Improve Patient Care by Increasing Your Immuno-oncology Knowledge

Publication Date: Jan 29, 2019

In the rapidly expanding field of immuno-oncology (IO), checkpoint inhibitors are gaining new or expanded approvals with such increasing frequency that it’s hard for community-based oncologists and pathologists to keep up. Many are familiar with treating melanoma or lung cancer with these agents, but are less comfortable with treating other types of cancers.

“If pathologists are not in tune with the latest information on IO, they won’t be able to communicate with the oncologists on what tests are needed. This communication breakdown ultimately impacts the quality of patient care,” says Mamatha Chivukula, MD, FASCP, a community-based pathologist and a member of the ASCP Immuno-oncology Work Group.

The IO Work Group has created a comprehensive strategy to guide the development of specialized IO education for pathologists and laboratory professionals. As part of the strategy, ASCP recently launched two free CME recordings of panel sessions held at the ASCP 2018 Annual Meeting in October, which demonstrate how pathologists and laboratory leadership can engage members of the entire clinical care team. Moderating the sessions was Joseph Kim, MD, with whom ASCP is partnering to implement its IO education through a series of quality improvement projects in community hospitals nationwide.

In the first Annual Meeting panel discussion, Randall Oyer, MD, an oncologist at Lancaster General Health, a community cancer hospital in Lancaster, PA, explained how his hospital’s entire team came together to broaden their use of checkpoint inhibitors. By appropriately using biomarker test results, their oncologists were gaining more experience and greater familiarity using checkpoint inhibitors to treat many different types of cancers.

Lancaster General Health is also involved in the Oncology Care Model (OCM), a pilot program of the Centers for Medicare and Medicaid Services (CMS). The OCM aims to provide higher quality, better coordinated oncology care at the same or lower cost for Medicare beneficiaries. Through this program, Lancaster General Health has implemented proactive symptom management and expanded access to providers so that patients can avoid unnecessary emergency room visits.

In the second panel discussion, Dr. Chivukula, along with two panelists from academic institutions, discussed the evolving role of IO biomarker testing. The panelists from academic settings discussed how their labs often perform extensive biomarker testing based on different research protocols, whereas those in community settings have to be much more conscientious about ordering actionable tests that will provide timely results.

“As more community-based hospitals are acquired by large, academic health systems, they may send their tests to the ‘mother ship,’” said Dr. Kim. “Some academic centers have the capacity to handle that testing, while others may not have the bandwidth.”

Dr. Chivukula shared what is happening at Peninsula Pathologists Medical Group, a division of Sutter Health, in San Francisco, CA., where she is director of the immunohistochemistry lab. Dr. Chivukula and her colleagues work at several Sutter Health hospitals and they have seen an increase in molecular testing for many types of cancers.

“There is pressure on the hospital and the pathologists group to be up-to-date with the latest IO information,” she said. “That, in turn, fosters good communication between pathologists and oncologists. Members of our pathology group attend cancer society meetings and bring back new information they’ve learned to share with their colleagues.”

View the panel discussions on the ASCP web site at www.ascp.org/immuno-oncology.

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