Provenge Treatment Requires Multidisciplinary Care Coordination

The FDA approved the immunotherapy Provenge (sipuleucel-T) in April 2010 for the treatment of asymptomatic or minimally symptomatic metastatic prostate cancer that is resistant to standard hormone therapy. At the 36th Annual ONS Congress, researchers from the Seattle Cancer Care Alliance (SCCA) discussed their multidisciplinary care coordination approach for treating patients with Provenge.

Provenge treatment involves a complex, multi-stage process. The first step is leukapheresis, in which a patient’s immune cells are extracted and sent to a manufacturing facility. The immune cells are then cultured with a recombinant antigen to create the anticancer vaccine, Provenge. In the final stage, the drug is administered to patients intravenously. The treatment generally requires 3 cycles that usually occur 2 weeks apart.

The SCCA researchers realized that successfully managing this intricate treatment required a standardized, multidisciplinary approach. They put together a team that included an oncologist, pharmacist, financial personnel, infusion room nurses, and clinic nurses responsible for coordinating the treatment. Using the Plan-Do-Study-Act quality-improvement model, the taskforce devised, implemented, and revised a Provenge treatment strategy.

The initial steps included developing a step-by-step care coordination checklist for the clinic nurse; establishing Provenge handling and administration procedures for both pharmacy staff and infusion room nurses; and putting together educational materials for patients.

After Provenge treatment began at SCCA, the taskforce met on an ongoing basis to continuously refine its treatment strategy. “We met on a weekly basis to look at how things were going; [discuss] what kind of barriers we were coming up against; [and] tweak our policies, procedures, and checklists,” said the study’s lead researcher, Juanita Madison, MN, RN, AOCN.

At present, 100 patients have been screened at SCCA for Provenge treatment, 22 have been eligible for the immunotherapy, and 57 infusions have taken place. According to Madison, the primary takeaway from SCCA’s experience is that all centers providing Provenge need an institution-specific, multidisciplinary treatment process. Additionally, she said facilities with a large volume of patients receiving Provenge need a full-time oncology nurse to coordinate the logistical aspects of the treatment.