Members of the ACCC IO Institute Executive Committee provide a multidisciplinary perspective on the importance of clinical and financial education to ensure immunotherapy patients receive the right testing at the right time. (features Mark Faries, MD; David Ettinger, MD, FACP, FCCP; Sanjiv Agarwala, MD; and Niesha Griffith, MS, RPH, FASHP
As more patients with cancer are treated with immunotherapy, members of the multidisciplinary cancer care team need to coordinate with non-oncology clinicians and specialists to ensure that patients receive optimal care. Side effects and toxicities from immunotherapy differ from those of traditional cytotoxic chemotherapy. To provide optimal care for patients treated with IO agents, education on recognition and management of immune-related adverse events (irAEs) must extend beyond the treating oncology team to include other providers who may see the patient, such as Emergency Department providers, hospitalists, primary care physicians. Management of specific immune-related side effects may require consultation with specialists (e.g., dermatologists, gastroenterologists, pulmonologists, and others). Thus care coordination and communication between the treating oncologist and other providers is paramount, including discussion and understanding of survivorship care planning for this patient population.
Meet the members of the IO Multispecialty Coordination & Communication Working Group.
Dr. Faries is a surgical oncologist and the co-director of the Melanoma Program and head of Surgical Oncology at The Angeles Clinic and Research Institute in Los Angeles. He also is the surgical director for Experimental Therapeutics at Cedars-Sinai Medical Center. He received his undergraduate education at Haverford College and completed medical school at Cornell. He completed his residency in general surgery at the University of Pennsylvania and a surgical oncology fellowship at the John Wayne Cancer Institute.
Dr. Faries is principal investigator (PI) for the second Multicenter Selective Lymphadenectomy Trial, an international trial including more than 4,000 subjects. He serves on the American Joint Committee on Cancer (AJCC) Melanoma Staging Committee and the American Society of Clinical Oncology (ASCO)/Society of Surgical Oncology (SSO) Melanoma Guidelines panel and is a member of the editorial board of the Annals of Surgical Oncology. His research focuses on surgical treatment of melanoma and immunotherapy.
Regina Jacob, MD, MSCE, is an assistant professor of Clinical Medicine at The Lewis Katz School of Medicine at Temple University in North Philadelphia. She received her MD degree from The George Washington University in Washington, D.C., completed her internal medicine residency at Temple University Hospital, and earned a master’s degree in Clinical Epidemiology at The Weill Cornell Medical College of Cornell University in Manhattan, New York.
Dr. Jacob has two main research interests which both assess psychological adjustment and co-morbid medical conditions. She conducted a study called Coping with Lymphoma to Enhance Adjustment and Reduce Stress, which assessed the psychological adjustments which may occur after a diagnosis of lymphoma. She continues to grow her cancer survivorship expertise in education, designing curricula to educate internal medicine residents on how to appropriately tailor primary care for patients with a history of cancer.
Her second research interest involves assessing co-morbid conditions that result from chronic and cumulative trauma exposure. She is currently conducting a study called Trauma Alert! How Social Complexity Contributes to Medical Complexity, which assesses the prevalence of post-traumatic stress disorder (PTSD), adverse childhood experiences, depression, and co-morbidity in an underserved primary care population. While the effects of poverty on healthcare are known, there is still a large amount of work to be done with regards to how trauma associated with poverty results in negative health behaviors and subsequent poor medical and psychological outcomes.
The positive impacts of IO therapy are remarkable, the era of IO has also ushered in new challenges. The efficacy of IO has led to a growing population of patients living with and beyond cancer. This has challenged original concepts of survivorship care, starting with the very definition of “survivorship.”
Our busy community practice first began treating patients with immunotherapy through participating in the original ipilimumab clinical trials. We quickly realized that this new treatment paradigm would require us to create and implement an effective screening and management tool for our immunooncology (IO) patient population.
Patients with complex medical needs, such as those with active autoimmune conditions, hepatitis B or C, and those receiving corticosteroids at baseline, may now receive these agents in the community. This raises important questions regarding safety, monitoring, and the likelihood of an anticancer response in these patients.
Immune-related adverse events (irAEs) are a complex category of
symptoms driven by anti-cancer immunotherapy treatments.
The use of IO has burgeoned since the approval of ipilimumab
in 2011 through multiple approvals of anti-PD-1/PD-L1 drugs
and most recently CAR-T therapies, and so too has the number of
Survivorship care planning requires communication, care coordination, and education. Since immune-related adverse events are still being discovered, these discussions are even more imperative.