Bispecific Antibody Therapy | Managing Side Effects from Patient Empowerment Network on Vimeo.
What should myeloma bispecific antibody therapy patients know about managing side effects? Nurse practitioner Alexandra Distaso from Dana-Farber Cancer Institute discusses common short-term and long-term side effects, members of the healthcare team, medications for managing side effects, and how care partners can support bispecific antibody patients.
Alexandra Distaso, MSN, FNP-BC is on the Multiple Myeloma Nursing Team at Dana-Farber Cancer Institute.
See More from The Care Partner Toolkit: Bispecific Antibodies
Related Resources:
Transcript:
Katherine:
What are the short-term side effects associated with bispecific therapy?
Alexandra:
Yeah. So, the short-term side effects that we’re watching for are these reactions in the hospital called CRS, cytokine release syndrome, and neurotoxicity.
So, the CRS is an inflammatory response where cytokines are released and usually cause a fever. We monitor and make sure that the fever isn’t being caused by some sort of infectious process or there’s no other cause for the fever. And if not, then there are medications we can give to help reverse these side effects while you’re in the hospital.
Katherine:
Who else is on the healthcare team when someone receives these therapies?
Alexandra:
Yep. So, you’ll always meet with your oncologist or an oncologist at the academic medical center where you’re going to be getting the medication to go over potential side effects, what the treatment entails, and consent. We have nurses here that are specific to bispecific antibodies, that help coordinate with your local team if you’re going back to your local practice. We have the infusion nursing team who are the ones who are actually giving the bispecific antibody therapies. They explain kind of what to watch for at the site where the injection goes. And then we have pharmacists who are also available to meet with you and go over any questions you may have about the treatment.
Katherine:
What do we know about long-term side effects? Are there any?
Alexandra:
So, long term, what we’re really seeing is risk for infections. So, all of these medications lower your blood cell counts, and we have to watch for these opportunistic infections, fungal, bacterial, viral.
Which is why it’s important that we have everyone on supportive medications to try and prevent that from happening. But long term, that is certainly something that we’re seeing. With the talquetamab, there can also be some skin and taste changes, and those are not necessarily right at the inpatient dosing, but we can see that. But those are things we’re also managing in the months after the initial therapy.
Katherine:
Okay. Why is it so important that care partners let the healthcare team know of any changes that they see in their loved ones?
Alexandra:
I say this to my patients and their families all the time. They know their family member best, and they may be one to notice that they’ve been more tired, or their energy just isn’t the same, or they do have a little cough that maybe the patient hasn’t even really noticed. And those are all things that we want your observation, we want you to speak up about, because the sooner we address some of these problems, the less complications the patients may have.
Katherine:
What are the supportive medications for somebody who might be having side effects?
Alexandra:
Yeah, so with the talquetamab (Talvey), which we’re primarily seeing a lot of skin side effects and mouth discomfort, a lot of the time we have special mouthwashes to prevent discomfort and irritation. Things like biotin to just keep the mouth moisturized. Steroid creams and nail ointments to help with sometimes some peeling of the skin.
And then for all bispecifics, we have everyone on viral prophylaxis. Something like acyclovir (Sitavig or Zovarax) or valacyclovir (Valtrex). PJP prophylaxis. So, something like sulfamethoxazole and trimethoprim (Bactrim) or dapsone (Aczone). And almost all of our patients are on an IVIG infusion once a month to help support their immune system and prevent against infections.
Katherine:
Alexandra, you mentioned care partner looking for a cough, for instance, in a patient.
What other things should care partners be looking for?
Alexandra:
Any kind of change in the patient’s baseline is always helpful to know. So, if people are feeling much more tired, even if you’re not due for your therapy, sometimes calling to say that they just don’t seem themselves, we can check their blood counts. And again, sometimes they might need a blood transfusion, or their white count might be quite low, and they might need some Neupogen or filgrastim to help kind of support their blood counts. So, really kind of notifying us, even if it doesn’t seem like a big thing, it’s always better to call.
Bispecific Antibody Therapy Support | Care Team Members and Resources
/in Care Partner Programs, Care Partner Resources, Care Partner Resources Video, Care Partner TK, Care Partner TK Bispecific Understanding, MM Treatments and Clinical Trials, MM Videos TC, Multiple Myeloma /by Kara RayburnBispecific Antibody Therapy Support | Care Team Members and Resources from Patient Empowerment Network on Vimeo.
What should myeloma patients know about bispecific antibody therapy support? Nurse practitioner Alexandra Distaso from Dana-Farber Cancer Institute discusses care team members and support resources for bispecific antibody therapy patients and care partners.
Alexandra Distaso, MSN, FNP-BC is on the Multiple Myeloma Nursing Team at Dana-Farber Cancer Institute.
See More from The Care Partner Toolkit: Bispecific Antibodies
Related Resources:
How Can Bispecific Antibody Therapy Care Partners Be Proactive?
