensive education plan to get pathologists up to speed on IO. One component of the curriculum is the “IO ChangeMakers” series, which took place in Spring 2018. IO ChangeMakers empowers pathologists and laboratory professionals to help shape their institutions’ policies, procedures and protocols for patient care around IO. The curriculum includes online courses that examine the role of biomarkers and focus on adaptive challenges.
“Many would say there are IO issues that are black and white, yet there are a lot of issues in the gray area, where there are differing opinions. What academics are doing in research institutions might be very different from what community hospitals are doing in the standard of care,” says Joseph Kim, MD, who runs a company called Q Synthesis that specializes in quality improvement initiatives.
ASCP is partnering with Dr. Kim to implement its IO education through a series of quality improvement projects in community hospitals nationwide. Through an independent educational grant from Bristol-Myers Squibb, ASCP and Q Synthesis have partnered with Lancaster General on one of these initiatives.
“My role was to work with this group of health systems and say, ‘Now that you have gone through these online education activities, what does this mean to you and how do we implement it?’” he explains. Dr. Kim is facilitating IO workshops nationwide to guide oncology staff, nurses and pathologists around decisions that focus on institutional policies and standards.
As part of the initiative, Lancaster General—which is affiliated with the Penn Medicine Family—recently convened its multidisciplinary cancer care team to discuss how to change its patient cancer education process. One of the first things the hospital did was to train nurses, pharmacists and physicians to respond to side effects related to IO therapy. “People can go to the ER and say they’re on chemotherapy, but they’re not,” Dr. Oyer explains. “So we developed a way to work with our ER and purchased patient identification cards which say, ‘I’m on IO and here are things you need to look for quickly.’”
“We see pathologists as key members of our team,” he says. “That’s part of reason we were right for ASCP’s pilot IO education project. We have disease-specific, multidisciplinary oncology teams. We’ve been doing this for years.”
Dr. Kim and Dr. Oyer were part of a panel at the ASCP 2018 Annual Meeting that discussed the key findings related to the challenges and barriers overcome while implementing IO education in a community cancer center. Learn more about how the Lancaster General team put this into practice at their institution by clicking here.
For additional IO education from ASCP, please visit www.ascp.org/immuno-oncology.
- Boccia R, Choti M. NCCN Clinical Practice Oncology Forum: Fostering multidisciplinary cancer care in a community setting. 2017; http://www.medscape.org/viewarticle/575352.