8 Common Questions About Infusion Therapy — and Answers from RCCA’s Denis Fitzgerald, MD

If your physician has prescribed an infused medication for you, you’re in good company.

In recent years, the Food and Drug Administration (FDA) has approved dozens of therapies that must be administered intravenously in order to work properly. The list of conditions now treated with infused medications is long and constantly growing. It includes dermatologic, gastrointestinal, respiratory, musculoskeletal, and neurologic conditions; infections, including COVID-19; anemia and other blood disorders; and many forms of cancer. As a result, millions of Americans now receive infusions to manage chronic conditions or treat acute issues. 

“Given the trends in drug development, the use of infused therapies is only going to increase in the years ahead, meaning that more and more people will need to decide where to receive their infusions,” says Denis Fitzgerald, MD. As a board-certified medical oncologist and hematologist who practices in the Little Silver, NJ office of Regional Cancer Care Associates (RCCA), the physician has long experience with chemotherapy and other cancer treatments administered via infusion.

“Patients should consider several factors in choosing where they will be treated, including safety, setting, cost, convenience, and staff experience,” says Dr. Fitzgerald, who also serves as Board Chairperson of RCCA, one of the nation’s largest networks of oncology specialists. In a recent interview, he addressed several common questions about infusion, and explained why a community oncology clinic can be the ideal setting to receive infusions for a wide range of conditions other than cancer.

  1. What conditions or illnesses is infusion therapy used to treat?

Infusion therapy has been a mainstay of cancer treatment for decades, starting with chemotherapy and today also including many targeted therapies and immunotherapies.

Turning to conditions beyond cancer, however, infused medications are used to treat Crohn’s disease and ulcerative colitis, multiple sclerosis, iron-deficiency anemia, rheumatoid and psoriatic arthritis, plaque psoriasis, some forms of asthma, chronic pain, and immune-deficiency disorders, among others conditions.

Many people, including postmenopausal women and men being treated with hormonal therapies for prostate cancer, receive infusions to protect their bone health and prevent osteoporosis. Antibiotics sometimes will be infused to control and cure a particularly fast-moving or dangerous infection. Further, some people are born with problems of metabolism or other conditions that require periodic infusions to replace enzymes critical to their health.

An intravenous (IV) drip also can provide nutrition, medication, and rehydrating fluids to people experiencing nausea and vomiting due to pregnancy, illness, or medication side effects.

  1. Why would my physician prescribe an IV drug instead of an oral medication?

It is important to talk with your physician about why he or she prescribed a specific treatment for you, but there are several reasons a doctor might choose an infused therapy.

The monoclonal antibody therapies that have revolutionized the treatment of conditions ranging from multiple sclerosis and rheumatoid arthritis to Crohn’s disease and COVID-19 consist of proteins that would be degraded and lose their effectiveness if they were taken in pill form and exposed to the digestive functions of the gastrointestinal system.

In other cases, a physician may choose an infused therapy over an oral medication when it is important to deliver the drug quickly, such as when a patient has an aggressive infection that the doctor wants to contain and then eradicate.

  1. Do I need to go to the hospital for my infusion?

No. Infusions once were administered exclusively in hospitals, but over the last 20 years or more, community-based infusion therapy centers have established themselves as a safe, cost-effective, and convenient alternative to receiving infusions in the hospital setting. These centers are equipped to deliver infusion therapy in a comfortable environment and are staffed with clinicians who specialize in managing every aspect of infusion treatment. More recently, some infused medications have been delivered in patients’ homes by a trained nurse.

In my experience, a community-based infusion center represents an ideal balance in terms of offering the convenience and cost-effectiveness that you may not have in the hospital, and the access to a team of clinicians and breadth of resources for dealing with side effects that you won’t have when an individual clinician is providing care in your home. 