What Is the Role of a Care Partner in Bispecific Antibody Therapy?
Bispecific Antibody Therapy | Managing Side Effects
Transcript:
Katherine:
Besides yourself, what other staff members can care partners turn to for support?
Alexandra:
So, at our office, we have an amazing group of triage nurses who are available Monday to Friday all during office hours. We have after-hours. If your patient or family member spikes a fever and you’re worried they just don’t look good, there’s always a doctor on 24/7 that you can page to kinda ask for advice and see what to do from there. And again, we have infusion nurses who are giving these injections every day.
And they are wonderful resources on what you might feel later in the day, what that site might look like, side effects that might pop up. So, really, anyone wants to be there to answer questions to make it easier for the patient or the family.
Katherine:
Are there social workers or psychologists on the team as well?
Alexandra:
Yes. We have an amazing group of social workers at Dana-Farber. And one thing that I really like about the way our program is run is that we have a social worker who is dedicated specifically to myeloma. So, they’re very familiar with these medications and the hospitalization requirements, which can be extremely tough. And so having resources and just someone to talk to, both through social work and our psychosocial oncology department, is also a wonderful resource to have.
Katherine:
What about online resources? Do you have any recommendations?
Alexandra:
So, I think that the IMF, the International Myeloma Foundation, and the NCI, have amazing resources for patients.
Actually, the IMF has an entire caregiver support page with kind of caregiver self-help, and ways that you can care for the patient. Care for the caregiver, and care for the patient. I think the MMRF has wonderful resources, and they also have a lot of online forum videos about bispecific antibodies and the different treatments for myeloma that are available if you want to learn more. And then same thing with The Leukemia & Lymphoma Society. Excellent resources online.
What Is the Role of a Care Partner in Bispecific Antibody Therapy?
/in Care Partner Programs, Care Partner Resources, Care Partner Resources Video, Care Partner TK, Care Partner TK Bispecific Understanding, MM Treatments and Clinical Trials, MM Videos TC, Multiple Myeloma /by Kara RayburnWhat Is the Role of a Care Partner in Bispecific Antibody Therapy? from Patient Empowerment Network on Vimeo.
How can a myeloma care partner support a bispecific antibody therapy patient? Nurse practitioner Alexandra Distaso from Dana-Farber Cancer Institute explains ways that care partners can offer logistical and emotional support and shares tips for staying well-informed and organized during the treatment journey.
Alexandra Distaso, MSN, FNP-BC is on the Multiple Myeloma Nursing Team at Dana-Farber Cancer Institute.
See More from The Care Partner Toolkit: Bispecific Antibodies
Related Resources:
How Can Bispecific Antibody Therapy Care Partners Be Proactive?
How Has Bispecific Antibody Therapy Impacted Myeloma Care?
Bispecific Antibody Therapy Support | Care Team Members and Resources
Transcript:
Katherine:
As I mentioned, Alexandra, this program is aimed at helping care partners understand the process and how they can support their loved ones. What do you feel is the care partner’s role?
Alexandra:
I feel like the best way for care partners to support patients is to kind of take the time to learn about the myeloma and the therapy and try to do the best they can to just be there for not just moral and emotional support, but the other little things that they may need. Coordinating rides, if it’s a family member, asking friends for help.
And then other things like insurance phone calls can be incredibly time-consuming and taxing. Or waiting at the pharmacy to pick up medications. Any, even little things like that, I think take a huge load off the patients who are doing this day in and day out.
Katherine:
Yeah. Are there key questions that care partners should ask as they begin the process?
Alexandra:
I think the best thing that patients and caregivers can do is if they have questions prior to the visit is to make a list. ‘Cause, I’m guilty of this myself, as soon as I show up at my doctor’s office, I completely forget what I wanted to say. So, making a list prior to the appointment, I think, is hugely beneficial. And then I don’t think that it’s ever a bad thing to ask for the doctor or nurse practitioner or pharmacist, whoever you’re meeting with, to see if they can repeat themselves. We’re putting a lot of information into a very short period of time.
And to try and keep track of, again, schedule, supportive care medication, when you’re going to need to be in the hospital, how long, what your follow-up will be, taking notes during the visit or asking to hear it again is always helpful. Not even just for the caregiver, but sometimes for the patient who’s still trying to wrap their head around some of the change in therapy.
Katherine:
Right. Yeah. That’s really good advice. As we’ve covered, it’s not always easy being a care partner. What would be your best advice for those who are caring for someone undergoing bispecific antibody treatment?
Alexandra:
I would say it’s hard to put out how important care members are to the entire care team. Again, not just for the logistical, getting the patients to appointments, getting their medication, but really having someone the patient feels comfortable to be able to lean on. And again, they may say, “I’m so overwhelmed in these visits, and I really need some help.
