Clinical Summary

• A rural community cancer program implemented bispecific T-cell engager therapy for adult and pediatric oncology patients.
• Over 13 months, 6 patients were treated without grade 3 or higher cytokine release syndrome (CRS) or neurotoxicity events.
• Local treatment delivery reduced travel burden, improved patient quality of life, and strengthened continuity of care.

Bispecific T-cell engager (BiTE) therapies are increasingly used to treat hematologic malignancies and some solid tumors, but access remains challenging in rural regions where patients often must travel to urban cancer centers. As presented in an abstract at the 2026 Oncology Nursing Society (ONS) Congress, a nursing-led initiative sought to operationalize BiTE therapy within a rural community cancer program to improve access and patient outcomes.

The project aimed to provide timely and safe local treatment for adult and pediatric patients while reducing financial toxicity, travel demands, and disruption to family support systems. The implementation strategy was led by an oncology clinical nurse specialist in collaboration with hematologist-oncologists, pharmacists, and nursing staff.

Key operational components included formulary expansion, inpatient billing workflow optimization, and development of electronic health record order sets for BiTE dosing and toxicity management. The team also implemented grading tools, documentation workflows, nursing job aids, and standardized care transition processes.

Education and preparedness were major priorities. Training focused on BiTE mechanisms of action, monitoring protocols, and management of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Resources were integrated into the institution’s intranet and supported through recorded educational content to promote sustainability. Risk Evaluation and Mitigation Strategy (REMS) compliance training also extended to emergency department, intensive care, and hospitalist teams.

Over a 13-month period, 6 patients safely received BiTE therapy across inpatient and outpatient settings, including initial ramp-up dosing. No grade 3 or higher CRS or ICANS events were reported.

Investigators noted positive patient-centered outcomes. Patients described improved quality of life, reduced travel burden, and better emotional well-being because treatment could be delivered within their local community. The model was additionally adapted for pediatric hematology-oncology workflows.

Nursing staff reported increased confidence and competency in delivering BiTE therapy, while continuity of care improved through integrated multidisciplinary coordination.

The author noted that “BiTE therapy can be safely and effectively delivered in rural settings through strategic planning, interdisciplinary collaboration, and robust education.” The project also highlighted the importance of localized care in reducing stress and improving patient satisfaction.

Future research should evaluate long-term outcomes, cost-effectiveness, and scalability of similar models in other rural cancer programs. The author also emphasized the importance of incorporating patient-reported outcomes and caregiver feedback into future care delivery strategies.

In summary, the initiative provides a practical framework for expanding access to novel immunotherapies in rural oncology settings while maintaining safety and patient-centered care.

Source:

Scaramuzzo L. Operationalizing BiTE Therapy in a Rural Community Cancer Program to Expand Access and Improve Outcomes. Presented at the Oncology Nursing Society Annual Congress; May 13-17, 2026. San Antonio, TX.