Cancer care becomes more inclusive in response to immunotherapy


By Mardi Chapman

20 Nov 2017

Models of cancer care are being shaped by immunotherapies – with more emphasis on collegiality and teamwork between medical sub-specialists, a growing role for oncology nurses and the need to incorporate patient reported outcomes.

The Clinical Oncological Society of Australia (COSA) ASM was told the changes would affect all centres – small and large, regional and metropolitan – and was largely driven by the toxicities associated with immunotherapy.

Speaking after his presentation Dr Rob Zielinski, medical oncologist at Central West Cancer Care Centre in Orange, NSW told the limbic immunotherapy use at his centre had increased from about 5% of all treatments one year ago to 9%.

“In ten years time immunotherapy will probably be 50% of all treatment in the day suite.”

He said what that meant was the days of acting only within the cancer centre and with oncology colleagues were over.

“The models of care are probably less formal here compared to the city but you need a team of internal medicine specialists now. You need a hepatologist, rheumatologist or a respiratory physician to help you navigate and manage the toxicities that immunotherapies are causing.”

He said while he might be confident providing hormone replacement to a patient with an immune related thyroiditis, he was likely to call on a gastroenterologist to jointly co-manage a patient with colitis or hepatitis.

“The flow-on effects are increased collegiality and teamwork amongst physicians in hospital which is a really good thing on multiple levels and particularly for the patients.”

He said nurses played an increasingly important role – checking more frequently on patients and teasing out whether new symptoms were relatively benign or the ‘harbinger of a nasty autoimmune toxicity’.

“Education of the patient is also fundamental and a well educated, well informed patient is the goal. They may get diarrhea and blame it on a bad takeaway and it’s actually inflammatory bowel side effects.”

He said there was compelling evidence that the use of web-based patient reported outcomes resulted in a survival benefit for cancer patients compared to standard care.

“Patients live longer because they take action before they get too sick or they keep well enough to receive more cancer treatment,” he said.

Dr Zielinski said as nursing and oncology staff were becoming familiar with immune related adverse effects, GPs and emergency physicians became the next in line for upskilling.

“They’re used to seeing patients on chemo and if they’ve got diarrhoea, might send them home with some Gastro-Stop but that won’t be enough if it’s colitis. They’ll need steroids.”

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