Could you ask these things?” Helping them keep track of all these medication changes and appointments and visits and any sort of even small things like grabbing them a water so that they’re staying hydrated. Those little things make such a difference to people. And I think doing those things, no matter how small they feel, really helps support the patients through these changes in therapy.
Bispecific Antibody Therapy | What Is the Treatment Duration and Response?
/in Care Partner Programs, Care Partner Resources, Care Partner Resources Video, Care Partner TK, Care Partner TK Bispecific Understanding, MM Treatments and Clinical Trials, MM Videos TC, Multiple Myeloma /by Kara RayburnBispecific Antibody Therapy | What Is the Treatment Duration and Response? from Patient Empowerment Network on Vimeo.
What can myeloma bispecific antibody therapy patients expect for treatment duration and response? Nurse practitioner Alexandra Distaso from Dana-Farber Cancer Institute discusses treatment factors that may impact response, common monitoring tests during treatment, and what might be considered an ideal therapy response.
Alexandra Distaso, MSN, FNP-BC is on the Multiple Myeloma Nursing Team at Dana-Farber Cancer Institute.
See More from The Care Partner Toolkit: Bispecific Antibodies
Related Resources:
How Can Bispecific Antibody Therapy Care Partners Be Proactive?
What Is the Role of a Care Partner in Bispecific Antibody Therapy?
Bispecific Antibody Therapy Support | Care Team Members and Resources
Transcript:
Katherine:
How long will a patient be on a therapy like this?
Alexandra:
So, we still don’t know exactly the long-term duration of response. I think the most recent update we have was a median of 18 to 22 months was the last report. Which is a great response for what we have in myeloma.
Katherine:
So, does the length of time a patient is on a therapy depend on the patient themselves, their comorbidities, et cetera?
Alexandra:
Sometimes their comorbidities, but it is usually more just how their myeloma responds. So, every month when you’re coming in for therapy, even if your therapy is weekly or biweekly, every month, we’re monitoring your myeloma markers, and every month we’ll go over those markers to make sure we’re still seeing a good response. Usually, we’ll do a PET scan or a skeletal survey to also monitor everyone’s bones and any other lesions, they may have.
Katherine:
What is considered an ideal response?
Alexandra:
An ideal response. A lot of times we’re seeing everyone’s light chains go to even an undetectable level. So, even if we see some partial responses where the light chains were, let’s say they were 100 and they’re going down into the normal range, that’s still wonderful.
If it stayed like that for months, we wouldn’t make any changes. But best-case scenario, we see them go to a level that we can’t detect them in the blood work.
Bispecific Antibody Therapy | Managing Side Effects
/in Care Partner Programs, Care Partner Resources, Care Partner Resources Video, Care Partner TK, Care Partner TK Bispecific Understanding, MM Treatments and Clinical Trials, MM Videos TC, Multiple Myeloma /by Kara RayburnBispecific Antibody Therapy | Managing Side Effects from Patient Empowerment Network on Vimeo.
What should myeloma bispecific antibody therapy patients know about managing side effects? Nurse practitioner Alexandra Distaso from Dana-Farber Cancer Institute discusses common short-term and long-term side effects, members of the healthcare team, medications for managing side effects, and how care partners can support bispecific antibody patients.
Alexandra Distaso, MSN, FNP-BC is on the Multiple Myeloma Nursing Team at Dana-Farber Cancer Institute.
See More from The Care Partner Toolkit: Bispecific Antibodies
Related Resources:
Bispecific Antibody Therapy | What is the Treatment Duration and Response?
What Is the Role of a Care Partner in Bispecific Antibody Therapy?
Bispecific Antibody Therapy Support | Care Team Members and Resources
Transcript:
Katherine:
What are the short-term side effects associated with bispecific therapy?
Alexandra:
Yeah. So, the short-term side effects that we’re watching for are these reactions in the hospital called CRS, cytokine release syndrome, and neurotoxicity.
So, the CRS is an inflammatory response where cytokines are released and usually cause a fever. We monitor and make sure that the fever isn’t being caused by some sort of infectious process or there’s no other cause for the fever. And if not, then there are medications we can give to help reverse these side effects while you’re in the hospital.
Katherine:
Who else is on the healthcare team when someone receives these therapies?
Alexandra:
Yep. So, you’ll always meet with your oncologist or an oncologist at the academic medical center where you’re going to be getting the medication to go over potential side effects, what the treatment entails, and consent. We have nurses here that are specific to bispecific antibodies, that help coordinate with your local team if you’re going back to your local practice. We have the infusion nursing team who are the ones who are actually giving the bispecific antibody therapies. They explain kind of what to watch for at the site where the injection goes. And then we have pharmacists who are also available to meet with you and go over any questions you may have about the treatment.
Katherine:
What do we know about long-term side effects? Are there any?
Alexandra:
So, long term, what we’re really seeing is risk for infections. So, all of these medications lower your blood cell counts, and we have to watch for these opportunistic infections, fungal, bacterial, viral.
