The newest frontier in medicine is immuno-oncology (IO), a rapidly evolving field and, perhaps, the most important recent discovery for cancer therapy. This therapy has only been used on patients for a few years. Yet, this revolutionary cancer treatment pioneered by the winners of the 2018 Nobel Prize for Medicine has been hailed as the future of fighting the disease.
Historically, medical oncologists have been in the driver's seat in terms of cancer care,directing the care and making sure patients are receiving appropriate therapies. However, pathologists are now emerging as leaders to actively guide the appropriate use of IO agents and shape treatment decisions.
With new IO drugs and new therapies continually coming into service—there aremore than 2,000 IO treatmentsunder development—it is a challenge for clinicians in the oncology community to learn how to use a new drug and understand its side effects. An estimated 80 percent to 90 percent of cancer care is delivered in the community, as opposed to academicsettings.1
“IO is radically different from the standard chemotherapy/radiation treatment.It has its own set of mechanisms of actions, toxicities, side effects (immune-related adverse events), monitoring, parameters, etc.,” says Randall Oyer, MD, an oncologist at Lancaster General Health, a community cancer hospital, in Lancaster, PA.“There is still no single standard available for most related biomarker testing.”
To address these challenges, ASCP has developed a comprehensive education plan to get pathologists up to speed on IO. One component of the curriculum is the “IO ChangeMakers” series, which took place in Spring 2018. IO ChangeMakers empowers pathologists and laboratory professionals to help shape their institutions’ policies, procedures and protocols for patient care around IO. The curriculum includes online courses that examine the role of biomarkers and focus on adaptive challenges.
“Many would say there are IO issues that are black and white, yet there are a lot of issues in the gray area, where there are differing opinions. What academics are doing in research institutions might be very different from what community hospitals are doing in the standard of care,” says Joseph Kim, MD, who runs a company called Q Synthesis that specializes in quality improvement initiatives.
ASCP is partnering with Dr. Kim to implement its IO education through a series of quality improvement projects in community hospitals nationwide. Through an independent educational grant from Bristol-Myers Squibb, ASCP and Q Synthesis have partnered with Lancaster General on one of these initiatives.
“My role was to work with this group of health systems and say, ‘Now that you have gone through these online education activities, what does this mean to you and how do we implement it?’” he explains. Dr. Kim is facilitating IO workshops nationwide to guide oncology staff, nurses and pathologists around decisions that focus on institutional policies and standards.
As part of the initiative, Lancaster General—which is affiliated with the Penn Medicine Family—recently convened its multidisciplinary cancer care team to discuss how to change its patient cancer education process. One of the first things the hospital did was to train nurses, pharmacists and physicians to respond to side effects related to IO therapy. “People can go to the ER and say they’re on chemotherapy, but they’re not,” Dr. Oyer explains. “So we developed a way to work with our ER and purchased patient identification cards which say, ‘I’m on IO and here are things you need to look for quickly.’”
“We see pathologists as key members of our team,” he says. “That’s part of reason we were right for ASCP’s pilot IO education project. We have disease-specific, multidisciplinary oncology teams. We’ve been doing this for years.”
Dr. Kim and Dr. Oyer were part of a panel at the ASCP 2018 Annual Meeting that discussed the key findings related to the challenges and barriers overcome while implementing IO education in a community cancer center. Learn more about how the Lancaster General team put this into practice at their institution by visiting www.ascp.org/immuno-oncology.
In Spring 2018, ASCP and Q Synthesis LLC presented the virtual Immuno-Oncology (IO) Leadership Cohort, which was a CME program that provided articles, case studies and live, online discussions around: current use of biomarker testing and checkpoint inhibitors; the evolving landscape of IO; how to apply leadership skills and navigate complex clinical issues, operational issues, policies and procedures around IO; and how to lead change and implementation efforts in a multidisciplinary cancer care team setting. The project was one component within a larger CME initiative,“A Community Pathologist–Driven Approach to the Implementation of Best Practices in Immuno-oncology [IO] Across the Multidisciplinary Cancer Care Team [COMPATH-IO],” supported by an independent educational grant from Pfizer/Merck KGaA. Additional educational resources in IO can be accessed by visiting: https://www.ascp.org/content/learning/immuno-oncology
ASCP and Q Synthesis LLC are pleased to recognize the following individuals for participating in an IO ChangeMakers Discussion Group and the IO Leadership Cohort:
- Sara Acree, MD - Wellstar Health System
- Riley Alexander, MD, MBA - Intermountain Healthcare
- Stephen M. Berns, MD - Delnor Hospital
- Amarpreet Bhalla, MD, FASCP - University at Buffalo, SUNY
- Curtis Buchholz, MD, FASCP - Central Peninsula Hospital
- Pierre Bush, MLS(ASCP) - VA Medical Center
- Thomas Charles (Tom) King, MD, FASCP - Immunovia, Inc.
- Karen Clark, MT(ASCP)SH - Baptist Memorial Hospital
- Anthony Coleman, MS(ASCP) – Independent Contractor
- Michael Cruise, MD, FASCP - Cleveland Clinic
- Virginia Espina, PhD, MT(ASCP) - George Mason University
- Allen Flack, MD, FASCP - Pathology Associates of North Texas
- Amanda W. Gayhart, MLT(ASCP) - Baptist Memorial Health Care
- Rondell Graham, MD, FASCP - Mayo Clinic
- Tamiqua T. Graham, MLS(ASCP) - Memorial Sloan Kettering Cancer Center
- Margaret L. Gulley, MD - University of North Carolina School of Medicine
- Katja Gwin, MD, FASCP - University of Texas Southwestern Medical Center
- Lisa M. Haley, MB(ASCP) - Johns Hopkins School of Medicine
- Eyas M. Hattab, MD, MBA - University of Louisville School of Medicine
- Valerie Joyner, MLT(ASCP) - Georgia Cancer Specialists, North Side Hospital Cancer Institute
- Rina Kansal, MD - Penn State Hershey Medical Center, Penn State University Group
- Elham Kamangar, MD - Tucson Pathology Associates
- Babatunde Oloyede, PhD, MSHS, MLS(ASCP)CM - United States Public Health Services/Federal Medical Center
- Horatiu Olteanu, MD, PhD, FASCP - Mayo Clinic
- Jamie Pert, HTL(ASCP)MB, QIHC - Beaumont Laboratory
- Shadi A. Qasem, MD, FASCP - University of Kentucky Health Care
- Arundhati Rao, MD, PhD - Baylor Scott & White Health
- Kim Romang, MT(ASCP)SCYM - Intermountain Health Care
- Evita T. Sadimin, MD - Rutgers Cancer Institute of New Jersey
- Rana Samuel, MD - VA Western New York Healthcare System (VAWNYHS)
- Deepika Sirohi, MD, FASCP - ARUP Labs and University of Utah School of Medicine
- Patrick Tam, MLS(ASCP)MB, SH - Kaiser Permanente
- Bevan Tandon, MD - BioReference Laboratories
- Timothy Walls, MD, FASCP - Sentara Norfolk General Hospital
- Tong Yang, MD - Ochsner Medical Center
- Hillary Zalaznick, MD, FASCP - Myriad Genetic Laboratories, Inc.
- Alejandro Zuretti, MD, FA
References:
- Boccia R, Choti M. NCCN Clinical Practice Oncology Forum: Fostering multidisciplinary cancer care in a community setting. 2017;http://www.medscape.org/viewarticle/575352.
This article, originally published November 2018, was updated on June 17, 2019.
