Multidisciplinary Care Improves Management of TRAEs in Patients Receiving Active Cancer Treatment

The establisment of a multidisciplinary supportive care program at ambulatory infusion centers in Houston, Texas, helped to improve the management of treatment-related adverse events (TRAEs) in patients with cancer undergoing active treatment, the results of a study published in JCO Oncology Practice showed.¹

“This study confi rms that multidisciplinary care for patients in an ambulatory infusion center setting leads to improvement in TRAEs. Data collected in this study provides direct evidence for a pharmacist-led program to enhance cancer care,” study authors, led by Clement Chung, PharmD, MS, wrote in their published report.

Two ambulatory infusion centers, Houston Methodist Baytown Hospital (Baytown) and Houston Methodist West Hospital (West), implemented the multidisciplinary program in October 2018 and March 2020, respectively. The study continued through October 2021.

As part of the program, oncologists, oncology nurses, and oncology clinical pharmacists built a collaborative relationship and a workflow for determining management for TRAEs as well as follow-up.

Pharmacists managed supportive care issues with evaluations of the interventions and symptoms over 1 to 3 months while the patient continued to receive treatment. Oncologists followed the patient and subsequently collaborated to adjust the management plan.

Evaluation of the benefi ts provided by the implementation of the multidisciplinary program was conducted through a retrospective chart review by the overall team as well as the institutional review board.

The primary goal of the study was the early identification and management of specific symptoms and treatment completion rates, and these factors were compared for the multidisciplinary team interventions and the oncologist-led interventions.

Overall between the 2 centers, 308 patients were treated during the study time period and received 469 interventions in this time. The multidisciplinary team handed 286 of these symptom-management interventions compared with 183 by oncologists alone.

Of these patients, the median age was 63 years (range, 27-88) and 55% were female. The most common tumor types seen in patients were gastrointestinal (GI) cancers (22.7%), followed by breast cancer (21.1%), lung cancer (14.9%), hematologic malignancies (14.5%), and genitourinary cancers (13.0%).

Multidisciplinary TRAE symptom management was required most for patients with GI cancers, followed by lung and breast cancers.

Approximately 85% of all patients were able to complete all of their courses of treatment in the infusion centers.

More treatment interruptions due to TRAEs were reported at Baytown than at West. No pre-implementation data were available for Baytown, as it was a newer facility, so the impact could not be fully evaluated. But for West, the difference in treatment interruptions and/or discontinuations from before to after the program’s launch was not considered statistically significant (P = .27).

After implementation of the program, the most common cause of treatment interruption and/or discontinuation at Baytown was immune-related adverse events (IRAEs; 15%), followed by dermatological toxicities (7%) and mucositis (7%). Whereas at West, the most common causes were IRAEs (7%) or neuropathy (7%).

Multidisciplinary team interventions showed a statically signifi cant improvement over oncologist-led interventions in the number of interventions reported (P = .004) and in reducing the occurrence of patient-reported symptoms after 1 month of intervention (P = .03). Patient-reported symptoms tended to be grade 1 or 2 and were easily mitigated through pharmacologic strategies.

Significant improvements were seen in the multidisciplinary cohort by individual TRAE types from the first encounter to follow-up, including a 96.0% reduction seen in diarrhea occurrences, an 80.0% reduction in IRAEs, and a 73.3% reduction in dermatologic events compared with respective reduction rates in the oncologist-led cohort of 40.0%, 44.4%, and 42.3%, respectively. The greatest reduction in occurrences in the oncologist-led intervention cohort was with neuropathy (60.0%).

Rates of hospitalizations and emergency visits were similar across both cohorts due to severe or unpreventable TRAEs.

“This type of symptom management is valuable for hospitals with limited resources. It supports oncologists by realigning clinical pharmacy services from the clinic to the infusion center, without incurring additional labor cost,” the study authors wrote.

An overall improvement in the management of TRAEs was seen with the multidisciplinary program as about 40% of escalated AEs of all grades were managed by the team. Additionally, both patient and provider satisfaction improved.

In the multidisciplinary cohort, treatment completion rates were 80% to 89%, which was higher than the rates seen in the oncologist-led intervention cohort (75%-82%; P = .71).

Chung et al noted that despite interventions occurring during COVID-19, the pandemic was not a major factor in patient volume, treatment rates, or TRAE management.

_REFERENCES:

_{1. Chung C, Rome A, Desai M, Abanonu F, De la Casas C. Optimizing multidisciplinary treatment-related adverse eff ects detection and reduction in patients undergoing active cancer treatments in ambulatory infusion centers. JCO Oncol Pract. 2022;18(9):e1553-e1561. doi:10.1200/OP.21.00910}