Author(s):
A recent ACCC video series with three cancer programs centered on how Tumor Treating Fields (TTFields) therapy can be integrated into everyday practice without overwhelming clinical or administrative teams or the patients they care for.
Tumor Treating Fields (TTFields) therapy has moved past its early days as an experimental option in cancer care. With FDA approval for glioblastoma, as well as non-small cell lung cancer and pancreatic cancer, TTFields has grown into a powerful tool for providers. The wearable device delivers alternating electrical fields, noninvasively, to the tumor site, disrupting cancer cell division without significantly affecting healthy tissue. As adoption grows, conversations are shifting from clinical impact to how to actually bring TTFields into everyday practice. How to start a TTFields program, sustain it, and support patients throughout are now the real questions community centers are asking themselves.
These questions were at the center of a recent educational video series between ACCC and the clinical teams at Coastal Cancer Center, Orlando Health Cancer Institute, and Willis-Knighton Cancer Center —three programs with established TTFields experience across glioblastoma and emerging indications. These conversations focused on how programs operationalize TTFields day-to-day, from getting a program off the ground to supporting patients through what was described as a real lifestyle shift.
Across all three conversations, it was clear that starting a program takes more than just a phone call to the manufacturer. It begins with a champion, someone who believes in the therapy and brings it to their institution. But unlike a pill or an infusion, TTFields asks something new from the entire care team, not just the physician writing the order. Programs that have sustained their program over time have made a deliberate effort to train and certify the entire care team. At Coastal Cancer Center, they strove to certify every provider across specialties as new indications became available.
“We've made an effort in our group to, when a new technology becomes available, make sure that every provider in our practice gets certified so that we're all aware of what's available to our patients.” - Emily Touloukian, DO, FASCO, Coastal Cancer Center
That kind of broad buy-in was supported by existing infrastructure. Tumor boards, multidisciplinary meetings, and case reviews became the arenas where TTFields evolved from special case scenarios to part of routine clinical conversations. At Orlando Health Cancer Institute, they also noted that getting a program running meant training staff specifically on how to place device orders and fill out paperwork required by insurers, long before a patient could ever use the device.
All programs were in consensus: the majority of the big questions and concerns don’t come up during the patient’s initial visit. They come up weeks or months into treatment—a skin reaction, a device alarm, or just general issues integrating the device into their daily routine.
Handling patient concerns requires two aspects to work in tandem: internal coordination and a strong relationship with the manufacturer. At Willis-Knighton Cancer Center, that meant setting up a de facto point person for patients utilizing TTFields. This allowed the team to route questions quickly and efficiently and provided an accessible resource for both patients and the care teams. As Jessica Nash, a physician assistant at Willis-Knighton, says of the relationship with the manufacturer: “It’s great. I email them daily with questions. They email me daily with questions.”
These relationships matter when something goes awry. Dr. Emily Touloukian, at Coastal Cancer Center, recounted a story of a patient suffering from a chemotherapy-derived rash, which could have prevented treatment. The care team reached out to the manufacturer, and they helped devise a personalized approach to her care to avoid further irritation. As she put it, the manufacturer “specialized the treatment for the patient… [they were] able to operationalize the treatment for her, which otherwise, we may not have been able to do.”
For patients, starting TTFields therapy means more than just a new treatment plan; it reflects a very real adjustment in daily life. Programs describe a target wear time of roughly 75% of the day, or about 18 hours. While some downtime is necessary—such as showering or changing arrays—other downtime can come from discomfort with the device. Limiting that downtime is a big part of effective treatment.
Since using the device involves tasks that are difficult for a patient to accomplish alone—shaving the site, placing the arrays, or changing the battery—caregiver involvement isn’t optional. Caregiver education shouldn’t be treated as an afterthought; it should be built into the workflow from the start. As Erin Singh, a nurse practitioner at Orlando Health, puts it, “Education for caregivers is absolutely essential.”
Even though TTFields therapy reflects a very real lifestyle change for the patients, many can adjust to it over time. Dr. Fernando Santos, of Orlando Health, noted that patients “can still go out and play sports and carry on a normal life. They can work with it, they can go to do grocery shopping, and walk around and really live their normal life.”
Across all three programs, clear patterns emerged: TTFields adoption isn’t about a single decision; it's about the structures built around the therapy. It’s about a multidisciplinary team that’s informed and behind the therapy. It’s a deliberate process for getting the program off the ground, not just a concept. It requires communication pathways that stay open long after the first visit, between all parties involved in care, whether it’s the provider, the patient, or the caregiver; each should be given equal weight at the table. As TTFields expands into new indications, these programs offer grounded starting points for community implementation.
These themes, drawn from video series with Coastal Cancer Center, Orlando Health Cancer Institute, and Willis-Knighton Cancer Center, are explored in greater depth in ACCC’s new guide: Tumor Treating Fields: A Guide for Program Implementation. This guide offers cancer programs a practical roadmap for building a TTFields program from the ground up, including communication strategies for providers and patients, and lessons learned from programs that have successfully implemented it.
From challenging misconceptions about breast cancer to incorporating paramedical tattooing for survivors after reconstruction, gather valuable takeaways from Oncology Issues in observance of Breast Cancer Awareness Month.