Which is why it’s important that we have everyone on supportive medications to try and prevent that from happening. But long term, that is certainly something that we’re seeing. With the talquetamab, there can also be some skin and taste changes, and those are not necessarily right at the inpatient dosing, but we can see that. But those are things we’re also managing in the months after the initial therapy.
Katherine:
Okay. Why is it so important that care partners let the healthcare team know of any changes that they see in their loved ones?
Alexandra:
I say this to my patients and their families all the time. They know their family member best, and they may be one to notice that they’ve been more tired, or their energy just isn’t the same, or they do have a little cough that maybe the patient hasn’t even really noticed. And those are all things that we want your observation, we want you to speak up about, because the sooner we address some of these problems, the less complications the patients may have.
Katherine:
What are the supportive medications for somebody who might be having side effects?
Alexandra:
Yeah, so with the talquetamab (Talvey), which we’re primarily seeing a lot of skin side effects and mouth discomfort, a lot of the time we have special mouthwashes to prevent discomfort and irritation. Things like biotin to just keep the mouth moisturized. Steroid creams and nail ointments to help with sometimes some peeling of the skin.
And then for all bispecifics, we have everyone on viral prophylaxis. Something like acyclovir (Sitavig or Zovarax) or valacyclovir (Valtrex). PJP prophylaxis. So, something like sulfamethoxazole and trimethoprim (Bactrim) or dapsone (Aczone). And almost all of our patients are on an IVIG infusion once a month to help support their immune system and prevent against infections.
Katherine:
Alexandra, you mentioned care partner looking for a cough, for instance, in a patient.
What other things should care partners be looking for?
Alexandra:
Any kind of change in the patient’s baseline is always helpful to know. So, if people are feeling much more tired, even if you’re not due for your therapy, sometimes calling to say that they just don’t seem themselves, we can check their blood counts. And again, sometimes they might need a blood transfusion, or their white count might be quite low, and they might need some Neupogen or filgrastim to help kind of support their blood counts. So, really kind of notifying us, even if it doesn’t seem like a big thing, it’s always better to call.
How Is Bispecific Antibody Therapy Administered?
/in Care Partner Programs, Care Partner Resources, Care Partner Resources Video, Care Partner TK, Care Partner TK Bispecific Understanding, MM Treatments and Clinical Trials, MM Videos TC, Multiple Myeloma /by Kara RayburnHow Is Bispecific Antibody Therapy Administered? from Patient Empowerment Network on Vimeo.
How is myeloma bispecific antibody therapy given to patients? Nurse practitioner Alexandra Distaso from Dana-Farber Cancer Institute explains how the treatment is administered in the body, hospital types to access the treatment, and what patients should expect for the procedure and monitoring.
Alexandra Distaso, MSN, FNP-BC is on the Multiple Myeloma Nursing Team at Dana-Farber Cancer Institute.
See More from The Care Partner Toolkit: Bispecific Antibodies
Related Resources:
Bispecific Antibody Therapy | What is the Treatment Duration and Response?
What Is the Role of a Care Partner in Bispecific Antibody Therapy?
Bispecific Antibody Therapy | Managing Side Effects
Transcript:
Katherine:
So, let’s dive into the process. How is this treatment administered, and what’s the frequency?
Alexandra:
So, currently, all of the bispecifics are given as subcutaneous injections.
And all of them do require a current hospitalization visit, somewhere between four and 10 days, depending on which medication you’re getting and what schedule you’ll be on. So, everyone is required to be in the hospital. Again, we’re trying to move that outpatient to minimize patients’ times in the hospital if we have to. And you get a lower dose with that first exposure to each of the medications, and then we build up the dose for the doses in the hospital into what will eventually be your outpatient weekly, or biweekly dosing.
Katherine:
Okay. Are there only certain medical centers that have this therapy? How widely available is it?
Alexandra:
So, right now, the step-up dosing, the inpatient hospitalization part of bispecifics is primarily only at academic medical centers. So, it is a little bit more restricted in that initial therapy. But what we are seeing is that a lot of the community practices are able to enroll and give these medications in the community.
So, some patients will come see us for a consult and the initial step up, but then they’re able to go back to their primary team after the first cycle so that they’re not commuting back and forth to Boston all the time.
Katherine:
That’s good to know. So, once the therapy has been given to a patient, what happens next?
Alexandra:
When you’re admitted for these initial step-up dosings, we closely monitor you for reactions in the hospital. That’s why we kind of are doing this in in-patient settings to monitor very closely for CRS and neurotoxicity, which we’ll talk about a little bit later. While you’re in the hospital, they’re checking your labs every day, they’re monitoring your vital signs, they’re doing silly questions like, “Do you know your name and the year,” to kind of monitor how you’re functioning. Once you have passed kind of the step-up dosing, either you’ll come back to me and your primary team at Dana-Farber, or we’ll communicate with your local team to set up your schedule for moving forward.
