When and Where Immunotherapy Is Administered to Cancer Patients Matters
- A new research study by researchers at Yale School of Medicine published in JAMA Oncology found that a growing number of metastatic cancer patients are receiving immunotherapy within the last month of their expected survival.
- The study included more than 20,000 diverse patients who were all diagnosed with stage 4 melanoma, lung, and kidney cancer. Among them, those who received immunotherapy treatment at a high-volume academic cancer care facility had higher survival outcomes compared to patients who received treatment at a low-volume or non-academic facility.
- Academic centers and community centers both offer standard-of-care treatment for various cancers. However, academic centers may have more access to certain treatments that are still in the clinical trial phase.
- Immunotherapy is a cancer treatment that triggers your immune system to search for and attack cancer cells, microscopic or more extensive tumors.
A new study from Yale School of Medicine sheds light on the added value of immunotherapy as an effective cancer treatment in some later stage cancer patients. However, when and where it is administered to patients also impacts a patient’s overall survival.
Immunotherapy is a cancer treatment that triggers your immune system to search for and attack cancer cells, microscopic or more extensive tumors. Within the study that was published in JAMA Oncology, researchers found a growing number of cancer patients at advanced stages are starting immunotherapy within one month of death.
Read MoreAdditionally, patients who receive this treatment in high-volume healthcare facilities tend to have a higher survival rate than those who receive immunotherapy at low-volume hospitals or non-academic healthcare facilities.
“Low-volume and non-academic hospitals have worse survival for immunotherapy as a whole, plus are more likely to have patients immunotherapy initiated within the last 30 days of life,” Dr. Khan explained.
He believes these facilities are “less resourced than high volume and academic hospitals,” which could be contributing factors to the poorer survival outcomes.
The study found that within the last decade, the number of metastatic cancer patients being given immunotherapy in the last month of their life has “significantly increased…accounting for one in 14 immunotherapy treatments overall.”
Dr. Khan and his fellow researchers studied a diverse group of more than 20,000 stage 4 melanoma, non-small cell lung cancer, and renal cell carcinoma or kidney cancer patients.
Despite the findings providing health practitioners added insight into the value of immunotherapy and where it is administered, researchers say more research is still needed.
Helping Patients Understand Immunotherapy as a Treatment Option
- Can I Get Molecular Testing at Community-Based Cancer Centers?
- ‘A Game Changer’: New Combination Immunotherapy for Advanced Melanoma Offers More Options For Patients
- A New Option for Some People With Lung Cancer: How This Immunotherapy/Chemotherapy Combo Can Increase Treatment Success
- A Promising New Study Suggests Women with an Aggressive Form of Breast Cancer Could Benefit from Immunotherapy
- After Immunotherapy, Imaging Test Results Can Be Misleading
- An Exciting Win for Immunotherapy
- Beating Aggressive Melanoma: An Immunotherapy Success Story
- What to Know About Approved Immunotherapy Combination for Endometrial Cancer
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Where You Receive Cancer Care Can Make a Difference
Academic centers and community centers both offer standard-of-care treatment for various cancers. However, academic centers may have more access to certain treatments in the clinical trial phase.
Standard care refers to delivering the appropriate treatment by standards formed based on current medical literature and national guidelines.
Academic cancer centers might have better access to ongoing clinical trials, but clinical trials differ from standard-of-care. Clinical trials seek to explore the effects of a new medication or compare new treatments to the current standard of care. Additionally, SurvivorNet experts say there is a significant amount of variability between academic and community centers, making it difficult to make broad claims comparing the different cancer centers.
“In terms of access to standard care, be it chemotherapy, targeted therapy, or immunotherapy, all those approved drugs are available for use regardless of where you get treatment or care,” Dr. Chul Kim, a medical oncologist at MedStar Health in Washington, D.C. explained to SurvivorNet.
How Immunotherapy Works
Immunotherapy is a medicine that triggers your immune system to search for and then attack cancer cells, whether microscopic or in the form of more extensive tumors.
“Immunotherapy originally started as being an indication for patients who had stage four disease,” Dr. Anna Pavlick, a medical oncologist at Weill Cornell Medicine, tells SurvivorNet.
“In the beginning, we began trying to make vaccines to try to trick the immune system into attacking a protein that we thought was important in the cancer. These vaccines for cancer almost never worked. The problem was the cancer was using a different track of the immune system to block it from attacking,” Dr. Ronald Natale, director of the Lung Cancer Clinical Research Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center in Los Angeles, told SurvivorNet.
“Well, scientists developed treatments, antibodies that would block PD-L1 from blocking the immune system. This unleashed the immune system to resume its attack on the cancer very successfully, at least in some patients,” Dr. Natale added.
“We have now done studies looking at using immunotherapy for patients who have stage three disease. Because we know that these patients have a 50/50 chance of whether this is going to come back or not, we want to make those odds of it coming back even less. But it is not chemotherapy. It does not bring down your immune system. It does not predispose patients to infection. It does not make them lose their hair,” Dr. Pavlick continued.
While immunotherapy is adequate for most patients, it has some side effects, most related to inflammation. You might experience diarrhea when your colon is inflamed or itching when your skin is inflamed. You can also have pain in your liver or pancreas if you have pancreatitis or hepatitis.
RELATED: Immunotherapy in Recurrence
WATCH: Understanding immunotherapy side effects.
Common Immunotherapy side effects include:
- Fatigue
- Nausea or stomach discomfort
- Joint pain
- Diarrhea or constipation
- Cough
- Rash
- Loss of appetite
- Changes in blood cell counts
- Fever
More severe adverse reactions include:
- Pancreatitis: Inflammation of the pancreas
- Colitis: Inflammation of the large intestine
- Pneumonitis: Inflammation of the lungs
- Hepatitis: Inflammation of the liver
- Thyroiditis: Inflammation of the thyroid gland
If you experience severe side effects, your doctor may need to temporarily or permanently stop your immunotherapy treatment.
“The side effects of immunotherapy are not, quote, forever. Depending upon the severity depends upon how we manage it. There are some patients who will get diarrhea, and we can give them treatments to calm down their diarrhea, which lasts a couple of days. It might be sporadic over a couple of weeks,” Dr. Pavlick said.
WATCH: Why immunotherapy Isn’t for Everyone
Immunotherapy doesn’t work for everyone with cancer. Dr. Vamsidhar Velcheti, the director of thoracic oncology at NYU Perlmutter Cancer Center, says that, unfortunately, it’s still difficult to predict which patients will respond well to immunotherapy treatments.
“The ways cancer generally escapes the body’s immune system is by protecting itself by producing certain proteins,” said Dr. Velcheti. “PD-L1 is one of those proteins that actually helps protect the cancer from the body’s immune system. For patients with high levels of PD-L1, you could potentially use single-agent immunotherapy with good outcomes. The problem is that these proteins are constantly in flux.”
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