Four regional sites partner to implement an Immunotherapy alert card.

Abstract

Over the previous 6 years in Australia, immunotherapy has emerged as an effective cancer therapy as part of cancer treatment. While immunotherapy can be very effective it is not risk free. Patients may potentially experience immunerelated adverse events (IRAEs) that differ from the traditional chemotherapy treatment side effects. These are usually not serious but they must be managed in a new way. Several near misses have been identified by clinicians. In order to better prepare GPs, Urgent Care Centres and local Emergency Departments for the increase of presentations of patients on immunotherapy four regional health services partnered with two Integrated Cancer Services to develop and promote an immunotherapy alert card. There are estimated to be approximately 2500 patients eligible for immunotherapy in population treated by the four services. The project aims were to improve the systematic management of patients receiving immunotherapy treatment in the region by: 1. Developing a standardized immunotherapy pathway for inclusion in the medical wards. 2. Assessing the current level of GP/ED staff (in different rural and regional contexts) as to their knowledge about immunotherapy via a survey, pre and post education including asking about their awareness of wall card and pathway in the medical record. 3. Providing GP education provided in partnership with the relevant primary health networks 4. Providing educational sessions for GPs and ED staff (drawing on existing resources eg eviQ training). 5. Developing and implementing a tailored patient wallet sized card. 6. Publishing and promoting the card and pathways. The services worked together to develop a patient pathway and wallet-sized alert card to identify who the patients are that are on immunotherapy and what side effects to look out for and to liaise with their cancer treatment centre. The wallet-sized alert card and patient pathway have been implemented in all four sites. Doctors prescribing the immunotherapy will give patients the card and hospital doctors and nurses have been trained in how to use it. The project has also included over 22 GP and emergency department education sessions. Overall over the four sites 93 nursing staff attended and 8 medical staff attended. 101 evaluations were completed. Training feedback has indicated increased learning outcomes and understanding of immunotherapy. The project also included extensive newspaper and television coverage. Discussions are underway with EviQ to publish the card and protocol and results from an implementation evaluation are being calculated.