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Where Does Survivorship Stand in the Era of Immuno-Oncology?

Nalley, Catlin

doi: 10.1097/01.COT.0000652328.00633.1b
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cancer survivor
cancer survivor:
cancer survivor

ORLANDO—With the recent advances in immuno-oncology (IO), cancer patients with once limited options have seen durable responses and increased survival. And as outcomes continue to improve, patients treated with these agents are transitioning into post-treatment survivorship.

Patients who undergo immuno-oncology treatment face a number of late physical and psychosocial effects that impact their quality-of-life. Therefore, survivorship care teams must be aware of the unique survivorship needs of this patient population.

During a panel discussion at the Association of Community Cancer Centers (ACCC) 36th National Oncology Conference, experts in the field addressed best practices and strategies to provide optimal care to IO patients.

Unique Survivorship Needs

As the field of immuno-oncology continues to grow, so does the understanding of the needs of patients treated with this approach.

“Immuno-oncology drugs are now moving into earlier treatment and so we are seeing people who are completing therapy with these agents, but we're also seeing patients who are being maintained on IO therapy,” said panelist Jennie R. Crews, MD, MMM, FACP, Medical Director, SCCA Affiliate Network, Community Sites and Research Integration, Seattle Cancer Care Alliance. “These patients are living for many years and are essentially survivors of their cancer, even if their disease may still be present on diagnostic imaging.”

These patients share a number of concerns with other cancer survivors, including feeling tired, anxiety, concerns for the future, fear of recurrence, etc. “However, in addition to those commonalities, there are unique needs of patients who have either been on IO treatment or continue on IO treatment,” Crews noted. “Specifically, immune-related adverse events (IRAEs).”

Currently, there are still unknowns about the long-term nature of these events, according to Crews. “We are gathering more information as patients are living longer. We have data now on the incidence and severity of these adverse events, but we still don't have a comprehensive understanding of the late and long-term effects and what the consequences of these IRAEs may be for the lifetime of the patient.”

Addressing Gaps in Care

As more of these patients transition into post-treatment survivorship, potential gaps in care must be addressed to ensure their needs are met.

“Currently, we are not specifically asking about side effects that might be indicative of a related toxicity,” Crews noted. “Also, we may not have the professionals providing survivorship care who have knowledge about these side effects and how to manage them.

“So, just like we've seen with IO therapy, in general, we must broaden our team and educate stakeholders who maybe previously weren't part of the patient's care team,” she continued. “This is an opportunity for us to educate those who are providing survivorship to better understand IO therapy and its toxicities.”

Another potential area for improvement relates to the documents patients are provided during their survivorship visit. “The treatment summaries and care plans are usually designed around traditional chemotherapies and hormonal therapies, not immuno-oncology,” Crews said. “Therefore, we have had to update our tools to reflect these newer drugs.

“Facilities across the country are beginning to think about how to incorporate processes that meet the needs of these patients,” she explained. “And there are resources available to help. For instance, ACCC is working on developing templates and other tools that survivorship programs can use as a guide.”

Key Takeaways

ACCC attendees left this session with a better understanding of the changing landscape of survivorship care as well as tools to help them better serve their patients.

Crews highlighted several key takeaways, starting with the evolving definition of survivorship. “We've been in a mode where we considered patients eligible for survivorship when they've been treated with curative intent,” she noted. “However, we know that the broadest definition of cancer survivor is someone who has been diagnosed with cancer from the time of their diagnosis throughout their life. And we have to shift our thinking to include all patients throughout their cancer journey.”

There can also be sensitivity around the word survivor. “We need to let patients identify as they wish to be identified,” Crews advised. “We can have a discipline of survivorship and clinics that are survivorship focused, but not all patients appreciate the label of survivor and it's important we remember that.”

Another takeaway is the importance of ongoing research on the long-term impact of immuno-oncology. “We need to ensure that research around immuno-oncology captures the late and long-term effects of these agents now that we're seeing patients live for years on these drugs that may carry side effects forward into the future.”

Crews emphasized the importance of education and access to the necessary tools. “We need to make sure that all members of the of the cancer team are educated to address these issues,” she said. “And that includes our team members who are providing survivorship care.”

With a growing number of cancer survivors, awareness for survivorship has improved.

“As we have more survivors among us, there is a growing awareness of the issues they are facing,” Crews noted.

“This was not an area that had broad attention and focus in the past, but that is changing,” she concluded. “It is a very positive shift and I hope it will also increase the research around latent long-term effects and how we can intervene to minimize and prevent them.”

Catlin Nalley is a contributing writer.

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