Management Across Settings: An Ambulatory and Community Perspective for Patients Undergoing CAR T-Cell Therapy in Multiple Care Settings

Clin J Oncol Nurs. 2019 Apr 1;23(2):27-34. doi: 10.1188/19.CJON.S1.27-34.

Abstract

Background: Many patients are referred to chimeric antigen receptor (CAR) T-cell therapy programs from outside their primary oncology setting and community. Collaboration between the referring and treating providers is required to coordinate safe and effective care.

Objectives: This article presents an overview of key considerations for referring providers and institutions prior to and following CAR T-cell therapy.

Methods: Definitions of the consultation and workup, leukapheresis, bridging, lymphodepleting chemotherapy, infusion and monitoring, and long-term follow-up phases are presented, along with specific considerations for referring centers.

Findings: Although CAR T-cell therapy is limited to select centers, the process of supporting and educating patients and their caregivers requires a partnership between referring and treating providers. As CAR T-cell indications expand, management of patients in diverse settings requires a collaborative and evidence-based approach to support safe and effective care.

Keywords: CAR T-cell therapy; care coordination; community-based care; referring centers.

MeSH terms

  • Ambulatory Care*
  • Humans
  • Immunotherapy, Adoptive*
  • Neoplasms / therapy*
  • T-Lymphocytes / immunology*