CAPACITY BUILDING: Achieving Early Recognition and Improved Management of irAEs, an Interprofessional Approach

In working with multiple institutions, we have found a common theme/challenge that seems to be evident regardless of the organizational structure of the oncology services. The management of IrAEs is delegated to local/community hospitals/clinics and to emergency or primary care providers who may not be aware of immunotherapy protocols.

Project Objective:

To allow oncology teams to review internal system(s) for identifying, reporting and managing IrAEs whether patient presents internally, at an institution in the catchment area or somewhere outside of network and develop approaches where the entire healthcare team can support patients who have (or are receiving) immunotherapy.

Provided by University of Virginia School of Medicine and School of Nursing

Faculty List

William J. Brady, MD

Details

• Planning committee member
• Professor of Emergency Medicine & Cardiovascular Medicine
• University of Virginia

Jann Balmer, PhD, RN

Details

• Planning committee member
• Strategic Advisor and Consultant to University of Virginia

Elizabeth M. Gaughan, MD

Details

• Associate Professor
• Department of Medicine, Hematology and Oncology
• University of Virginia Health System

Lisa A. Kottschade, R.N., C.N.P.

Details

• Associate Professor of Oncology
• Nurse Practitioner, Melanoma and Cutaneous Oncology Program
• Mayo Clinic, Rochester, Minnesota

Evelyn M. Bargmann, MD

Details

• General Medicine, Geriatrics and Palliative Care

Lisa S. Wood, RN, MS, OCN

Details

• Oncology Nurse Educator
• Medina, OH

Target Audience

The target audience for these activities includes:

• Primary care: Physicians in IM, FP, DO, APRNs, PAs, Pharmacists, RNs
• Emergency Departments: Physicians, APRNs, PAs, EMTs, RNs, CNAs
• In-patient: Physicians Hospitalists, Critical Care, APRNs, PAs, Pharmacy, RNs

Desired Outcomes

1. Demonstrate a team-wide approach articulating how to improve awareness and recognition of irAEs as patients are evaluated in the ED and other ancillary settings
2. Predict methods for clinicians/healthcare teams to clearly differentiate between “chemo” and immunotherapy regimes for patients with cancer
3. Appraise how to modify the differential diagnosis when a patient has received immunotherapy for cancer
4. Describe how clinicians/healthcare teams can proactively differentiate irAEs rather than by exclusion and incorporate in the differential for patients who are receiving or have received immunotherapies
5. Review organ-specific summary of presentation signs and symptoms
6. Incorporate the assessment of new symptoms that are treatment related with organ-specific assessments (e.g. pneumonitis: O2 saturation levels; computed tomography (CT) of chest; rule out progression of disease, lymphangitic spread, pulmonary embolism, and pleural effusion).
7. Describe grading of irAEs including signs and symptoms according to CTCAE criteria.
8. Summarize management and referrals of serious and severe irAEs to include multidisciplinary team.
9. Classify irAEs by current organ-specific grading according to CTCAE criteria.
10. Review management of irAEs in ambulatory settings.

Accreditation and Designation Statement

In support of improving patient care, this activity has been planned and implemented by the University of Virginia School of Medicine and School of Nursing is accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

AMA PRA CATEGORY 1 CREDIT

The University of Virginia School of Medicine and School of Nursing designates this enduring material for a maximum of 8.0 AMA PRA Category 1 Credits.™ Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ANCC CONTACT HOURS

The University of Virginia School of Medicine and School of Nursing awards 8.0 contact hours for nurses who participate in this educational activity and complete the post activity evaluation.

HOURS OF PARTICIPATION

The University of Virginia School of Medicine and School of Nursing awards 8.0 hours of participation (consistent with the designated number of AMA PRA Category 1 Credit(s)™ or ANCC contact hours) to a participant who successfully completes this educational activity. The University of Virginia School of Medicine and School of Nursing maintains a record of participation for six (6) years.

MOC Part II

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 8.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Disclosures

The following have disclosed no financial relationship or interest with any proprietary entity producing healthcare goods or services.

• Jann Balmer, PhD, RN
• Evelyn Bargmann, MD
• William Brady, MD
• Elizabeth Gaughan, MD
• Gretchen Keefer, MBA
• Lisa Kottschade, RN, CNP
• Pamela Lace, MA
• Laura Wood, RN, MS, OCN

Disclosure of faculty financial affiliations

The University of Virginia School of Medicine and School of Nursing as a Joint Accreditation Provider adhere to the ACCME Standards for Integrity and Independence in Accredited Continuing Education, released in December 2020, as well as Commonwealth of Virginia statutes, University of Virginia policies and procedures, and associated federal and private regulations and guidelines. As the accredited provider for this CE/IPCE activity, we are responsible for ensuring that healthcare professionals have access to professional development activities that are based on best practices and scientific integrity that ultimately supports the care of patients and the public.

All individuals involved in the development and delivery of content for an accredited CE/IPCE activity are expected to disclose relevant financial relationships with ineligible companies occurring within the past 24 months (such as grants or research support, employee, consultant, stock holder, member of speakers bureau, etc.). The University of Virginia School of Medicine and School of Nursing employ appropriate mechanisms to resolve potential conflicts of interest and ensure the educational design reflects content validity, scientific rigor and balance for participants. Questions about specific strategies can be directed to the University of Virginia School of Medicine and School of Nursing of the University of Virginia, Charlottesville, Virginia.

The faculty, staff and planning committee engaged in the development of this CE/IPCE activity in the Joint Accreditation CE Office of the School of Medicine and School of Nursing have no financial affiliations to disclose. All financial affiliations have been mitigated to ensure independence and integrity in the educational content.

Disclosure of discussion of non FDA approved uses for pharmaceutical products and/or medical devices

As a Joint Accreditation provider, the University of Virginia School of Medicine and School of Nursing, requires that all faculty presenters identify and disclose any off-label or experimental uses for pharmaceutical and medical device products. It is recommended that each clinician fully review all the available data on new products or procedures prior to clinical use.

Disclaimer Information: CE activities accredited by University of Virginia School of Medicine and School of Nursing are offered solely for educational purposes and do not constitute any form of certification of competency. Practitioners should always consult additional sources of information and exercise their best professional judgment before making clinical decisional of any kind. Learners are not authorized to copy, modify, reproduce, re-publish, sub-license, sell, upload, broadcast, post, transmit or distribute any of the Course Materials.