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Delivery of Care for Pediatric Patients Receiving Blinatumomab: A Children's Oncology Group Study
Janice S Withycombe1, Holly R Kubaney, Maki Okada
1Author Affiliations: Clemson University, Clemson (Dr Withycombe, Ms Bloom, and Dr Parker); and Prisma Health Children's Hospital, Greenville (Dr Withycombe), South Carolina; Dell Children's Blood and Cancer Center, Austin, Texas (Mrs Kubaney); Miller Children's & Women's Hospital, Long Beach, California (Mrs Okada); and Children's Hospital of Orange County, Orange (Mrs Yun), California; Texas Children's Hospital, Houston (Dr Rau), and SickKids, Toronto, Ontario, Canada (Dr Gupta and Mrs Zupanec).
Insights
Pediatric oncology nurses successfully manage blinatumomab (a leukemia immunotherapy) infusions, with most children receiving treatment at home. However, significant practice variations exist across Children's Oncology Group institutions.
Area of Science:
- Pediatric Oncology
- Immunotherapy
- Hematologic Malignancies
Background:
- Blinatumomab is a key immunotherapy for B-lineage acute lymphoblastic leukemia in children.
- Continuous 28-day infusions of blinatumomab present complex care coordination challenges.
- Nurses play a critical role in managing blinatumomab administration and patient care.
Purpose of the Study:
- To survey Children's Oncology Group (COG) institutions on blinatumomab administration practices.
- To assess inpatient versus home/outpatient blinatumomab administration strategies.
- To identify current standards of care for blinatumomab in pediatric oncology.
Main Methods:
- A cross-sectional survey was conducted between August and December 2021.
- Surveys were completed by a single respondent per COG institution actively involved in blinatumomab coordination.
- A 78% participation rate (150/192 institutions) was achieved.
Main Results:
- Most blinatumomab administration occurs in outpatient settings.
- Hospitalization durations for the first cycle varied: 53% stayed 73 hours to 7 days, 31% ≤72 hours, and 9% the full 28 days.
- Small- to medium-sized institutions reported longer hospitalizations (P = .03).
- Low rates of unplanned clinic or ER visits were observed.
Conclusions:
- Most COG institutions effectively coordinate home-based blinatumomab infusions for pediatric leukemia patients.
- Significant variations in blinatumomab administration practices exist across institutions.
- Findings provide a baseline for benchmarking and standardizing blinatumomab care.
Background:
Blinatumomab is an immunotherapy agent used in pediatric oncology for the treatment of B-lineage acute lymphoblastic leukemia. Administration of blinatumomab, via continuous 28-day infusion cycles, can present multiple decision points and challenges related to patient care. Nurses are at the forefront of coordinating and delivering care for patients receiving blinatumomab.
Objective:
To describe the current state of practice across Children's Oncology Group (COG) member institutions regarding blinatumomab administration in both inpatient and home/outpatient settings.
Methods:
Between August and December 2021, a cross-sectional survey was used to determine current institutional practices related to blinatumomab administration. A single targeted respondent who was actively engaged in coordinating blinatumomab administration completed the survey on behalf of each COG institution.
Results:
Survey participation rate was 78% (150/192). During the first 28-day blinatumomab cycle, 71 institutions (53%) reported patient hospital stays between 73 hours and 7 days; 42 (31%) reported hospital stays ≤72 hours, and only 12 (9%) reported hospitalization for the full 28-day infusion. Small- to medium-size institutions were more likely to report longer hospitalizations ( P = .03). Most blinatumomab administration occurred in the outpatient setting, with low rates of unplanned clinic/emergency room visits.
Conclusions:
The majority of COG institutions have navigated the complex coordination of care required for children to receive blinatumomab at home. Wide variations in practice were noted across institutions.
Implications For Practice:
This study describes current institutional practices surrounding administration of 28-day blinatumomab infusions in children with leukemia and offers a starting point for institutional benchmarking and standardization of practice.
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