Survey: Real-world Management of Patients With RCC Prescribed Immunotherapy, TKI Combinations

A recent online survey shed light on current practice patterns regarding treatment selection, guideline-based management of adverse events, care coordination, and patient education for individuals with renal cell carcinoma (RCC) treated in community oncology practices.

Results of the survey were presented at the 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium.

Patients with RCC have benefited from first-line immunotherapy and tyrosine kinase inhibitor (TKI) treatment combinations. To improve the clinical benefit of such regimens, better risk stratification is needed to guide treatment selection and treatment-related adverse events should be appropriately managed.

Laura S. Wood, RN, MSN, OCN, and colleagues at the Association of Community Cancer Centers administered an online survey from July through September 2022 to evaluate current practice patterns for patients with RCC who are treated in community cancer programs. The survey was also shared with advanced practitioner, pharmacist, and oncology nurse members of the Advanced Practitioner Society for Hematology and Oncology and the Kidney Cancer Association who provide care to patients with RCC.

A total of 104 respondents were included in the data analysis, most of whom were surveyed from community cancer care programs or private practices (69%) in urban or suburban settings (90%) that average 25 to 75 patients with RCC annually (77%).

Most respondents (89%) used a combination of an immunotherapy and a TKI as initial treatment for advanced clear cell disease, while 61% of respondents reported frequent use of risk scores for newly diagnosed patients.

Forty-five percent of regimen-specific patient education reportedly happens at a separate visit, conducted by the oncologist (23%) or the infusion nurse (22%), and 37% of respondents conduct this education on the first day of treatment. Responsibility of providing comprehensive patient education varied by program; oncologists (23%), infusion nurses (22%), clinic nurses (20%), advanced practice providers (18%), and pharmacists (16%) were the most noted individuals who undertook this role.

Researchers also reported on frequency of monitoring adverse events. Most respondents (54%) monitored on day 1 of the cycle and again mid-cycle in patients receiving immunotherapy, while 40% monitored only on day 1 of the cycle in patients receiving single-agent TKIs. Clinic nurses were primarily responsible (40%) for monitoring treatment adherence in patients receiving TKIs and subsequently triaging for associated adverse events.

“Opportunities exist to increase utilization of risk assessments, create patient education materials for the multidisciplinary cancer care team, and address the optimal frequency of adverse event monitoring,” researchers concluded.