Implementing BiTE therapy in rural Wisconsin: A single center experience.

Abstract

e13542 Background: Bispecific T-Cell Engagers (BiTE) are an innovative oncology treatment for patients with refractory malignancies. BiTE therapy is currently approved for a number of diseases, however, rural and underserved communities often face limited access to such advanced cancer treatments, further highlighting the importance of ensuring equitable care. The project focused on a cancer center in rural Wisconsin, where integration of BiTE therapy into the health system presented unique challenges due to resource constraints and the need for cross-specialty collaboration to manage treatment-related toxicities. Methods: Standardized operating procedures and educational materials were developed for a multidisciplinary healthcare team. Evidence-based guidelines and clinical experience informed tools for managing immune effector cell-associated neurotoxicity syndrome and cytokine release syndrome. Templates and best practice alerts were created for Computerized Physician Order Entry (CPOE) system, including standardized of labs, medications, and decision support. Educational programs were tailored for diverse disciplines, including emergency medicine, intensive care, neurology, hospitalists, pharmacists, and nurses, many of whom operate in resource-limited settings. Training covered pathophysiology, risk factors, symptom grading, and pharmacological treatment. Instruction on new CPOE templates included order entry and system navigation. Pre-and post-training assessments evaluated participants’ knowledge and confidence. This project was deemed quality improvement and exempt from Institutional Review Board oversight. Results: The project delivered tools and protocols for BiTE therapy toxicity management, including assessment forms, treatment algorithms, and EMR templates. A Best Practice Alert in Epic was introduced to prompt chart reviews and oncologist consultations. A templated phrase standardized oncologist documentation, ensuring consistent communication. A dedicated order set streamlined toxicity management, including emergency medication protocols. Education initiatives enhanced understanding and management of BiTE therapy toxicities, ensuring that providers in rural Wisconsin were better equipped to manage complex cases. Despite challenges logistical coordination, foundational tools were successfully implemented, fostering collaboration and patient safety. Conclusions: This underscores the critical need to for access to advanced cancer treatments in rural and underserved areas. By implementing standardized tools, educational programs, and IT optimizations, the providers were empowered to deliver cutting-edge care and improve patient outcomes. Continued focus on education, collaboration, and resource development will ensure that innovative therapies like BiTE are accessible to all patients, regardless of geographic or socioeconomic barriers.