Physician Views on the Provision of Information on Immune Checkpoint Inhibitor Therapy to Patients with Cancer and Pre-Existing Autoimmune Disease: A Qualitative Study

Abstract

Immune checkpoint inhibitors (ICIs) have improved cancer outcomes but can cause severe immune-related adverse events (irAEs) and flares of autoimmune conditions in cancer patients with pre-existing autoimmune disease. The objective of this study was to identify the information physicians perceived as most useful for these patients when discussing treatment initiation with ICIs. Twenty physicians at a cancer institution with experience in the treatment of irAEs were interviewed. Qualitative thematic analysis was performed to organize and interpret data. The physicians were 11 medical oncologists and 9 non-oncology specialists. The following themes were identified: (1) current methods used by physicians to provide information to patients and delivery options; (2) factors to make decisions about whether or not to start ICIs in patients who have cancer and pre-existing autoimmune conditions; (3) learning points for patients to understand; (4) preferences for the delivery of ICI information; and (5) barriers to the implementation of ICI information in clinics. Regarding points to discuss with patients, physicians agreed that the benefits of ICIs, the probability of irAEs, and risks of underlying autoimmune condition flares with the use of ICIs were most important. Non-oncologists were additionally concerned about how ICIs affect the autoimmune disease (e.g., impact on disease activity, need for changes in medications for the autoimmune disease, and monitoring of autoimmune conditions).

Learning Needs of Patients with Cancer and a Pre-Existing Autoimmune Disease Who Are Candidates to Receive Immune Checkpoint Inhibitors

“…Interestingly, some evidence suggests that physicians and patients may have different perspectives on patients' information needs. In a qualitative study reporting the determinants of ICI prescription and in our previous study evaluating physicians' views on information needs in this population, clinicians perceived general information about ICI treatment to be more useful than personalized or specific information [29,30]. In contrast, the patients who participated in our study expressed the need for more detailed information and personalized risk/benefit probabilities.…”

“…We observed several additional differences from our previous study involving physicians. Although the key information needs raised by physicians were similar to those raised by patients, several were raised only by patients: reasons for stopping or modifying treatment (for cancer or autoimmune disease); when to contact the provider; the possibility of autoimmune disease progression or organ damage; the need for sharing information among providers; and lifestyle changes that may ameliorate adverse effects [30].…”

Immune-related adverse events of anti-PD-1 immune checkpoint inhibitors: a single center experience

“…There have been numerous recommendations for the management and possible prevention of autoimmune irAEs ( 5 , 14 , 16 , 18 – 21 , 34 ). In our cohort, 60% of irAEs were Grade 1 and most irAEs were easy-to-control and only very few patients required the discontinuation of ICI therapy.…”

“…Finally, our results also suggest a close relationship between ICI efficacy as determined by PFS and irAEs. Despite the possible limitations of our study, we collected and analyzed data in the CEE region and provided more information on ICI-related irAEs for practicing physicians ( 34 ).…”