Bispecific Antibodies for Myeloma | Patient Eligibility Requirements
/in Care Partner Programs, Care Partner Resources, Care Partner Resources Video, Care Partner TK, Care Partner TK Bispecific Understanding, MM Treatments and Clinical Trials, MM Videos TC, Multiple Myeloma /by Kara RayburnBispecific Antibodies for Myeloma | Patient Eligibility Requirements from Patient Empowerment Network on Vimeo.
What are the myeloma patient eligibility requirements for bispecific antibodies? Nurse practitioner Alexandra Distaso from Dana-Farber Cancer Institute discusses patient types that work well with bispecific antibody therapy, patient eligibility requirements, and updates about research developments with bispecifics.
Alexandra Distaso, MSN, FNP-BC is on the Multiple Myeloma Nursing Team at Dana-Farber Cancer Institute.
See More from The Care Partner Toolkit: Bispecific Antibodies
Related Resources:
Bispecific Antibody Therapy | What is the Treatment Duration and Response?
How Is Bispecific Antibody Therapy Administered?
Bispecific Antibody Therapy | Managing Side Effects
Transcript:
Katherine:
Well, who is this treatment approach approved for, and what are the eligibility requirements?
Alexandra:
So, one thing that’s great about bispecific antibodies is that there is not a lot of restriction on who we can use these therapies for. So, these are great for patients who are a little bit more frail or maybe aren’t up for something like a CAR T, or whose disease is a little further along, and they don’t have time to wait for something like CAR T, which requires collecting of cells and manufacturing. What’s great about these medications is that they’re off the shelf. They’re ready to go kind of when you need them. There are restrictions in terms of how many lines of therapy that you need to have had before you can currently get bispecifics.
So, right now, you need to have four prior lines of therapy, and that needs to include an immunomodulatory agent. So, something like a lenalidomide (Revlimid) or a pomalidomide (Pomalyst), a proteasome inhibitor like bortezomib (Velcade), and a monoclonal antibody like daratumumab (Darzalex) before you’re eligible for these.
Katherine:
Have there been any recent bispecific antibody research developments that patients should know about?
Alexandra:
So, there are at least three bispecific antibodies that are hopefully coming into approval in the next several months to year, cevostamab being one of them. It’s a very exciting time for myeloma with all of these medications being approved. Teclistamab (Tecvayli), elranatamab (Elrexfio), and talquetamab (Talvey) in the last year. There’s still a lot of research on bispecific antibodies, especially trying to bring them all outpatient instead of just having inpatient treatment, and in addition, looking at them with other medications, such as teclistamab with daratumumab.
How Has Bispecific Antibody Therapy Impacted Myeloma Care?
/in Care Partner Programs, Care Partner Resources, Care Partner Resources Video, Care Partner TK, Care Partner TK Bispecific Understanding, MM Treatments and Clinical Trials, MM Videos TC, Multiple Myeloma /by Kara RayburnHow Has Bispecific Antibody Therapy Impacted Myeloma Care? from Patient Empowerment Network on Vimeo.
What has been the impact of bispecific antibody therapy for myeloma care? Nurse practitioner Alexandra Distaso from Dana-Farber Cancer Institute discusses how bispecific antibody therapy fights cancer and patient situations that are served especially well by the therapy.
Alexandra Distaso, MSN, FNP-BC is on the Multiple Myeloma Nursing Team at Dana-Farber Cancer Institute.
See More from The Care Partner Toolkit: Bispecific Antibodies
Related Resources:
Bispecific Antibodies for Myeloma | Patient Eligibility Requirements
How Is Bispecific Antibody Therapy Administered?
Bispecific Antibody Therapy | Managing Side Effects
Transcript:
Katherine:
We’re going to be focusing on bispecific antibody therapy. It’s a relatively new approach. What is it exactly?
Alexandra:
Yeah. So, bispecific antibodies are a really exciting new therapy in myeloma that we’ve had for within the last year.
So, we have three bispecific antibodies that are currently approved right now. And the way that they work is, the medication binds to the tumor site on your plasma cell, where the myeloma cell is, and it binds to a T cell, which is your immune system cell. And it kind of works to redirect the T cell, your immune system, to kill off the cancer cells in your body.
Katherine:
Okay. How has this treatment impacted the state of myeloma treatment and care?
Alexandra:
This has been a great option for patients who are now triple-class refractory and further into their myeloma journey. The development of these new drugs represents really kind of a new era in myeloma. We’re having a lot of patients who are now exposed to more therapies with using three or four drug therapies in the first-line setting. So, having an extra line of therapy now further down the road has been a great option for a lot of patients.
