QCCA Panel Highlights Expansion of Innovation at Independent Community Oncology

Members from independent oncology practices gathered to discuss value management, theranostics, clinical trial access, and innovations in pharmacy at the Quality Cancer Care Alliance (QCCA) Summer 2022 National Leadership Summit, held August 10-12, 2022, at The Bell Harbor International Conference Center in Seattle, Washington.

With a focus on “Harnessing Innovation in Independent Community Oncology,” the summit included panels on topics such as the shift from the Oncology Care Model to the Enhancing Oncology Model and CAR-T cell therapy.

To kick off the meeting, Sibel Blau, MD, president and CEO of QCCA, led a panel on integrating innovation into independent community oncology. Joining Blau to share how their practices are innovating in the field were:

• Alti Rahman, practice administrator at Oncology Consultants
• Beth Page, COO, director of compliance at Cancer Specialists of North Florida
• Frank Senecal, MD, director of oncology at the Franciscan Healthcare System, Northwest Medical Specialties
• Justin Floyd, DO, president of Cancer Care Specialists of Illinois

Value Management

According to Rahman, value and impact are 2 main factors of innovation.

“If you don’t value it, you won’t change it,” he said, noting that change must start at the top with alignment of values between an organization’s management and executive board, because value management is needed at all levels and in all aspects of an organization.

Further, work structure, whether there is an established team focusing on the issue, and what resources are being invested to create this innovation all determine how much value is put into the innovation.

“It's not something that you're looking at generating an ROI [return on investment] out of,” Rahman emphasized. “It is something that you invest in in order to create stronger foundations and roots in what we're doing in community practice.”

His second point was, “If you can’t measure it, you can’t change it.”

Based on this, it is important for the organization to set a clear goal within its limits, as well as understand the magnitude of the issue at hand and how the innovation’s impact is being measured.

Rahman explained that the job of the provider starts in the middle of the patient’s journey after receiving a diagnosis. However, the provider needs to not only focus on how to make things move efficiently at an operational level, but also think about the patient’s journey so far and how their life is affected after treatment.

Rahman pinpointed prior authorization as an area in need of overhaul; he said it adds unnecessary time to the process of getting treatment to patients. To address this, Oncology Consultants looked into how the time was being spent and invested in automation, reducing the turnaround from 20 minutes to 11.8 minutes.

Additionally, after filtering through which parts of the process were deemed to not add value, including redundancies and repetitions, the overall authorization process went from 2 to 3 days down to 1 day between when the physician ordered the therapy and when the prior authorization was approved by the payer.

“As we look at our organization, we have to continuously assess what we're doing and then review the capacity for change and improvement throughout as a culture of innovation,” Rahman closed.

Theranostics

Page explained theranostics, which are precision therapies that combine therapeutics, diagnostics, and nanoscience. This type of treatment uses 1 radioactive drug to identify and diagnose a malignancy, and another to deliver therapy for the malignancy and any metastatic tumors.

By comparison, traditional radiation only targets 1 disease site, which makes radiation less effective for patients with metastatic tumors. Radiation can also damage healthy tissue surrounding the malignancy.

Theranostics available at Cancer Specialists of North Florida include lutetium Lu 177 vipivotide tetraxetan (Pluvicto), lutetium Lu 177 dotatate (Lutathera), and radium Ra 223 dichloride (Xofigo). Data presented at the QCCA Summit show Lutathera and Xofigo result in more than $8000 and $2200 in average profits per injection, respectively.

Page emphasized the importance of operationalizing this therapy correctly, stressing that practices that fail to set up the correct system risk losing all profit.

To avoid this loss while also minimizing waste and improving the patient experience, Page explained that Cancer Specialists of North Florida has a team that meets the same day every week. This team includes 1 member who handles scheduling, 1 part-time nurse who stays in the room with the patient for 6 hours to avoid pulling a nurse from the clinic’s chemotherapy floor, and 1 imaging tech who is with the patient for around 30 minutes to administer the doses.

This team also moves between sites on different days of the week, but always consists of the same members on the same schedule.

Blau added that standard operating procedures are being developed to help practices build these teams.

According to Page, the global theranostics market is estimated to grow 9.6% annually through 2028, reaching a value of more than $123 billion. Primary factors driving this growth are the increase in prevalence of cancer and other chronic illnesses, and growing investments in biological research. At the same time, this trajectory could be impeded by challenges surrounding the regulatory landscape and a lack of reimbursement policies.

Clinical trials for this therapy are ongoing, with phase 3 trials happening at Telix Pharmaceuticals for TLX591, which is estimated to reach commercialization in the next 12 months. Additionally, a phase 4 trial at Zionexa is being initiated for Cerianna.

CAR T-Cell Therapy, South Sound CARE

Most CAR T-cell therapy programs are available through hospital settings, especially in metropolitan areas. In the northwest United States, according to Senecal, this means many patients eligible for the therapy that are referred to a limited number of centers have to wait longer to access it.

“The result of that is there is oftentimes a 2 month, 3 month waiting list for getting patients into therapy,” Senecal explained. “In addition, the rules and regulations from Fred Hutch [mean] patients need to stay in Seattle after they receive their therapy, so patients are making a commitment to stay for a pretty prolonged period of time.”

Senecal is also the founder of the South Sound CARE Foundation (SSCF), which aims to increase access to clinical trials and cancer research closer to patients in the South Sound region, and provide residents with cancer treatment options such as CAR T-cell therapy that are otherwise unavailable in their area.

Topics for ongoing trials through SSCF include blood cancers, breast cancer, genitourinary cancer, and quality of life.

SSCF also has a number of Compassionate Use trials for physicians and providers, designed for patients that are no longer responding to standard of therapy.

“These are individual ‘trials’ in which the FDA and pharmaceutical companies work together to provide access to drugs shown effective for specific tumor traits, but not available through other sources,” the foundation’s website explained. “The South Sound CARE team coordinates the process for our patients, facilitating the applications and locating potential Compassionate Use programs within pharma willing to partner to provide drug free of cost to patients.”

Mobile Pharmacy

According to Floyd, providing specialty drugs to patients has several challenges, including high costs, variable half-lives of drugs, and access to specialty infusion staff. Additionally, many patients have limited access to cancer care, especially if they are older in age, live in a rural area, or live in a smaller, vulnerable, or generally underserved population or geographic location.

On top of this, patients are sometimes unable to keep their appointments due to travel, poor health, and various other reasons.

Floyd also noted that, while Cancer Care Specialists of Illinois (CCSI) has been operating successfully for 30 years, he realizes the care design model is geographically challenging.

To overcome these obstacles, CCSI created a “first of its kind” mobile pharmacy, a pharmaceutical compounding vehicle that is not a licensed pharmacy but helps to deliver cancer care to patients by providing on-site chemotherapy medication compounding.

Issues with wasted drugs has also become a large problem in pharmaceuticals, both environmentally and financially. Chemotherapy drugs can be very expensive, and if they are transported to a center and then no longer needed, they must be disposed, contributing to both a waste in resources and high health care costs.

With the mobile pharmacy, the chemotherapy medication is not mixed until the patients are seen at the hospital and an exact prescription is made, saving valuable medical resources while reducing cancer care’ environmental footprint.

It also has led to financial savings, with Floyd noting waste savings of $664,248 in 2020, $804,833 in 2021, and $278,722 so far in 2022.

Finally, Floyd suggested that compounding drugs on site can improve patient access to clinical trials because they are no longer required to travel to a central hub for investigational drugs.