Oncology Workflows Shift as Drug Delivery, Monitoring Change: Angie Maynard, PharmD, MS

The shift toward subcutaneous administration of immune checkpoint inhibitors drove up patient volume enough to change how the practice is staffed and run, according to Angie Maynard, PharmD, MS, assistant professor at Lipscomb University. Higher volume translated directly into greater dispensing pressure in the pharmacy, she explained, along with an increased need for nursing staff and, specifically, a nurse dedicated to giving injections. That reallocation amounted to a workflow change for the practice.

Maynard said she anticipates another adjustment as bispecific therapies are implemented. Preparing for those agents means confirming the health care team is appropriately trained, securing an adequate supply of treatments for cytokine release syndrome (CRS) prophylaxis, and establishing a way to monitor dosing across the ramp-up schedule. The transition has been stepwise so far, but Maynard noted she expects bispecifics to require more than incremental adaptation.

What Remote Monitoring Catches Before the Next Visit

Monitoring, on the other hand, has moved outward. Patients no longer necessarily need to come in for a symptom check, and the team can follow up remotely and intervene earlier. When a patient reports a new rash or a change in stool frequency, Maynard explained that the practice can act rather than waiting for a callback or the next scheduled appointment, which sometimes comes later than the team would like.

She illustrated the value with a patient with prostate cancer, which is typically diagnosed when patients are in their mid-60s, an age at which many still have robust lives and intimacy is among the things that matter to them. This patient started androgen deprivation therapy (ADT) as part of triplet therapy and returned around week 3, reporting fatigue, low energy, and an inability to do things he had done with his partner. Despite prior education about what was driving the cancer, what he had internalized was the loss of quality of life. Through remote follow-up, the team learned he had been receiving testosterone injections elsewhere.

Where ePRO Systems Fit and Where They Stop

Electronic patient-reported outcome (ePRO) systems allow patients to report symptoms, with data suggesting they do so earlier than in the past. Maynard's practice does not yet have an ePRO system, though telehealth and follow-up calls have produced similar early catches. EPROs, she explained, currently capture symptomatic reporting rather than laboratory values.