[ACT]IVATED Endometrial Cancer Resource Guide en español II
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Advancements in Lung Cancer Clinical Trials | Updates for Veterans
/in LC Access and Affordability, LC Activated, LC Activated Veterans, LC Blog ND, LC Newly Diagnosed, LC Programs, LC Treatments and Clinical Trials, LC Videos AA, LC Videos TC, Lung Cancer, Non-Small Cell Lung Cancer, NSCLC Access and Affordability, NSCLC Newly Diagnosed, NSCLC Treatment and Clinical Trials /by Kara RayburnAdvancements in Lung Cancer Clinical Trials: Updates for Veterans from Patient Empowerment Network on Vimeo.
How can veterans help move lung cancer clinical trial advancements forward? Expert Dr. Drew Moghanaki from UCLA Health explains clinical trial groups that need more participants, available support resources for veterans, and patient advice.
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Transcript:
Lisa Hatfield:
Dr. Moghanaki, can you speak to ongoing clinical trials and research specifically for veterans? And are there any clinical trials or research studies available that focus on lung cancer treatments specifically tailored to veterans from underrepresented communities?
Dr. Drew Moghanaki:
Yeah. So we want to focus on the people we care about the most, which for many of us are veterans, but at the end of the day, partnering nationally and globally in clinical trials is probably the best thing that we can do. We don’t really think that the lung cancer is…that our veterans are dealing with is necessarily different than what a civilian may be. So by partnering, we have bigger scale to tackle these problems and get these studies done as quickly as possible.
When it comes to underserved communities, same thing. We do the VA and VA researchers definitely make a point of trying to get more underrepresented communities access to clinical trials. But again, we just usually geographic challenges are our biggest barrier. Someone wants to live in this beautiful part of the country up in a mountainside near a lake, but they’re two-and-a-half hours away from a city. That can be challenging for us.
But the good news is that the VA does provide a lot of housing. So for those veterans who live far away, if they want to come, we’ll take care of them. We’ll provide, if they’re eligible for your VA healthcare, we’ll provide them housing. We can even provide them with their meals. And so, and get them access to the best care. So basically my activation tip here is to be aware that clinical trials are really critical.
It’s how we’ve moved forward. It’s a tremendous opportunity to help other veterans behind themselves who will get lung cancer in the future. There’s nothing we can do at this time to stop the number of people getting lung cancer. And so the more research we can do, the better this world can be. And my activation tip is to speak up and ask if there is a clinical trial that you may be eligible for to help another veteran. And, of course, when you enroll in a trial, you’ll be getting basically the best treatments that we think are available at this time.
Lisa Hatfield: Great. Thank you. Thank you so much. Those activation tips were really great and patient-centered. And I think that’s what, at least me as a patient, watching that in the audience, that’s what I want to hear is what can I do to help advocate for myself? So thank you for those responses.
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Lung Cancer Care for Veterans: Advancements in Radiation Oncology
/in LC Access and Affordability, LC Activated, LC Activated Veterans, LC Blog ND, LC Newly Diagnosed, LC Programs, LC Treatments and Clinical Trials, LC Videos AA, LC Videos TC, Lung Cancer, Non-Small Cell Lung Cancer, NSCLC Access and Affordability, NSCLC Newly Diagnosed, NSCLC Treatment and Clinical Trials /by Kara RayburnLung Cancer Care for Veterans: Advancements in Radiation Oncology from Patient Empowerment Network on Vimeo.
What should veterans with lung cancer know about radiation oncology advancements? Expert Dr. Drew Moghanaki from UCLA Health explains recent advancements in radiation oncology and radiotherapy, where the advanced therapies are accessible, and proactive patient advice.
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Transcript:
Lisa Hatfield:
Dr. Moghanaki, are there any promising advancements or techniques in radiation oncology that could potentially improve outcomes for veterans with lung cancer?
Dr. Drew Moghanaki:
Yeah, there really are. So back in the old days, radiotherapy was just an open beam that we would shine towards a general area of the body. And they did a good job of getting control of the cancer, but, unfortunately, it would injure a lot of normal tissues. Today, radiotherapy is much more precise and targeted. In fact, our precision is within less than a millimeter of what we aim at. And so military analogy is this is like your best sharpshooter that can hit a small, less than a one-inch target from a 1,000 yards away.That’s basically what we’re able to do. We’re not a 1,000 yards away. The machine’s right there. We can see inside the human body. We can see the tumor, especially if it’s moving, and we can deliver highly concentrated high dose X-rays specifically to the tumor with a very little amount of exposure to the area around it.
So we’re just not seeing our patients getting injured from radiotherapy, and we’re seeing sometimes some situations up to 100 percent complete tumor control with no further growth. So it’s really important for veterans to know. So my activation tip is if surgery is on the table, you might want to check in with a radiation oncology team as well to see, well, is radiotherapy an option as an alternative? It might be safer and just as good and maybe better. So a lot of people don’t know about this because this is not taught as much, but radiotherapy is really one of the major forms of curative therapy for lung cancer.
