With a theme this year of “Immunotherapy: Molecules and Mountains” the 44th Annual Scientific Meeting promised a brave new world of exciting developments in cancer treatment. The sub-theme of safety and quality dovetailed nicely by focusing on how best to deliver new age treatments and to understand and manage the unique set of side-effects and toxicities as they emerge; involving and working in partnership with other non-oncological medical disciplines as required.
The morning plenary session provided a sophisticated overview of the complexities of selecting and treating patients
The morning plenary session on Day 2 provided a sophisticated overview of the complexities of selecting and treating patients. All aspects of patient care were considered; from molecular and pathological drivers, clinical trials, response rates and survival to the problems of drug resistance and the particular challenges in safety and efficacy for some patient populations.
From this high level consideration of the general issues involved in managing immunotherapy treatment, the second plenary of the day narrowed down the focus to an in depth discussion of the clinical experiences of several patients. Co-chaired by COSA President Elect Professor Nick Pavlakis and Dr Alex Menzies, the format was that of an MDT panel discussion that has proved popular in recent meetings. Case histories were presented by the Chairs and robust discussion ensued between the panel members representing nursing, medical and radiation oncology, surgery and palliative care.
Other concurrent symposia throughout the day presented the usual challenges for conference delegates choosing between a selection of interesting and diverse offerings. The dual themes of immunotherapy and quality and safety were carried through; along with sessions on translational research, improving cancer health services, supportive care and the “best of the best” oral presentations.
One session of particular interest focused on the complex interplay of issues impacting on treatment adherence and compliance. Four speakers presented different aspects that contribute to the challenges for patients in adhering to recommended treatments; thus dispelling the myth that patients who don’t comply with treatment regimens are “difficult” or “irresponsible”.
In Australia, where we have a universal health care system that offers first class health care largely provided at no direct cost to the patient, it is frequently a surprise to patients that they can incur high levels of out of pocket expenses. Due to the variations in income and personal life circumstances there is no threshold at which difficulty meeting expenses (financial toxicity) tips into real financial distress, where patients and families may have to make choices between paying for aspects of their health care or meeting other living expenses. Some relatively small amounts of money can make treatment choices unaffordable for some low income patients.
At the other end of the financial toxicity scale is the decision made by some patients to use savings, mortgage extension or superannuation funds to access treatments that may be unscrupulously touted as “miracle cures” or “breakthroughs”. Such treatments are usually unproven and may be offered in overseas countries. Desperate patients may cling to the hope that this “last resort” treatment is worth depleting all of their savings, to the detriment of the financial security of surviving family members. The growing use of social media platforms to access public money via “crowdfunding” is an emerging domain of concern due to the potential for attempts to “con” money through the use of fraudulent claims about the efficacy of unproven treatments, or even about the cancer diagnosis itself.
Tish Lancaster, Clinical Nurse Consultant in Gynaecological Cancer at Westmead Hospital highlighted the social determinants that may influence treatment compliance. A range of factors, including poor health literacy, geographical remoteness, mental health history, homelessness, substance use, social isolation, inflexibility in employment arrangements and transport logistics all have the potential to impact on the ability of patients to commit to rigorous treatment regimens.
Professor Jane Turner from the University of Queensland and the Royal Brisbane and Women’s Hospital, and her Clinical Psychologist colleague Maree Grier, focused on the personality, behavioural and previous exposure to stressful life events as factors to be considered when patients appear to be responding in a non-compliant matter. Both Jane and Maree used case examples to highlight the importance of assessing early influences on adjustment and coping, thereby enabling appropriate psychological interventions to address anxiety, depression and complicated grief.
As always, there was something for everybody in a full and stimulating Day 2 program.