ACCC Survey Reveals Biggest Challenges and Concerns Regarding IO Therapies

The Association of Community Cancer Centers’ (ACCC’s) annual survey on immuno-oncology (IO) therapies highlighted major concerns among health care providers regarding financial impacts, education, and access to clinical trial data.

Despite the COVID-19 pandemic, there was a 22% increase in the amount of actively investigated immuno-oncology (IO) agents since 2019, according to an annual report from the Association of Community Cancer Centers (ACCC).

The 2020 IO Census Survey invited respondents to share their thoughts on barriers to IO treatments, their top priorities, and difficulties with providing and managing treatment regimens for patients that arose during the pandemic.

“Remarkably, the world of IO is shifting once again in ways that will demand ongoing education to ensure providers stay on the cutting edge of care,” wrote the authors.

Immunotherapies have the potential to improve patient outcomes by allowing them to continue to live their daily lives thanks to short treatment durations. The development of new IO therapies has grown significantly since 2011 and by August 2020, there were 4720 IO agents and 504 targets being investigated in more than 6200 ongoing clinical trials.

The current number of approved IO therapy indications is over 60 and more than 800 trials are evaluating the effects of chimeric antigen receptor T-cell therapies. However, about half of the survey respondents said that they are “very” or “extremely” unfamiliar with emerging IO therapies.

The authors of the report received 39 complete responses from a representative sample containing ACCC members, most of whom were from community cancer programs that use IO agents to treat an average of 21 to 50 patients weekly.

Concerning barriers to treatment, financial toxicity and poor coordination with subspecialists were the highest-rated challenges, with 80% to 87% of respondents rating them as “moderately,” “very,” or “extremely” challenging. Respondents rated managing patient demand, patient education, survivorship care, and operational issues as less challenging.

Regarding respondents’ top concerns, obtaining reimbursement for IO agents that are used off label, collecting patient-reported outcomes, and having access to clinical trials investigating IO therapies were rated as important issues for cancer programs. Additionally, medical oncologists rated having information on IO treatments available as their top concern, and nurse managers prioritized having the ability to work directly with payers for the purposes of explaining unique aspects of IO therapies.

When asked about challenges related to the COVID-19 pandemic, 43% and 40% of respondents said that maintaining day-to-day operations for clinical trials for IO therapies was “extremely” or “very” challenging, respectively. Decision-making and adjusting treatment regimens were ranked as “slightly” or “not at all” challenging by 10% and 3% of respondents, respectively.

The COVID-19 pandemic has also led to a substantial rise in the use of telemedicine and virtual communication, which became eligible for reimbursement when CMS regulations on reimbursement requirements, interstate medical licensing, synchronous videoconferencing, confidentiality, compliance, and patient physical location were suspended.

“Although it remains unclear which telemedicine regulations will be reinstated in a post-pandemic world, the rapid expansion and uptake of telemedicine in oncology during COVID-19 have revealed its potential to effectively monitor and manage patients being treated with IO therapies,” said the authors.

The ACCC IO Institute said that will expand efforts to educate nononcology subspecialists about immune-related adverse events. Survey respondents indicated that more education material needs to be directed toward patient access, advocacy, and financial impact (96%); biomarkers and molecular testing (92%); clinical applications and optimization (85%); evidence, data, and publication updates (73%); and survivorship care (73%).

“The explosive expansion of IO therapies in community cancer programs during the past decade has engendered a tremendous learning curve in oncology….Remarkably, the world of IO is shifting once again in ways that will demand ongoing education to ensure providers stay on the cutting edge of care,” the authors wrote.


Immuno-oncology in 2021: committed to the cutting edge of care. Association of Community Cancer Centers. July 29, 2021. Accessed August 3, 2021.