Lisa Hatfield:
Okay, thank you. As a patient, I always have follow-up questions to clarify a couple of things. So I have another follow-up question to this, the question you just answered. So I know that not all veterans are seen at VA hospitals or VA facilities. If they are being seen at a VA facility, will they have access to the latest and greatest radiation radiotherapy services, or do only some centers have these special types of therapies?
Dr. Drew Moghanaki:
Yeah, well, when it comes to the VA’s commitment to provide the best care for every single veteran who’s eligible, there’s a logistical challenge in that it’s hard to deliver care to veterans everywhere, especially super sub-specialty care like thoracic surgery or radiation therapy. The equipment’s expensive. There’s a lot of staff that has to be hired. You can just look at airports. We don’t have a major commercial airport in every town and city in the U.S. They’re in major towns, major cities.
And that’s kind of how things are with the VA medical centers. And even when you look at the network of 130 VA medical centers in the 50 states of the U.S. only just more than 40 of them actually have radiotherapy on site at that VA medical center. So a lot of veterans who actually need radiation therapy are going to be getting that through the VA referred out to the community providers.
And so it’s important to if you’re at the VA, you’re very likely to get high-quality radiation therapy because a lot of oversight, the federal government’s watching. In fact, it’s the most regulated radiation oncology service in this country at this time. But if you’re going out into the community, make sure you do your homework. And my activation tip would be then make sure you do your homework and try to make sure that the department of radiation oncology you’re going to really does have the best technologies. And there’s lots of different ways to look at this, including going online and reading more about what the quality of care might be in the community.
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Are There Lung Cancer Outcome Disparities for Veterans?
/in LC Access and Affordability, LC Activated, LC Activated Veterans, LC Blog ND, LC Newly Diagnosed, LC Programs, LC Videos AA, Lung Cancer, Non-Small Cell Lung Cancer, NSCLC Access and Affordability, NSCLC Newly Diagnosed /by Kara RayburnAre There Lung Cancer Outcome Disparities for Veterans? from Patient Empowerment Network on Vimeo.
Do lung cancer outcome disparities exist for veterans? Expert Dr. Drew Moghanaki from UCLA Health discusses veteran outcome studies for civilian versus VA healthcare, efforts on improving outcomes over time, and proactive advice for accessing the best lung cancer care.
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Related Resources:
Combating Disparities: Veterans’ Healthcare Access and Quality
Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols
Lung Cancer Care for Veterans | Advancements in Radiation Oncology
Transcript:
Lisa Hatfield:
Dr. Moghanaki, can you discuss any disparities or differences in health outcomes among veterans compared to the general population when it comes to lung cancer treatment?
Dr. Drew Moghanaki:
Yeah, when it comes to lung cancer treatment, there’s new data that’s showing that since the discovery of better drugs and safer surgery and more effective radiotherapy, that survival rates are improving gradually, especially over the last 10 years. We’ve seen this same trend with VA data as well, that veterans, whether they’re getting care in a community or in the VA, the outcomes are getting better.
Are there disparities? Well, there’s notable disparities that we’ve identified which is that although outcomes in general are getting better for female and male and Black and white and other ethnic sections of the population, there continues to be a disparity in the civilian sector in that our Black patients, whether civilian or veteran, have inferior outcomes. And, of course, we know this is associated largely with other socioeconomic issues related to a long history of racism in this country that’s led to segregation and unequal access to health care and well-being opportunities.
But what we see in the VA, whether you’re Black or white, actually the outcomes are the same. So there’s something that VA is doing that’s addressing the barriers that are affecting people in the general population. And in fact, we see in some of our studies, Black veterans actually have better outcomes. And so we’re learning that it’s much more than just biology by itself, that there really are socioeconomic factors. And when you’ve got a healthcare system that’s more than just a healthcare system, it’s a benefit system as well.
We really provide a nice safety net that helps address those disparities. But the sad truth is that it definitely disparities do continue to exist outside the VA healthcare system. So my activation tip is, if you’re a veteran with maybe some less resources than others, again, check into the VA because the VA provides not just healthcare, but also a lot of support services, especially when you have lung cancer, which as mentioned, is just very difficult to deliver and requires more than just access to a doctor.
Lisa Hatfield:
And I’d like to mention a paper also that you published regarding improving outcomes over a certain time period. There was a paragraph in there where you had a discussion about potential contributing factors to the improvement of outcomes over time. Are you willing to discuss those a little bit, what those potential factors are for improving outcomes in patients with lung cancer?
Dr. Drew Moghanaki:
Yeah, there are three main components. One is making sure you get the diagnosis right. Making sure you do the right biopsies and you send the specimens for what’s called biomarker testing to make sure you know what type of lung cancer. There’s now more than a dozen different types of lung cancer. And if you don’t get that biomarker test, you’re not going to know. You’re just going to be treated with standard therapy. If you get the biomarker testing, you can get personalized medicine with a drug that’s more likely to work and probably safer than the older conventional chemotherapies, which still has a role. But sometimes we can skip chemotherapy altogether and go directly to a targeted therapy.
