Integrating interventional radiology into melanoma care: A quality improvement initiative to advance intratumoral therapies and multidisciplinary collaboration.

Abstract

e23312 Background: Despite advances in immunotherapy (IO), management of advanced melanoma after anti-PD-1 progression remains challenging. Intratumoral IO and other interventional radiology (IR)-based approaches are emerging options for select patients, yet their integration into care is limited by inconsistent multidisciplinary collaboration and lack of standardized referral workflows. We implemented a quality improvement (QI) initiative to assess multidisciplinary practice gaps and improve integration of IR-based therapies in melanoma care. Methods: Healthcare professionals (HCPs) involved in melanoma care (N = 133) from 3 academic and 3 regionally tethered community oncology centers completed baseline surveys assessing familiarity with IR, multidisciplinary collaboration, referral workflows, and follow-up. Participating teams engaged in QI exchange sessions to review findings and develop site-specific action plans. Follow-up surveys from site representatives (N = 7) evaluated post-intervention practice changes. Results: At baseline, integration of IR in melanoma care was limited. Although tumor board (TB) participation varied across institutions, only 21% of HCPs reported inclusion of IR in these discussions, and 13% reported not participating in TBs at all. While 44% of HCPs regularly collaborated with IR, only 15% had standardized referral workflows. Top challenges working with IR included limited communication/collaboration between teams (43%), difficulty accessing IR services (41%), and lack of standardized referral workflows (31%). Post-referral communication was also inconsistent: 26% of HCPs reported uncertainty regarding treatments delivered or discussed with patients, 17% reported receiving no follow-up communication from IR, and only 20% reported having direct case-based discussions with IR. These challenges were attributed to unclear handoffs or division of responsibility (34%), patient confusion regarding care management (32%), and difficulty integrating IR recommendations into broader treatment plans (28%). To address these gaps, teams developed action plans focused on identifying IR champions to participate in TBs, standardizing referral workflows, and strengthening partnerships with local IR services. In follow-up surveys, teams reported improvements in confidence, multidisciplinary communication and collaboration, inclusion of IR in treatment planning, and access to IR services. Conclusions: This initiative identified persistent gaps integrating IR into melanoma care, particularly in multidisciplinary engagement, referral standardization, and post-referral communication. Implementation of action plans was associated with improvements in collaboration, confidence, and workflow integration, supporting coordinated delivery of intratumoral therapies.