  1. You mentioned side effects. Is infusion therapy safe?

All medications carry some risk of adverse effects, and that risk varies among IV agents – just as it does among oral medications. Your physician will counsel you on side-effect risks and will choose the medication and dosage designed to provide the most benefit with the least likelihood of a side effect.
Regardless of which medication is infused, people may experience pain, redness, swelling, or tenderness at the injection site during and sometimes after the infusion. These things do not occur in many cases, but they are the adverse effects we see most often. They typically are mild and of short duration. Other adverse effects tend to be specific to the particular medication you are receiving.

At RCCA, our nurse practitioners, nurses, and pharmacy personnel are thoroughly familiar with each of the dozens of medications we infuse – not just for cancers but for the other conditions I mentioned above. Before an infusion, we thoroughly educate the patient on the medication, why it is being given, and what to expect – including potential side effects. Should there be an issue or concern, a physician is just steps away, and our team has the training and our centers have the resources to manage side effects, should they occur.

Further, RCCA’s infusion centers follow rigorous procedures to guard patients’ well-being. For example, our centers have specially designed “mixing areas” where medications are prepared for infusion in a manner that prevents airborne contaminants from infiltrating the medicine.

As infusion therapy becomes more prevalent, the regulations that govern preparation and administration of infused therapies are becoming increasingly stringent. We view this as a good thing, and at RCCA we stay abreast and ahead of regulatory changes, thoroughly complying with all new requirements.

  1. Is infusion therapy time-consuming?

Infusion time varies widely by medication. Some agents need to be infused over 2 hours or longer, while others can be delivered in 30 minutes.

Regardless of the medication and its administration time, receiving an infusion at a community-based clinic is considerably more efficient and convenient than hospital-based care. For example, when you come to an RCCA office, you park near the entrance, sign in, are assessed and counseled, receive your infusion, and get on with your day. At a hospital, the intake process alone can be quite time-consuming.

  1. Will my insurer cover the infusion?

Infused therapies typically are covered by insurance but are subject to the same requirements, such as prior authorization, as other medications.

One important consideration in terms of coverage is out-of-pocket cost to the patient. The cost of an infusion in a hospital may be twice as expensive as the cost of receiving the same infusion in a community-based clinic. Because hospitals have considerable overhead costs, they generally have contracts with insurers that allow them to charge higher rates than community clinics. Hospitals also routinely pass their overhead expenses on to their patients in the form of administration fees, steep co-pays, and other out-of-pocket expenses.

Because of this cost differential, many insurers have begun requiring that patients receive infusions in community-based centers whenever possible. 

  1. If I’m seeing a specialist in New York City, Philadelphia, or another major city, are there alternatives that would enable me to receive infusions closer to home?

Yes. The added convenience of receiving infusion therapy at a community-based clinic is a game-changer for many patients who see specialists at academic medical centers in New York, Philadelphia, or elsewhere.

Many people who receive infusions at an RCCA center near their home “go to the city” two or three times a year to see their neurologist, gastroenterologist, or other specialist but don’t want to travel there for regular infusions. Instead, they come to one of our centers, where they can receive care in a friendly, relaxed surrounding. Meanwhile, we have excellent working relationships with our infusion patients’ physicians. If, for example, a question arises concerning infusion therapy for a patient with multiple sclerosis, our team can quickly contact the referring neurologist for clarification.

  1. Why would a person go to an oncology clinic for an infusion when he or she doesn’t have cancer?

In the case of RCCA, the many people who come to us to receive infusions for conditions other than cancer do so because of the convenience, the cost benefits, the expertise of our team and — perhaps more than anything else — the patient-care experience. Our staff comes to know all of our patients quite well, and provides compassionate, individualized care. We make people’s time here as relaxing as possible. Our infusion areas are specially designed to give each patient privacy while ensuring that he or she looks out on an open area so that they don’t feel “closed in.”

In short, our long experience with infusion therapy not only for cancer but for a wide range of conditions enables us to provide expert care close to home.

 RCCA has more than 24 offices throughout New Jersey, Connecticut, Maryland and the Washington, D.C., area. For more information on the infused therapies and other services offered by RCCA, call (844) 928-0089 or visit RCCA.com.

 

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