The second big advancement comes in the treatment delivery itself. So surgical treatments are now much less invasive than ever before. In fact, many of our patients, they go to the operating room, they wake up with four Band-Aids, and half their lung is removed. Remarkable technology using robotic and video-assisted technologies. Same with radiotherapy.
Patients lay on a table and the machine, the very sophisticated machine just rotates around them, zaps these tumors. The patient can actually drive themselves back and forth to treatment and go home and and live their lives. We’ve got patients getting lung radiotherapy, and they’re playing golf the next day. It’s unbelievable. And then the third really comes down to survivorship, which is that our patients, even if we really can’t cure their cancer, like a lot of advanced diabetes, we just can’t cure, we can keep our patients going as they live a high-quality life moving forward and make sure that their journey, unfortunately, with their lung cancer that they obviously didn’t ever want to have, that their journey is the best that it can be.
So my activation tip here is if you’ve got cancer, to really understand lung cancer, to really appreciate that there’s been a lot of advances and if you’re not feeling that you have access to those advances, get a second opinion and go to a bigger place that actually has an integrated approach to lung cancer care with a multidisciplinary team were the doctors in different specialties are working together and are focused on giving the best lung cancer care.
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Veteran Lung Cancer Risk | Understanding Exposures and Screening Protocols
/in LC Access and Affordability, LC Activated, LC Activated Veterans, LC Blog ND, LC Newly Diagnosed, LC Programs, LC Videos AA, Lung Cancer, Non-Small Cell Lung Cancer, NSCLC Access and Affordability, NSCLC Newly Diagnosed /by Kara RayburnVeteran Lung Cancer Risk: Understanding Exposures and Screening Protocols from Patient Empowerment Network on Vimeo.
What’s important for veterans to know about lung cancer risk? Expert Dr. Drew Moghanaki from UCLA Health discusses known veteran lung cancer risk factors, screening recommendations, and proactive patient advice involving the PACT Act.
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Related Resources:
Combating Disparities: Veterans’ Healthcare Access and Quality
Are There Lung Cancer Outcome Disparities for Veterans?
Lung Cancer Care for Veterans | Advancements in Radiation Oncology
Transcript:
Lisa Hatfield:
Dr. Moghanaki, there is a stigma around military personnel being at higher risk for lung cancer than civilians. Is there an elevated risk for those in the military? If so, why and who should be screened?
Dr. Drew Moghanaki:
Yeah, the stigma of veterans being at higher risk for lung cancer is real. And I think Hollywood had a big role in it. And is it appropriate? Well, I never liked the word stigma, but I think it’s important for the public. And of course, soldiers or any military personnel who served in the armed forces appreciates that back in the days the bases were much dirtier than they are today. And there was a lot of exposure to a lot of things that can cause cancer and actually other health problems as well, such as diabetes and Parkinson’s disease and Alzheimer’s and other things.
So yes, it’s true that our veterans, especially if they were working around toxic chemicals or in the Middle East, where the open burn pits were leading to inhalation of a lot of toxic fumes, that these folks are at a higher risk and should be more proactive with any symptoms. So if you’re just a 45-year-old, 55-year-old male or female, and you’ve got a cough, generally speaking, you may not be so worried and just hope it goes away.
But if you’ve been on these dirty bases, it’s important to look into this and find out now how dirty are the bases? Well, there’s been the media I think over exaggerates exactly what was going on and what was on these bases. But there are lots of federal reports that have documented exactly some of the, for example, like if you were stripping aircraft with a certain stripping material, a lot of these substances are currently now chemicals are banned because we as soon as we learn that they’re toxic, we basically ban them.
But generally speaking, yeah, health concerns are a little bit elevated if you’ve served in the military and especially if you’ve been deployed in the field of battle. And so my activation tip is if you’ve had an office job, well, you probably have the same risk as your neighbor wherever you’re living. But if you were in a combat zone or on a base where there were a lot of chemicals, probably want to pay a little more attention and check in with your primary care doctor to get some appropriate screening tests for yourself.
Lisa Hatfield:
Are there any programs in place right now where veterans who’ve had those exposures or potential exposures, where they are being screened regularly or is it up to the veteran to ask that question?
Dr. Drew Moghanaki:
So if a veteran is plugged in with the VA healthcare system, the primary care network here is set up to offer the appropriate screening. But if you’re not, it’s important to look into this. Again, I’m just going to keep saying over and over again, if you’re a veteran who’s not yet eligible, if you know anyone, please check in. Congress has radically expanded the eligibility within the PACT Act is actually primarily centered around this issue of risk. It’s about toxic exposures that the VA is still learning about and VA physicians like myself are still learning about. And so these programs definitely exist to address them, but the best way to do it is to get registered for VA healthcare.
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