From Good to Great—Managing Treatment-Related Adverse Events

First-line immunotherapy and tyrosine kinase inhibitor treatment combinations are changing the narrative for previously untreated patients with advanced renal cell carcinoma. While clinical outcomes are significantly improving for these patients, recent studies have shown that we can, in fact, do better. 

If leveraged properly, real opportunities for improvement could enable oncology providers to guide treatment selection with greater precision based on risk scores for greater outcomes, develop and enhance patient education, and optimize the management of treatment-related adverse events, particularly in community-based cancer care settings.  

In an Association of Community Cancer Centers (ACCC) online survey conducted between July and September 2022—in part with the Best Practices for the Management of Treatment-related Adverse Events in Renal Cell Carcinoma education program—advanced practice providers (e.g., physician assistants, nurse practitioners, pharmacists) and other oncology nurse members of the Advanced Practitioner Society for Hematology and Oncology (APSHO) and Kidney Cancer Association were asked to evaluate current practice patterns related to treatment selection, guideline-based management of adverse events, care coordination, patient education, prior authorization, and barriers to the optimal management of patients with renal cell carcinoma. 

Results revealed several key areas for improvement. While most survey respondents (89 percent) report using a combination of an immunotherapeutic and tyrosine kinase inhibitor as an initial treatment for advanced renal cell carcinoma, little more than half (61 percent) report frequently utilizing risk scores for newly diagnosed patients. Risk stratification—integrating critical factors, such as tumor grade and stage with patients’ performance status—can help inform treatment selection and act as a powerful clinical tool in predicting long-term survival, likelihood of tumor recurrence, and other factors related to clinical outcomes. 

In examining protocols for patient education, everything from who provides it (e.g., oncologist, infusion nurse, clinic nurse, or advanced practice provider) to when these conversations are taking place (e.g., on the first day of treatment, as a separate visit, etc.) vary across survey responses. However, survey findings show that less than half (45 percent) of regimen-specific patient education took place as a separate visit, ahead of patients’ first day of treatment. 

While the frequency and responsibility of adverse events monitoring also differ across survey respondents based on regimen, 40 percent report monitoring only on day one of the treatment cycle in patients receiving single-agent tyrosine kinase inhibitors. Optimal management of treatment-related adverse events could include multiple timepoints for monitoring, such as on day one of the treatment cycle and mid-cycle in patients receiving immunotherapy.  

These findings correlate with a previous ACCC education program that was completed in 2019, which also revealed the need for comprehensive education and improvement in guidelines-based management of treatment-related toxicities related to immune-checkpoint inhibitor combination regimens for patients with advanced renal cell carcinoma. 

The path from good to great is clear; by identifying and addressing the clinical challenges associated with these treatment combinations with increased guidance, education, and strategies for optimizing the management of treatment-related adverse events, oncology providers and their patients can benefit from improved clinical outcomes. 

For more information, visit the ACCC website. 

The ACCC Best Practices for the Management of Treatment-related Adverse Events in Renal Cell Carcinoma education program is supported by Pfizer.