'We've just had to hit the ground running': Health professionals' experiences of cancer immunotherapy: A qualitative study

Background This paper reports early findings from a qualitative investigation of people’s experiences of cancer immunotherapy with immune checkpoint inhibitors. Cancer immunotherapy is transforming outcomes for some people affected by cancer. Clinical trials have found that immune checkpoint inhibitors (ICIs) demonstrate clinical benefit across various cancers. Several ICIs are now approved for a range of cancers and used across UK cancer centres. However, there is little research focused on UK healthcare professionals’ experiences of delivering and supporting people receiving ICI’s together with their associated education and training needs. Method This study sought to obtain in-depth insight into healthcare professionals’ experiences of caring for people receiving cancer immunotherapy and their associated education, training and support needs. NHS ethical approval was granted for the participating NHS sites. UK healthcare professionals (11 nurses, 3 doctors and 2 pharmacists) from oncology services, primary and secondary care (acute oncology) were recruited using purposive and snowball sampling. In view of COVID-19 physical distancing requirements, digitally-recorded, semi-structured telephone interviews were conducted between May and September 2020. Transcribed, anonymised data were analysed using Braun and Clarke’s reflexive, thematic analysis. Results Data suggest healthcare professionals have variable educational and training needs relative to supportive care in cancer immunotherapy. The provision of immunotherapy care, particularly within oncology, is currently approached predominantly through the biomedical lens of toxicity management. Perspectives on holistic patient care, including psychological support, were limited. This disparity might be owing to ICI treatment as relatively novel compared with other anti-cancer treatments. Professionals considered ICIs as complex to manage, with significant efforts to establish a range of toxicities from both single-agent and combination ICI treatment ongoing, with many still considered unknown. Conclusion Further research should consider how healthcare professionals’ ongoing education and training needs for holistic supportive care can be best addressed. Impact statement This study seeks to make recommendations for ICI supportive care guidance development, cancer immunotherapy education materials for healthcare professionals, cancer policy and further research.