Survey shows rapid, uneven adoption of immunotherapy across U.S. oncology practices

Most oncology practices deployed immunotherapies as part of their clinical care strategy within 2 years of FDA approval for cancer indications, results of a study in JAMA Oncology showed.

Nevertheless, researchers observed uneven adoption of novel immunotherapies based on practice type, practice size and location.

“There is good news in these results,” Nancy L. Keating, MD, MPH, professor of health care policy and medicine in the department of health care policy at Harvard Medical School, told Healio. “Even though there were some delays in [immunotherapy] adoption, deployment has been fairly rapid overall, and it was also pretty complete.”

Background

Previous research has shown the adoption of new technology in cancer care can often be slow and variable, according to Keating.

Due to their exceptional results in patients with solid tumors, the researchers wanted to assess the speed of immunotherapy adoption among U.S. oncology practices and whether any delays occurred based on practice location, size or affiliation.

“It is important to understand how well we are doing at identifying and incorporating really high value, highly effective treatments into our clinical practice,” Keating said.

“Unlike a lot of new technologies, [immunotherapies] don't require a lot of specialized equipment or big capital expenses to start using them,” she added. “We thought that that could lead to the possibility of more rapid adoption than for some other technologies, such as robotic surgery or [novel] radiation therapy techniques.”

Methodology

Keating and colleagues conducted a cohort study using data from a 20% random sample of Medicare fee-for-service beneficiary claims filed for 6-month chemotherapy regimens between 2010 and 2017.

The analysis comprised patients who received immunotherapy for cancer indications the FDA approved during the study period, including melanoma, kidney cancer, lung cancer, and head and neck cancer.

Whether a practice adopted immunotherapy served as the study’s primary outcome. Researchers evaluated practices based on location (rural vs. urban), practice affiliation (academic, nonacademic or independent) and practice size (one to five physicians vs. six or more physicians).

Key findings

The analysis yielded 71,659 chemotherapy claims filed at 1,732 oncology practices across the United States during the study period.

Most practices (85%) were in an urban setting, lacked affiliation (52%) and had more than six physicians (72%).

Investigators found rapid adoption of immunotherapy within 2 years of FDA approval. For example, a weighted 9% of practices had provided immunotherapy to at least one patient with melanoma within 6 months of approval.

Weighted adoption rates at 6 months reached 51% for lung cancer, 62% for kidney cancer and 56% for head and neck cancer. Weighted adoption rates 2 years after FDA approval increased to 76% of practice for melanoma, 95% for lung cancer and 81% for kidney cancer.

Researchers observed variation in immunotherapy use based on practice type, with adoption at rural practices 11 percentage points lower (95% CI, –16 to –6) than at urban practices. Likewise, immunotherapy adoption was 27 percentage points lower (95% CI, –32 to –22) at clinics with five or fewer vs. six or more practitioners.

Practices affiliated with academic systems had higher immunotherapy adoption rates compared with independent practices (difference of –6 [95% CI, –9 to –3] percentage points) and those affiliated with nonacademic systems (difference of –9 [95% CI, –11 to –6] percentage points).

Clinical implications

Despite an initial lag in immunotherapy uptake among rural, smaller oncology clinics, Keating said overall weighted adoption curves were “very high,” even among practices that were initially slow to provide these novel therapies.

“Interventions to increase adoption really need to focus on the first use, not rapidly increasing use once they have been prescribed to the first patient,” Keating told Healio, adding that it’s unsurprising that smaller practices would be slower to adopt newer treatment technologies.

“They don’t have the volume, so it takes a little more time to gain some experience and comfort level with new things,” she said. “They may just be waiting a little bit before they test the waters.”

For more information :

Nancy L. Keating, MD, MPH, can be reached at keating@hcp.med.harvard.edu.