Managing Survivorship Care After Immunotherapy

By Regina Jacob, MD, MSCE

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Regina Jacob, MD, MSCE
Assistant Professor, Clinical Medicine;
Director, Social Determinants of Health Curriculum, Internal Medicine Residency Program
Lewis Katz School of Medicine at Temple University

Regina Jacob, MD, MSCE, is an assistant professor of Clinical Medicine at The Lewis Katz School of Medicine at Temple University in North Philadelphia.  She received her MD degree from The George Washington University in Washington, D.C., completed her internal medicine residency at Temple University Hospital, and earned a master’s degree in Clinical Epidemiology at The Weill Cornell Medical College of Cornell University in Manhattan, New York.

Dr. Jacob has two main research interests which both assess psychological adjustment and co-morbid medical conditions.  She conducted a study called Coping with Lymphoma to Enhance Adjustment and Reduce Stress, which assessed the psychological adjustments which may occur after a diagnosis of lymphoma.  She continues to grow her cancer survivorship expertise in education, designing curricula to educate internal medicine residents on how to appropriately tailor primary care for patients with a history of cancer. 

Her second research interest involves assessing co-morbid conditions that result from chronic and cumulative trauma exposure.  She is currently conducting a study called Trauma Alert! How Social Complexity Contributes to Medical Complexity, which assesses the prevalence of post-traumatic stress disorder (PTSD), adverse childhood experiences, depression, and co-morbidity in an underserved primary care population. While the effects of poverty on healthcare are known, there is still a large amount of work to be done with regards to how trauma associated with poverty results in negative health behaviors and subsequent poor medical and psychological outcomes.
  September 11, 2018

Since its inception, survivorship care has always been a compendium of communication, care coordination, and education. Many of the anxieties and struggles that arise in survivorship care can usually be traced back to a breech in the standard of one of these three dimensions.

Primary care providers express discomfort about managing the care of a cancer survivor usually because they are unaware of the treatments that patients have received. Similarly, patients feel nervous about leaving their oncologists because they are worried their primary care providers would be unaware of how to manage their complex care. These anxieties already exist for treatments that have been studied for several years, of which the long-term side effects are well known, so imagine how much more of a concern this is for treatments that are relatively new.

Immunotherapies are novel, exciting, and effective. But when it comes to the long-term effects, they are still largely unknown. This means that there is a fourth dimension of potential anxiety in the care of a cancer survivor who received immunotherapy: the unknown.

It is often said that the oldest and strongest kind of fear is fear of the unknown, and many times the best way to address fear is to ensure open lines of communication. This could also be said for immunotherapies and their associated adverse events. In order to better improve survivorship care, while also addressing the fear and anxiety involved in the post-treatment phase, providers need to communicate effectively with each other, which will naturally improve education and care coordination simultaneously. Since immune-related adverse events are still being discovered, these discussions are even more imperative.

The Association of Community Cancer Centers (ACCC) is working to compile a list of known immune-related adverse events for existing immunotherapies, which should help educate providers and enable cancer survivors to feel more empowered in their own care. In addition to these efforts, ACCC is open to hearing about other strategies to improve the communication, care coordination, or the education standard necessary for successful cancer survivorship care.

Building a Multispecialty Immuno-Oncology Toxicity Team with Checkpoint Inhibitors

Early recognition and management of immune-related adverse events (irAEs) is critical for quality care of patients receiving checkpoint inhibitor immunotherapy, and involving clinicians from other specialties is key to that recognition. Learn how one cancer program established a multi-specialty immunotherapy toxicity team with the necessary expertise to evaluate and manage patients with irAEs. Complementing the article is the ACCC IO Toxicity Team Companion Guide, which visually outlines 8 effective practices for developing a toxicity team at your program or practice.

Download the article and companion guide at accc-cancer.org/toxicityteam.