Una Hopkins, RN, FNP-BC, DNP1, Lorna Lucas, MSM2, Tara Perloff2, Pam Rattananont MPH2, Monique Dawkins2, Brissan Guardado2
1 White Plains Hospital, Center for Cancer Care, NY/USA
2 Association of Community Cancer Centers, Rockville, MD/USA,
As new approvals and indications for immunotherapy continue to transform treatment approaches in community oncology, oncology practitioners have a constant need to equip themselves with knowledge about immunotherapeutic drugs. Practitioners need to know how to prescribe and recognize, triage, and manage immune-related adverse events and champion educating their colleagues about the benefits and risks of immunotherapy. The need for education across the clinical spectrum is critical given the vast array of systemic side effects possible with these therapies.
Through a multidisciplinary curriculum tailored to the host institution, the goal of the Association of Community Cancer Centers Visiting Experts program was to engage participants on the nuances and complexities of IO, with a focus on advancements, operations, and effective practices.
The program was designed by a group of multidisciplinary oncology faculty including myself and structured around a bi-directional, or peer-to-peer, learning format that enabled cancer program participants and expert faculty to share experiences in real-time and identify effective practices for the complex implementation of IO. While oncology advanced practitioners learn about the clinical trials and science of IO, the experts learn about what it’s like to administer the therapies in a real-world environment, with a far greater number and variety of patients than are seen in clinical trials. The curriculum centers on evolving challenges in the field, including patient selection, management of immune-related side effects, support for patients and caregivers, and effective approaches for educating clinical colleagues on the unique intricacies of IO.
A series of 10 concentrated, one-day workshops convened by multidisciplinary oncology faculty—comprised of an oncologist, administrator, nurse, and pharmacist—experienced in the delivery of cancer immunotherapy, were held at cancer institutions nationwide in 2017 with 202 advanced oncology practitioners benefiting from this comprehensive program. For program participants, direct, peer-to-peer learning was vital. Participants not only valued the opportunity to connect with experts beyond their own programs who shared “on the ground” IO expertise, but their exposure to IO experts—especially from those involved in early immunotherapy trials—shored up their clinical confidence and validated their experiences. Participants know that they face future challenges in the expansion of their IO programs, such as using combination therapies—which will generate greater toxicity. Nonetheless, workshop participation emboldened staff and provided fresh ideas on how best to achieve their IO goals. Such goals include staffing a Symptom Management Unit by nursing professionals with immune-related adverse events expertise who can escalate care when required.
This program demonstrated the success of a bi-directional educational approach and effectiveness of team-based learning. Given the rapid approvals and new indications for IO therapies that are transforming treatment approaches in oncology, nowhere is the education need greater for interprofessional learning than in the oncology multidisciplinary team.
The program provides an opportunity to challenge a predominant mindset about what cancer treatment entails and to expose advanced oncology practitioners to the nuances of IO therapies which could lead to improvements and optimization of the care and management of patients being treated on IO agents.