Community Cancer Programs Lead the Way in Expanding Bispecific Therapy Access

In a Pharmacy Times® interview, Courtney VanHouzen, PharmD, clinical pharmacist at the Cowell Family Cancer Center at Munson Healthcare, at the Association of Cancer Care Centers 41st National Oncology Conference discussed the significant role of community bispecific programs in advancing health care access and treatment for patients with cancer.

Pharmacy Times: Can you describe what a community bispecific delivery program looks like?

Courtney VanHouzen, PharmD: So, a bispecific program in the community looks like a lot of professionals coming together to problem solve, what I would anticipate, are a good amount of barriers. It is feasible, but it's definitely new to the community setting. I would say across the United States, we've seen its success being used clinically, notoriously in larger academic centers, large medical centers; but being able to feasibly put together a program that not only provides providers with the tools and capabilities to be able to feasibly give it, but also to keep patients safe and at home. There's a lot that comes into that, but I think having really good interprofessional communication, making sure that not only our staff but our patients are educated on signs and symptoms to look out for, and developing procedures and policies in order to monitor these patients, I think it can definitely be done. I think it just in a little it takes a little bit of a village.

Pharmacy Times: What challenges or obstacles are there regarding effective implementation of these programs, particularly in rural areas?

VanHouzen: I would say the biggest barriers to implementing bispecific therapies in the community are kind of threefold. I would say—depending on the size of your community center, for us, we have a pretty small inpatient oncology unit, and all of our oncologists are technically outpatient, and so they all work together to take calls overnight and on the weekend—if something were to happen to a patient at night time, even if they're in the hospital, it may not even be there oncologists who necessarily be taking that call. So, we really needed to work as a group to get behind this and make sure all the providers were comfortable utilizing these therapies and taking call on these patients.

We also needed to work with the ICU team, because for us at a community center, our nurses were either general medical nurses with specialty and oncology, or they were ICU level nurses. We didn't have kind of that larger academics. Have that bone marrow and blood transplant unit where they kind of have nurses that can do both. They have that critical care but an oncology background, we have one or the other. So, we had to work with the ICU team, work with the ED team, to all get on the same page in order to navigate these transitions of care for these patients, and make sure that we were all knowledgeable of cytokine release syndrome and how to take care of these patients appropriately.

And then, I would say financially, navigating bispecific therapies, both in the inpatient and in the outpatient worlds, takes a good amount of research and making sure that we're being fiscally responsible with our resources at the hospital, and that we're able to keep our doors open and our lights on to serve our community. So those I would anticipate would be probably the larger barriers for community sites.

Pharmacy Times: What does the future of community delivery programs for bispecifics and other immotherapies look like?

VanHouzen: I think community cancer centers are a wonderful touch point, and I think for many Americans and rural America, they're one of the only options for care. And so we have a responsibility in the community setting to, not bite off more we can more than we can chew, but at the same time make sure that we're offering everything we're able to offer for these patients, so that they're still getting the best cancer care they can receive, no matter where they live, no matter what their socioeconomic statuses. From the community standpoint, we really have to be able to be open-minded and work together. Just because you don't see a solution to a problem, it doesn't mean it doesn't exist, and it doesn't mean you can't work with someone else to to get over that barrier and open these options for patients who otherwise wouldn't have them.

We’ve always had to embrace change in oncology. It is a constantly evolving field, with new oncolytics that come out on a daily, weekly, monthly basis. It's very unique in medicine to have as many FDA approvals as we see in oncology. So, a nature of the beast in oncology is just change, and we all have to acclimate to it. And just because we're in the community setting doesn't mean we have to slowly acclimate. I think that we just have to come together and lean on each other and figure out how to problem solve so that patient care doesn't suffer. And that our communities trust us to take care of their loved ones.

I think it's a really beautiful thing to support your own community and not have to refer patients elsewhere to areas they're uncomfortable with and unfamiliar with. So, it's just the future. Unfortunately, humans, we don't love change, but I think we can certainly work together to make it possible to give bispecifics in the community moving forward.