Identifying obstacles to optimal integration of cancer immunotherapies in the community setting.

Abstract

87 Background: The rapidly expanding indications for cancer immunotherapies pose a significant challenge to community clinicians to integrate this new class of agents into practice. Community cancer centers need guidance around the practical issues that must be addressed to implement immunotherapy safely and effectively to patients in their own communities. The Association of Community Cancer Centers (ACCC) initiated a quality improvement (QI) research study to assess the impact of comprehensive educational interventions targeting the multidisciplinary cancer care (MDCC) team on evidence-based integration of immunotherapies in the community setting. Methods: The QI study collected baseline data from two community cancer centers to identify barriers to optimal implementation of immunotherapies at each institution for the following metrics: co-morbidities in patients, immune-related adverse events (irAEs), laboratory tests, ER visits and hospitalizations, patient education materials, and immunotherapeutic adherence. Retrospective data was collected for 100 patients initiating immunotherapy between Dec 2017-April 2018. Results: Analysis of the data revealed that only 61% of the patients fully completed the immunotherapy treatment as planned. Eighty-one percent of patients were found to have 4 or more irAEs. On average patients were each diagnosed with more than 2 co-morbidities, including cardiac disease, diabetes, dyslipidemia, hypothyroidism, hypertension, and obesity. Using Fisher’s exact test to calculate two-tailed P values, we attempted to investigate a correlation between the number of co-morbidities to the lack of treatment adherence. We found a trend towards statistical significance between lack of treatment adherence and patients with two or more co-morbidities ( P value = 0.1256). Conclusions: Timely management of irAEs is crucial for the adherence to the immunotherapy regimen. The baseline data collected in our QI study revealed a trend towards the impact of the presence of two or more co-morbidities on treatment adherence. However, we did not find a statistically significant correlation between treatment adherence and the number of irAEs recorded in patients.