AJMC Roundtable: Management of Cancer Immunotherapy (CIT)

The content of this video was developed independently by AJMC® with support from Genentech.

Kathy Oubre, MS: Given the burgeoning IO (immuno-oncology) pipeline over the next several years and our ability to keep up with all the new products and indications, we're actually working with our EMR (electronic medical record) vendor on a few new products and software enhancements to help manage this drug pipeline for all indications, including immunotherapy, because we are also a multi-specialty infusion center. There are a few things that we're looking at; we are a pilot site for our EMRs treatment decision support tool, which we hope will aid the physician when reviewing therapy selections for treatment. We have talked to them about embedding best practices within the EMR to help alert or remind the physician of potential new drugs, therapies, or indications available for their patients in certain disease states. Lastly, we're also working with our EMR vendor on better ways to identify cohorts of patients that are appropriate for immunotherapy, targeted therapy, or even rare disease state products. We're currently looking at sourcing these eligible patients through specific EMR reports or through entering discreet data in our clinical trials software to identify these patients, not for clinical trials, but for best therapy selections.

It really was less of a surprise from the roundtable discussion, and more of an affirmation, that despite our varied location across the US, we're all kind of in the same boat. We all have the same concerns, issues, wins, and successes. Providing high quality, low-cost care to our patients and staying up to date with that never-ending pipeline of new IO products and new indications. But what's fun is listening to how we all tackle those issues and achieve our goals. All of it is a little bit different. I like hearing everyone's perspectives, workflows, ideas, and kind of just listening to what everyone's saying. Maybe it's an approach that I haven't thought of before, or I haven't used before, or maybe we're all having a similar payer issue, and maybe someone has an approach which may enhance the way we are currently working with that issue.

The financial implications of immunotherapy involve many stakeholders; the practice, the caregiver, the family, and most importantly, the patient. Practices need to have systems in place at every part of the revenue cycle from the minute the patient walks in the door, or even prior to that. We're talking about benefits, verification, prior authorizations, drug contract management, and obtaining financial assistance, all with the goal of providing the best possible care with the least financial burden to the patient. Practices also need to continually educate patients and caregivers or the family members on a regular basis. Not just at the new patient visit, not just at the treatment education visit, but really at a constant cadence and reinforcing with those stakeholders side effect management, drug therapy, and when to call the practice. We want to care for our patients and avoid those costly ED (emergency department) visits for issues like pain, hydration, nausea, and vomiting — if you can bring those people into the practice, it does reduce the healthcare cost rather than that expensive ED visit, but it also allows us, who we have that relationship with the patient, to manage them better and it really just ends up with better outcomes. Lastly, and it's no surprise to anyone, cancer care is expensive, and financial toxicity is a real thing for patients and their families and has a multi-layered impact from being able to afford their therapy and maintain optimal nutrition. You don't want them to make a choice between rent, food, and healthcare. All of these things have an impact on treatment adherence.

After the CIT (cancer immunotherapy) roundtable, our organization met to evaluate how we currently address CIT management — what do we do well, and what can we do better? Some of what we can do better involves those pilots and discussions mentioned earlier with our EMR vendor. How can we better utilize our EMR to help us work smarter, not harder, to provide the best possible care for our patients? In addition to that, for 2022, we made the decision that one of our organization's initiatives will be to work with our data partners on a stronger level to brainstorm new, more efficient ways to use our data, to meet our practice objectives such as better looking at our prescribing patterns, duration of therapy and side effect management.

Transcript edited for clarity.