Changes in Your Practice: How Interventional Oncology Is Evolving

Interventional oncology is a rapidly evolving field, and clinicians are constantly adapting their clinical practice and office procedures to accommodate the latest advances. In this Q&A, Constantino Peña, MD, shares some of the recent changes he has made to his practice. Dr Peña is an interventional radiologist and the Medical Director of Vascular Imaging at the Miami Cardiac and Vascular Institute in Miami, Florida. He is a Course Director for the Symposium on Clinical Interventional Oncology (CIO).

Can you give an example of recent changes to your clinical practice and why you made those changes?

Practice is always changing. Sometimes our decision to perform a certain type of biopsy may be predicated on the anticipated treatment. Traditionally, we didn’t perform many renal mass biopsies, but now we perform them more frequently because of evidence that the histology is important. These biopsies yield information that we can use to determine the best treatment for the patient. Some biopsy results may indicate that a patient has a particular cell type and may not need to be treated. This information has been helpful and has changed our treatment algorithm.

How we follow certain patients has also changed, particularly the imaging tests used to follow a patient. It’s important to understand when an ultrasound, CT scan, MRI, PET scan, or nuclear medicine test may be appropriate. In some cases, a blood test is appropriate.

For example, until recently a neuroendocrine patient would be followed with imaging studies. Now, we feel more comfortable following these patients with a chromogranin A level, a blood test that gives us an idea of disease progression. The blood test is more sensitive because it shows active disease (a functional test), whereas sometimes an imaging test only shows a shadow or a density, and you can’t tell if something is active or not. The blood test allows more physiological assessment, a better assessment of what is functioning in the patient. Patients understand and appreciate the use of this approach as well.

Another similar practice change is performing a core biopsy when evaluating a lung mass.  Traditionally, we would be satisfied with a needle aspiration demonstrating a sample of cells to make the diagnosis. Today, we’ve realized that the quality of the biopsy is very important.  A  core biopsy allows for the assessment of architecture and allows for an assessment with molecular markers, which may determine the optimal therapy for the patient.

Are there any changes you recommend colleagues make to their clinical or office practice if they are not already doing so?

It’s important to be able to manage complications. Other physicians may have the impression that radiologists do not handle complications. You have to be aware that that perception may exist, and you need to combat it by actively managing and completely following up with your patients.

For example, after you perform a procedure, it’s important that someone contacts the patient the next day.  This information will allow you to assess the impact of your treatment and make sure your followup regimen is in place. You can also contact the other care providers and report to them how that patient is doing after the procedure.

This type of information and communication is criticial for the treatment team.  For example, if the patient was not eating and felt nauseous, you may tell her doctor that you prescribed an antiemetic. In some cases, you may need to see the patient in the office sooner than you had previously expected. Depending on the patient and the specific complication, there may be a need for a CT scan, an antibiotic prescription, or even a recommendation to go to the emergency department.

The key point is to remain actively involved following the procedure and not leave all complication management to other doctors. Keep in mind that you may know more about the procedure than other doctors, so it makes sense  to be the one driving the follow up, while still keeping other members of the team informed.

What if another doctor wants to step in?

Help is always good. I never turn help down. Collaborating with a colleague and managing complications together can be beneficial. Whether you are collaborating or handling the complication on your own, communication with the patient is critically important, as well as communication about the patient to other physicians. This approach ensures that everyone is on the same page.