Palliative Care & Oncology
The field of oncology and immunotherapy has undergone a rapid transformation over the past decade with the introduction of immune checkpoint inhibitors (ICI). These monoclonal antibodies have been designed to disrupt the PD-1/PD-L1 or CTLA-4 pathways, allowing the body’s T lymphocytes to recognize malignant cells as “other.” This in turns induces an inflammatory cascade, directly targeting the malignancy or augmenting other therapies. Since the approval of ipilimumab for the treatment of late-stage melanoma in 2011, the Federal Drug Administration has approved over 21 indications for these biological agents. Consequently, ICIs have become ubiquitous in cancer treatment centers, as well as in media and direct-to-consumer advertisements. While appropriately heralded as a major development in treatment paradigm, these agents can often have profound side effects, provoking autoimmune responses that can mimic psychiatric illness or require high doses of steroids for management.
In this oncology/palliative care SIG-sponsored symposium, we will provide information relevant for the mental health professional working in the cancer setting, including basic medical knowledge as well as managing different neuropsychiatric presentations and psychosocial issues that they may encounter. Emily Sorg, MD, will provide foundational information on the treatment, discussing biological mechanism of action for ICI appropriate for the mental health professional, as well current indications for treatment. Deepti Chopra, MD, will discuss the neuroendocrine sequelae, often manifesting as unspecified depressive symptoms or altered mental status. Katrina Burns, MD, will continue the discussion on adverse effects, focusing on autoimmune encephalitis and altered mental status from other etiologies. Finally, Andrew Edelstein, MD, will describe some of the psychosocial issues arising from this rapidly evolving field, such as the impact of direct-to-consumer marketing the can distort patient’s expectations of care and the financial burden these treatments can place on our health system.
Time (10 minutes) will be allotted at the end for audience discussion and questions.