An increasing number of medicines for psoriasis, Crohn’s disease, multiple sclerosis (MS), rheumatoid arthritis, asthma, and other chronic conditions are being delivered by intravenous infusion. These next-generation therapies provide patients with effective new treatment options, but also require them to make an important decision: where should I go for my infusion?
In many cases, the dermatologists, gastroenterologists, neurologists, rheumatologists and other specialists prescribing those medications recommend that patients receive their infusions at community-based cancer centers. To better understand why those physicians would send patients who don’t have cancer to an oncology practice, Advance Media recently interviewed three hematologists-oncologists with Regional Cancer Care Associates LLC (RCCA), one of the nation’s largest networks of oncology specialists. With more than 125 cancer specialists practicing at 31 care centers located throughout New Jersey, Connecticut, Maryland, Pennsylvania, and the Washington, DC areas, RCCA provides care to roughly 24,500 new cancer patients and 245,000 established patients each year. However, thousands of people with other conditions, such as MS or Crohn’s disease, also regularly visit RCCA offices for infusions. The RCCA physicians interviewed say that five factors shape those patients’ decisions:
1. Balancing safety and convenience
“For many years, infused therapies were delivered only in the hospital. Over the past 20 years or more, however, infusions have been given in community-based clinics, as well, and in some cases they now are even being administered by a visiting nurse in a patient’s home,” explains Denis Fitzgerald, MD, Board Chairperson of RCCA.
“While in-home administration represents the most convenient approach, only a few therapies are suitable for infusion at home. Even in those cases, there is always a concern about responding to an infusion reaction. Adverse events are uncommon, and visiting nurses are trained to provide initial care for them, but managing an infusion reaction in the home setting just doesn’t compare with responding to a medical issue in a fully staffed and equipped community clinic or hospital. At RCCA, there is always a physician on site when infusions are given. Doctors, as well as nurse practitioners, are just a few steps away should there be a problem or question,” notes Dr. Fitzgerald, a board-certified medical oncologist and hematologist who practices in RCCA’s Little Silver, NJ office.
At the same time, Charanjeev Kapoor, MD says that receiving an infusion at community-based clinics such as RCCA’s offices is more convenient than going to a hospital. “In terms of everything from parking to processing, the hospital entails much more of a hassle factor,” says Dr. Kapoor, who practices at RCCA’s Manchester, CT office. “At our offices, patients sign in, are assessed and counseled, and then receive their infusion in a very efficient manner, so that they can get on with their day and their lives,” says Dr. Kapoor, who is board-certified in internal medicine, as well as hematology and medical oncology. “I think community-based offices such as ours offer the best of both worlds in terms of convenience, accompanied by ready access to medical personnel and resources,” he adds.
That convenience extends to making life easier for patients who see specialists at academic medical centers in New York, Philadelphia, or other major cities, but who don’t want to travel to those centers for regular infusions, notes Dr. Fitzgerald. “We have many people who go to Manhattan two or three times a year to see their neurologist or gastroenterologist, but who don’t want to travel to the city every month – or even more often – for routine care, so they come to us for their infusions,” he explains.
2. Expertise and experience
By virtue of providing chemotherapy and other infused treatments to tens of thousands of patients each year, RCCA healthcare professionals have developed deep expertise with administering intravenous medications, says Dr. Fitzgerald. “Research across a number of professions shows that there is a clear relationship between volume and skill. That’s true of pilots and surgeons, and it’s also true of the members of our infusion teams,” he notes.
Dr. Kapoor adds that this expertise translates into very effective patient counseling that addresses people’s spoken and often-unspoken concerns. “Our nurses review why the medication has been prescribed, how it works, the data on its efficacy, and what people need to know about potential side effects, including symptoms and how we will address them should they arise,” he explains.
“Receiving an infusion in a hospital may cost a patient twice as much, or even more, than receiving an infusion of the same medication at the same dose in a community-based clinic,” says Dr. Fitzgerald. He explains that hospitals generally have contracts with insurers that allow them to charge higher rates than community clinics due to the institutions’ considerable overhead costs. Hospitals also charge administration fees for giving medications that are far higher than those of community-based practices, with those expenses hitting patients in the form of steep co-pays and other out-of-pocket costs. “Because of this cost differential, many private insurers have begun mandating that patients receive infusions in community-based centers rather than hospitals whenever possible,” he notes.
RCCA’s offices are designed expressly to provide a comfortable environment for people receiving chemotherapy and other types of infusions.
“Our West Hartford, CT office has 20 treatment chairs in an infusion room designed so that everyone can look out into an open area and not feel confined,” says Dr. Kapoor.
Dr. Fitzgerald explains that the RCCA offices also have specially designed “mixing areas” where medications are prepared for infusion in a manner that prevents introduction of airborne contaminants. “The regulations regarding preparation of infused therapies are quite rigorous, as they should be, and they actually are becoming even more stringent. We closely follow the evolving regulatory landscape so as to remain fully compliant with all new requirements,” he says.
The physical environment is only one aspect of the welcoming atmosphere for infusion patients, Dr. Fitzgerald adds. “One advantage of going to a community-based office rather than a large hospital is that our receptionists, nurses, pharmacists, pharmacy technicians, and office personnel all come to know our patients very quickly and develop an ongoing rapport with them.”
But are people who don’t have cancer uncomfortable coming to an oncology practice and sitting next to chemotherapy patients who, in some cases, clearly have late-stage disease? “Frankly, some people express that concern initially, but we find that their discomfort typically is gone by the end of their first session. In large part, that’s because of the upbeat atmosphere created by our staff and due to the incredible resilience, grace and good humor of our patients and their families. Non-oncology patients have even told me that the experience has given them a new perspective on their own situation, however serious it may be,” Dr. Fitzgerald explains.
5. Communication with referring physicians
One of the benefits of practicing in the community is that we have excellent working relationships with our colleagues from other specialties. We see them at the hospital, we know one another by name, we speak frequently. This is a tremendous advantage for our patients,” says Dr. Kapoor, noting that if, for instance, there is a question about the treatment of a patient who comes to RCCA’s offices for infusion of an MS therapy, he can quickly contact the referring neurologist to clarify matters.
Dr. Fitzgerald adds that there will be even greater use of infusion-administered medications in the years ahead, as more and more therapies being developed to treat chronic conditions will be delivered intravenously. He notes, “Given this trend, more patients will have to make a decision about where to receive their infusion. By considering all of the factors involved – such as safety, setting, cost, convenience, and experience – patients and their families can arrive at the choice that is right for them.”
With more than 80 oncology physicians and nurse clinicians practicing at 20+ care centers throughout Connecticut, Maryland, New Jersey and the Washington, DC area, RCCA provides care to roughly 22,000 new cancer patients and 225,000 established patients each year. RCCA offers those patients immunotherapy, targeted treatment, cell-based therapy and other cutting-edge treatments and diagnostic modalities, as well as access to clinical trials.