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Bringing CAR T-Cell Therapies to Community Oncology

The delivery of CAR T-cell therapy requires workforce and infrastructure not necessitated by more traditional cancer therapies, such as chemotherapy and radiation. While sustained remission and improved survival for patients with hematologic malignancies has led to a growing interest in CAR T-cell therapy among community cancer providers, there is a wariness among lesser-resourced programs and practices to take steps to offer CAR T-cell therapy. Smaller community cancer programs have expressed a preference for referring patients who are candidates for CAR T-cell therapy to larger cancer programs and academic medical centers, due to unfamiliarity with the therapy; inadequate reimbursement for steep costs; insufficient infrastructure; and the potential for unfamiliar life-threatening toxicities in patients.

In a series of surveys in 2016 and 2017, of nearly 400 US community oncologists/hematologists and practice administrators representing a diverse mix of practice types and geographic regions, 64% said the biggest barrier they face to successfully implementing CAR T-cell therapy is the logistics involved in administering treatment and patient follow-up.

ACCC, with support by Bristol Myers Squibb, Janssen Oncology, and Legend Biotech, is helping community cancer programs and practices of all sizes gain the education they need to offer CAR T-cell therapy, sharing effective practices on overcoming logistical and financial hurdles, and highlighting tips on the operational infrastructure (eg, care coordination and patient support) required for a successful program.

For more information on this program, please contact the ACCC Provider Education department.

From Oncology Issues

Issues: CAR T-Cell Therapy: A Significant Advance for Patients with Hematologic Malignancies
By Nicole Tapay

CAR T-cell therapies have ushered in a new era of treatment options for patients with certain hematologic malignancies. Thus, it is important to make these therapies accessible and affordable.
Changing the Tune for CAR T-Cell Therapy
Brittney M. Baer, BSN, RN, and Nancy C. Long, MSN, AGACNP-BC

Learn how Vanderbilt-Ingram Cancer Center in Nashville, Tenn. has been using monitoring devices for patients undergoing chimeric antigen receptor (CAR) T-cell therapy. Thanks to this technology, these high-risk patients can be remotely monitored 24/7.

Featured Webinars

From Planning to Implementation: Lessons Learned on Budgeting for CAR T-Cell Therapy

Providing access to the latest CAR T-cell therapies is a key concern to professionals and patients in the community cancer setting. This webinar will explore what resources are required for establishing CAR T-cell therapy services in the community setting and how cancer programs and practices can prepare and budget for successful implementation
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Financial Services and Navigation: Understanding Insurance Coverage for CAR T-Cell Therapy

This webinar will provide an overview of the current insurance coverage landscape for CAR T-cell therapy. The discussion will focus on existing financial barriers and challenges that cancer programs face as they help patients and caregivers navigate CAR T-cell therapy
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Featured Publications

As CAR T-cell therapy continues to show promise as an effective treatment for patients with acute lymphocytic leukemia, non-Hodgkin's lymphoma, and multiple myeloma, understanding the nuances of bringing this therapy to outpatient and community care settings is critically important.

In this four-part article series, ACCC highlights effective practices to identify and assess patients who may qualify for treatment, optimize care coordination between referring providers and accredited treatment centers, understand reimbursement associated with treatment, and spotlight cancer programs that have been successful in implementing CAR T-cell therapy in the outpatient setting.

Optimizing Care Coordination

With growing interest in bringing CAR T-cell therapy to more patients in community care settings, establishing referral relationships and care coordination between community oncology providers and FDA-certified treatment centers has made CAR T-cell therapy more accessible than ever before. ACCC highlights effective practices to improve the care coordination process from initial referral to post-infusion monitoring and long-term follow-up care for optimized, integrated care between community oncology providers and treatment centers.
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The Economics of CAR T-Cell Therapy

Despite the potential long-term benefits of CAR T-cell therapy, including durable remissions and improved patient outcomes, cost-prohibitive factors such as the high price of manufacturing CAR T-cell products and associated logistical expenses for extensive patient monitoring and supportive care continue to present barriers to its widespread use. ACCC examines the complex economic landscape of CAR T-cell therapy and explores the outlook for cost reductions in order to bring this innovative therapy to more patients.
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Essentials for Identifying Patients

As CAR T-cell therapy continues to show promise as an effective treatment for patients with acute lymphocytic leukemia, non-Hodgkins lymphoma, and multiple myeloma, it has become increasingly important for oncology providers and community-based cancer programs to be proactive in identifying patients who could benefit from this form of therapy. ACCC outlines essential steps for the identification, selection, and assessment of patients who may qualify for this life-saving treatment.
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CAR T-Cell Therapy in Action: Successful Examples in Outpatient Settings

As more community cancer centers consider the integration of outpatient CAR T-cell therapy services to expand accessibility, increase patient satisfaction, and control healthcare costs, significant infrastructural and operational considerations are required for successful implementation. ACCC shares key insights from cancer programs with effective CAR T-cell therapy programs in place in ambulatory settings, marking a transformative step in cancer care delivery.
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Bringing CAR T-Cell Therapies to Community Oncology Gap Analysis

Bringing CAR T-Cell Therapies to CO Cover Download

In recent years, chimeric antigen receptor T-cell therapy (CAR T) has emerged as an important treatment, offering the promise of disease-free survival to patients with relapsed/ refractory hematologic cancers. By attaching a chimeric antigen receptor to patients’ own T cells and then expanding these cells, CAR T-cell therapy creates a personalized immune therapy where the patient’s own cells are able to target cancer cells. The goal of a cancer cure has yet to be reached, but impressive response rates and progression-free periods have been achieved with CAR T-cell therapy in clinical trials, establishing CAR T as a new standard of care for certain cancers.

CAR T-cell Practice Profiles

As interest in expanding chimeric antigen receptor (CAR) T-cell (CAR T) therapies beyond small clinical trials to cancer programs across the country grows, providers are seeking key strategies and effective practices on how community cancer centers can overcome the infrastructural and financial hurdles of implementing CAR T-cell therapies locally. While challenging, the impact of offering commercial CAR T-cell therapy in small and large practices on patients and their continuity of care is tremendous and practices are eager to bring this emerging therapy into their communities. This two-article series explores how the cancer programs at the Billings Clinic Cancer Center and Fox Chase Cancer Center successfully evolved from clinical trial sites to centers for commercial CAR T-Cell therapy in their communities.

Remote Patient Monitoring of Patients on CAR T-Cell Therapy — [PODCAST] EP 95

While remote monitoring platforms have been used effectively throughout the COVID-19 pandemic to reduce the burden on patients and healthcare facilities around the country, Vanderbilt Ingram Cancer Center in Nashville, Tenn., has been using the technology in a different capacity—with its chimeric antigen receptor (CAR) T-cell therapy patients.
CAR T-Cell Practice Profile: Fox Chase Cancer Center

From clinical trial site to one of the few institutions in the country authorized to deliver all available FDA-approved CAR T-cell therapies, Fox Chase Cancer Center describes its successful evolution and identifies effective practices to help community cancer centers surmount the financial barriers to therapy as well as build strong referral networks with institutions offering cellular therapies.
CAR T-cell Practice Profile: Billings Clinic Cancer Center

As one of the largest health systems in Montana, the Billings Clinic Cancer Center describes its approach to establishing the infrastructure necessary to deliver CAR T-cell therapy in the community and how its strategies can be implemented by other community cancer centers across the country.