You became an oncologist to treat cancer, not manage the immune system.

There are other specialists for that.

When we unleash the immune system, we get a powerful, cancer-killing weapon – but we also get an immune system that is unchecked, dangerously unpredictable, and difficult to control. Oncologists were trained to treat cancer, not manage the immune system. That’s why cancer centers are increasingly moving to a multi-disciplinary approach, allowing oncologists to focus on what they do best and partner with other specialists for immune system management.

How Other Specialists Can Play a Role

To treat cancer, we unleash the immune system on purpose; but sometimes, the immune system becomes unleashed on its own, resulting in autoimmune conditions like rheumatoid arthritis, lupus, Sjogren’s syndrome, and almost forty others. In both instances, the unchecked immune system, whether induced or naturally occurring, can mistakenly attack healthy cells, damaging the skin, joints, bones, organs, any part of the body: In immunotherapy, these effects are known as side effects (irAEs); in autoimmune conditions, they’re known as symptoms. 

The specialists who treat autoimmune conditions, rheumatologists, in particular, are well versed in managing these symptoms. They have an entire arsenal of research-proven, time-tested medications and protocols for managing symptoms and regulating the immune system.

Oncologists who involve rheumatologists and other specialists are increasingly finding that autoimmune condition treatments and protocols are highly effective for managing, and preventing, irAEs in immunotherapy patients. This kind of multi-disciplinary care enables oncologists to circumvent any irAE pitfalls, allowing them to get their patients over the immunotherapy finish line successfully and allowing patients to maintain a high quality of life throughout and after immunotherapy. 

The Evolving Standard of Care

In medicine, as we learn, we evolve. 

We’re learning, via a growing body of research and experiential evidence, that multi-disciplinary cancer care improves outcomes; in response, we’re seeing a new standard of care emerge. Leading cancer centers such as Massachusetts General, Johns Hopkins Medicine, and Yale Medicine, among many others, have created multi-disciplinary cancer centers to address immune-related toxicities and irAEs. In this model, rheumatologists, gastroenterologists, endocrinologists, and other relevant specialists serve as active members of the care team to ensure that irAEs don’t stand in the way of treatment. 

Ironically, this evolution is being slowed by the speed at which we’re learning new information. Annual publication output on cancer immunotherapy grew from 366 papers in 2000 to 3,194 in 2021 — nearly a ninefold increase in two decades. And regarding irAEs, specifically: A bibliometric analysis of 17 years of irAE research documented a 46.44% annual growth rate in irAE-specific literature. It’s difficult to provide patients with cutting-edge care when the edge is moving so quickly.

What You Can Do

To keep evolving, we must make learning an active process – seeking out new information and new ideas, keeping a curious, open mind, and remaining open to change. This is often easier said than done; other physicians can help.