Building the Team Around Combination Therapy Delivery

Siddhartha Devarakonda, MD, of Providence Swedish Cancer Institute describes what it takes to deliver combination therapy for epidermal growth factor receptor (EGFR)-mutated advanced non–small cell lung cancer (NSCLC) outside a trial, crediting financial advocates, social workers, nurses and pharmacists. He says patients panic at the cost of oral therapy, that asking why a patient cannot travel often surfaces a solvable barrier, and that caregiving responsibilities go unaddressed unless raised directly. His clinic runs a 1-hour nurse teaching visit that maps medications, skin care products and appointments onto a calendar, and his pharmacy prints multilingual labels. Matthew Gumbleton, MD, PhD, of Huntsman Cancer Institute says less resourced practices still have to meet patients where they are, would like to see treatment delivered at home eventually, and calls the time toxicity of cancer care substantial.