Important Study For Cancer Patients: High Volume Hospitals Produce Better Outcomes For Advanced Cancer Patients Who Receive Immunotherapy– Where You Get Treated Can Matter

Dr. Sajid Khan is the lead author of the study. He is also the section chief of Hepato-Pancreato-Biliary (HPB) and Mixed Tumors at Yale School of Medicine. He tells SurvivorNet that “immunotherapy is not effective for many patients with early-stage disease.” Hence, this contributed to metastatic cancer patients diagnosed with melanoma, non-small cell lung cancer, and kidney cancer being chosen for the study.

He adds that surgery is the mainstay treatment for these types of cancer patients in the early stages of their cancer.

“Immunotherapy is sometimes administered in an adjuvant (post-operative) setting. However, in metastatic cancers, immunotherapy is highly effective for treating melanoma, non-small cell lung cancer, and kidney cell cancer,” Dr. Khan added.

Additionally, patients who receive this treatment in high-volume healthcare facilities tend to have a higher survival rate than those who receive immunotherapy at low-volume hospitals or non-academic healthcare facilities.

“Low-volume and non-academic hospitals have worse survival for immunotherapy as a whole, plus are more likely to have patients immunotherapy initiated within the last 30 days of life,” Dr. Khan explained.

He believes these facilities are “less resourced than high volume and academic hospitals,” which could be contributing factors to the poorer survival outcomes.

The study found that within the last decade, the number of metastatic cancer patients being given immunotherapy in the last month of their life has “significantly increased…accounting for one in 14 immunotherapy treatments overall.”

Dr. Khan and his fellow researchers studied a diverse group of more than 20,000 stage 4 melanoma, non-small cell lung cancer, and renal cell carcinoma or kidney cancer patients.

Despite the findings providing health practitioners added insight into the value of immunotherapy and where it is administered, researchers say more research is still needed.

RELATED: An Immunotherapy Breakthrough: The Judy Perkins Story

Where You Receive Cancer Care Can Make a Difference

Academic centers and community centers both offer standard-of-care treatment for various cancers. However, academic centers may have more access to certain treatments in the clinical trial phase.

Standard care refers to delivering the appropriate treatment by standards formed based on current medical literature and national guidelines.

Academic cancer centers might have better access to ongoing clinical trials, but clinical trials differ from standard-of-care. Clinical trials seek to explore the effects of a new medication or compare new treatments to the current standard of care. Additionally, SurvivorNet experts say there is a significant amount of variability between academic and community centers, making it difficult to make broad claims comparing the different cancer centers.

“In terms of access to standard care, be it chemotherapy, targeted therapy, or immunotherapy, all those approved drugs are available for use regardless of where you get treatment or care,” Dr. Chul Kim, a medical oncologist at MedStar Health in Washington, D.C. explained to SurvivorNet.

How Immunotherapy Works

Immunotherapy is a medicine that triggers your immune system to search for and then attack cancer cells, whether microscopic or in the form of more extensive tumors.

“Immunotherapy originally started as being an indication for patients who had stage four disease,” Dr. Anna Pavlick, a medical oncologist at Weill Cornell Medicine, tells SurvivorNet.

“In the beginning, we began trying to make vaccines to try to trick the immune system into attacking a protein that we thought was important in the cancer. These vaccines for cancer almost never worked. The problem was the cancer was using a different track of the immune system to block it from attacking,” Dr. Ronald Natale, director of the Lung Cancer Clinical Research Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center in Los Angeles, told SurvivorNet.

“Well, scientists developed treatments, antibodies that would block PD-L1 from blocking the immune system. This unleashed the immune system to resume its attack on the cancer very successfully, at least in some patients,” Dr. Natale added.

“We have now done studies looking at using immunotherapy for patients who have stage three disease. Because we know that these patients have a 50/50 chance of whether this is going to come back or not, we want to make those odds of it coming back even less. But it is not chemotherapy. It does not bring down your immune system. It does not predispose patients to infection. It does not make them lose their hair,” Dr. Pavlick continued.

While immunotherapy is adequate for most patients, it has some side effects, most related to inflammation. You might experience diarrhea when your colon is inflamed or itching when your skin is inflamed. You can also have pain in your liver or pancreas if you have pancreatitis or hepatitis.

RELATED: Immunotherapy in Recurrence

WATCH: Understanding immunotherapy side effects.

Common Immunotherapy side effects include:

• Fatigue
• Nausea or stomach discomfort
• Joint pain
• Diarrhea or constipation
• Cough
• Rash
• Loss of appetite
• Changes in blood cell counts
• Fever

More severe adverse reactions include:

• Pancreatitis: Inflammation of the pancreas
• Colitis: Inflammation of the large intestine
• Pneumonitis: Inflammation of the lungs
• Hepatitis: Inflammation of the liver
• Thyroiditis: Inflammation of the thyroid gland

If you experience severe side effects, your doctor may need to temporarily or permanently stop your immunotherapy treatment.

“The side effects of immunotherapy are not, quote, forever. Depending upon the severity depends upon how we manage it. There are some patients who will get diarrhea, and we can give them treatments to calm down their diarrhea, which lasts a couple of days. It might be sporadic over a couple of weeks,” Dr. Pavlick said.

WATCH: Why immunotherapy Isn’t for Everyone

Immunotherapy doesn’t work for everyone with cancer. Dr. Vamsidhar Velcheti, the director of thoracic oncology at NYU Perlmutter Cancer Center, says that, unfortunately, it’s still difficult to predict which patients will respond well to immunotherapy treatments.

“The ways cancer generally escapes the body’s immune system is by protecting itself by producing certain proteins,” said Dr. Velcheti. “PD-L1 is one of those proteins that actually helps protect the cancer from the body’s immune system. For patients with high levels of PD-L1, you could potentially use single-agent immunotherapy with good outcomes. The problem is that these proteins are constantly in flux.”

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