NEW YORK — Lindsey Carlson, a nurse oncology nurse at Princess Margaret Cancer Center, is leading a virtual care counseling program for patients with metastatic breast cancer across the Canadian province of Ontario, with the goal of improving their access to comprehensive genomic profiling and clinical trials.
The nurse-led virtual care pathway will officially launch this fall with funding from Pfizer Canada and the Canadian nonprofit Rethink Breast Cancer. Although the pilot program has received one-year funding for patients with metastatic breast cancer who receive standard care at Ontario Community Cancer Centers, Carlson and her team hope that this type of support will eventually become part of care for patients with other types. From receiving cancer as well.
According to Carlson, the program facilitates communication with advanced cancer patients early in their care, rather than a repeat treatment experience or a relapse of available treatments. The program also stimulates collaboration between navigators’ nurses at comprehensive cancer centers such as Princess Margaret and community practices where patients often receive their diagnoses and first line of treatment.
“Currently, [at Princess Margaret] “We see patients at a time when their current anti-cancer treatment is no longer effective and are referred to our team,” Carlson said, explaining that under the current model, these patients may not know about biomarker testing options or clinical trials until their cancer has advanced. “It’s not the most efficient way to do things, and this [program] Kind of turns that on its head.”
Instead, Carlson and her team at Princess Margaret are inviting community oncologists from across Ontario to refer advanced breast cancer patients to the default pathway program early in the course of treatment, when they begin their standard treatment.
Patients referred to the program will receive a virtual consultation with the navigator’s nurse, in this case, Carlson. In these consultations, Carlson learns about the patient, their journey with cancer, their general health, and characteristics of their diagnosis and enters these details into the patient’s medical record at the Academic Cancer Center. The sessions also provide Carlson with an opportunity to begin educating patients about clinical trial opportunities and the value of genomic profiling tests.
The patient – who remains under the care of his primary oncologist at his community center – also has a virtual meeting with Princess Margaret’s oncologist to address questions about treatment and establish contact. After these initial conversations, the nurse navigator develops a customized plan for check-in through periodic calls as the patient undergoes treatment in a community setting.
“And then, at the right time – if and when that time comes – when a patient’s current treatment is no longer effective, we can then speed them up to get to our team. [at Princess Margaret]Carlson said. And because I would actually follow them in the community, the idea is that we’ll be able to anticipate potential trial opportunities for them and communicate these options to them and their oncologists. It’s kind of proactive compared to what’s currently going on.”
Early access to molecular profiling
From the outset, patients in the program are also given the opportunity to undergo comprehensive vital sign testing, which may identify opportunities for selected clinical trials with vital signs or targeted therapies in the event that standard-of-care treatment stops working.
To take the test free of charge through the program, patients will need to come to the Princess Margaret Cancer Center and provide a sample and consent. They will provide blood samples for natural tumor profiling and next-generation sequencing, Carlson said, although based on individual patient cases, there may be opportunities for patients to enroll in protocols for newer genomic profiling methods such as liquid biopsy. The Princess Margaret team will then share the results of the molecular tests with the patient and the primary oncologist via the communication channels established in the virtual care pathway.
“Within the province of Ontario, molecular profiling is really limited to a small number of disease-specific indicators,” she said. “Unfortunately, access to this more comprehensive characterization, which we offer through this project, is usually limited to enrollment in a research project in urban academic centers or commercial examinations, which can involve significant out-of-pocket expenses.”
According to MJ DeCoteau, founder and director of Rethink Breast Cancer, one of the main reasons Rethink and Pfizer Canada selected this project as one of three QI grant recipients is that the model has the potential to address variances in access to genomic profiling. .
“This funded project aims to increase access to patients receiving treatment in community hospitals, so that large educational institutions are not the only access point for genotyping,” Dikoto said. “The specific project is closely aligned with Rethink’s work to educate, empower and advocate for…historically disadvantaged groups [including] People diagnosed at a younger age, those with metastatic breast cancer, and people who are systematically marginalized because of race, income, or other factors.”
Pfizer Canada and Rethink will not share the exact amount of funding awarded through the grant, even though the funding for the three programs together, including this one, totaled C$280,000 ($21,765).
Greater role for nurses navigators
As part of a grant agreement with Pfizer Canada and Rethink Breast Cancer, Carlsson’s team at Princess Margaret will collect metrics throughout the year in order to assess whether and how successful the needle is in accessing clinical trials and genomic characterization. Carlson said the team aims to publish its findings, including metrics such as recruitment numbers in trials and outcomes reported by patients, at the end of 2023 or early 2024.
According to a spokesperson for Pfizer Canada, the drug company and Rethink Breast Cancer will jointly review project reports to determine if and how this initiative can be more widely adopted across Canada.
Carlson is optimistic that the model under trial in breast cancer has the potential to transform access to precision oncology more broadly, but says it will depend on the availability of specific nurse nurses. Virtual care pathways take time that oncologists, administrative staff, and clinic nurses may not have. “This will create more opportunities for nurse practitioners,” she said, adding that the role is gaining recognition in cancer centers in Canada and the United States and will become an integral part of care teams in a move with greater adoption of precision oncology.
In fact, in The micro-survey of tumors conducted by last year’s news for oncologists Mostly from academic cancer centers and large health systems, nearly a quarter of respondents said NAs were important intermediaries to facilitate vital sign testing and patient follow-up.
Scaling up the program will also require additional investment in communication frameworks between academic cancer centers such as Princess Margaret and community-based oncology settings. Standardizing the frequency and quality of this connection may require additional manpower and additional infrastructure, Carlson said. “Community oncologists are incredibly busy managing large patient burdens and complex care,” she said. “This is another part of the thinking behind this project: How do we take the burden off them?”
However, the program is not designed to infringe on patients’ relationships with oncologists in their communities regarding treatment decisions. “The patients are clearly under their care, so we work closely with them and leave all treatment decisions with them,” Carlson noted.
But due to the pace of advances in precision medicine, most Community oncologists welcome help When it comes to mindful care of vital signs. This has been Carlson’s experience so far.
“The reception has been incredibly positive,” she said, acknowledging that the program is still in its infancy, so the comments are purely anecdotal. “Based on what we’ve been told…oncologists don’t feel that their patients are likely to miss opportunities.”