Virtual clinic provides rapid, specialized cancer care for patients facing adverse events
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Many people who experience side effects from cancer treatment wait nearly a month to see a specialist with the necessary expertise.
For some, the delay can extend to almost 3 months.
Afreen Shariff, MD, MBBS, and Aabid Shariff, PhD, co-founded Citrus Oncology to dramatically expedite this process.
The virtual multispecialty cancer support clinic is designed to match patients with specialists within 2 business days to help manage side effects that include adverse drug reactions and treatment-emergent adverse events.
Medical experts in more than a dozen areas — such as endocrinology, cardiology, nephrology, dermatology and rheumatology — are available to address a range of effects, from fatigue to more debilitating conditions like rheumatoid arthritis, adrenal insufficiency and heart conditions unique to immunotherapy, chemotherapy or radiation.
"In 2024, there will be approximately 2 million new cancer cases — equivalent to about 5,480 diagnoses each day. Of these, 55% qualify for newer treatments like immunotherapy, where side effects are more sophisticated than nausea and hair loss. Oncologists, palliative care and onco-primary care are required for broad side effect care, but when these treatments begin causing more specialized side effects like type 1 diabetes, skin rashes, heart conditions and rheumatoid arthritis, we require other specialists to work with the oncologist," Afreen Shariff, an endocrinologist with expertise in endocrine disease among people with cancer, told Healio. “The number of people receiving these treatments increased from 1.5% in 2011 to 55% in 2023. This creates a very sharp need for multiple subspecialties that can co-manage patients with oncologists."
Healio spoke with Citrus Oncology’s co-founders to learn more about how the platform works, the benefits it provides to patients and oncology practices, and their desire to transform the supportive care landscape.
Healio: Why does it take so long for patients with cancer to get help managing treatment-related adverse events, and why is this problematic?
Aabid Shariff: Let’s take endocrinology as an example. The median time to see an endocrinologist is 72 days, but finding an endocrinologist who understands the effects of chemotherapy or newer immunotherapies and targeted agents can take even longer. These specialists need to keep up with the latest in cancer treatments and their impact on the diseases they treat. It’s not just about needing specialists; it’s about needing specialists who understand what is happening well enough to work in a coordinated fashion with oncologists. Those are very difficult to find.
Afreen Shariff: The impact of longer wait times and poor access to experts affects cancer treatment and can lead to poor outcomes from delaying care for side effects. Time is critical here — lives are at stake. A person’s treatment depends on the management of side effects, and their quality of life is impacted. Some may go in and out of the hospital due to acute symptoms that develop because of side effects. Most importantly, treatment interruptions can result in cancer progression.
Healio: What motivated you to launch Citrus Oncology?
Afreen Shariff: Over the last decade, I have treated thousands of patients with treatment related adverse effects. I understood their challenges and needs and worked with numerous oncologists to support them in taking care of their patients. A large cancer center may be able to provide this specialty care, but what about community practices or people in other parts of the world who require this kind of sophisticated help? There is a global unmet need for targeted side effect management. We have made tremendous progress in managing cancer — it’s no longer the killer it used to be — but what about side effects? This is a growing area of need, and patients deserve better.
Healio: How does Citrus Oncology harness multidisciplinary expertise?
Aabid Shariff: We have a national network of physicians who are available online to work with patients and oncology practices in the specialties with which they need assistance. The experts on our platform provide standardized, evidence-based treatment recommendations. Our proprietary clinical platform is designed by national experts in cardio-oncology, onco-endocrinology, rheum-oncology, derm-oncology, onco-nephrology and other specialties. This ensures that every patient with a side effect is treated with care and expertise throughout our platform.
Afreen Shariff: This is one way we mitigate the demand-supply mismatch. Our platform supports community specialists in providing targeted care for side effects. We also integrate AI models to help scale and make our process efficient.
Healio: How can oncologists get help for their patients?
Afreen Shariff: Oncologists can sign up as partner providers on our platform. When a patient experiences a side effect that requires specialist input, they can submit a referral through their electronic health record, providing relevant patient information and specific concerns. They will receive expert recommendations within 2 business days. The provider then reviews and implements the recommendations and can collaborate with Citrus specialists on any follow-up questions.
Healio: How does Citrus Oncology support clinical trials and facilitate value-based contracts with payers?
Afreen Shariff: We support clinical trials by developing standardized protocols for side effect diagnosis and initial assessments. Our nationally recognized medical advisory team consults on clinical trials to assist with protocols and implementation plans around toxicity identification and management. Trial sites have access to the protocols, which include structured triggers that prompt a consultation. Once a consultation is triggered, we help manage treatment-related side effects, potentially improving patient retention and adherence. Our platform can also be used to collect real-world data on side effect management, and we support remote monitoring of trial participants.
Unlike other platforms, we’re not trying to put a Band-Aid on the problem. We want to take ownership of side effects so oncologists or clinical trialists can focus on recruiting, implementing and retaining patients.
Aabid Shariff: Regarding value-based contracts, our fast access consultations for side effects have reduced hospitalizations from 11% to 2%. The Citrus intervention can have a real impact on the quality, safety and adherence to cancer treatments. Our services can contribute to better patient outcomes and satisfaction, which are key metrics in value-based care. We provide data on interventions and outcomes that can inform value-based payment models. Our platform also supports care coordination.
Healio: Do you plan to expand the platform?
Aabid Shariff: We plan to expand our network of experts to cover a wider range of side effects. We are working on integrating AI and machine learning to enhance our triage and recommendation processes. Additionally, we plan to develop more robust data analytics to provide insights on side effect patterns and management strategies to optimize for coordinated care.
We hope to expand our services to support more clinical trials and research initiatives and explore partnerships with cancer centers to integrate our platform into their care models. Another goal is to develop specialized programs for specific cancer types or treatment modalities.
Healio: Is there anything else you’d like to mention?
Afreen Shariff: This is more than a telemedicine platform. We're working to transform the landscape of supportive care in oncology. By addressing side effects promptly and effectively, we aim to improve not just individual patient outcomes, but the overall efficiency and effectiveness of cancer care delivery.
Our virtual model helps bridge gaps in access to specialized care, particularly for underserved communities. Every patient deserves access to expert care for cancer treatment-related side effects, and we're working hard to make that a reality.
For more information:
Aabid Shariff, PhD, and Afreen Shareef, MD, MBBS, can be reached at info@citrusoncology.com.
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