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  EP1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 206)

  • Event: WCLC 2019
  • Type: E-Poster Viewing in the Exhibit Hall
  • Track: Treatment in the Real World - Support, Survivorship, Systems Research
  • Presentations: 1
  • Now Available
  • Moderators:
  • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall

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    EP1.16-02 - Proactively Improving the Management of Immune-Related Adverse Events (irAEs) in a Community Cancer Program (Now Available) (ID 1874)

    08:00 - 18:00  |  Author(s): Melissa Carandang
    • Abstract
    • Slides

    Background
    

    As more patients with lung cancer are being treated with immune checkpoint inhibitor (ICI) therapy in community settings, there is a pressing need to properly identify and manage immune-related adverse events (irAEs). Promptly and correctly identifying and managing irAEs can be challenging since clinicians may lack knowledge about irAEs. Furthermore, patients may not know when to report symptoms. For these reasons, an educational research project supported by a grant from Genentech was developed to assess how cancer clinicians may improve the identification and management of irAEs.

    Method
    

    The cancer care team at St. Joseph Hospital Orange (SJO) reviewed 30 patient charts (9 lung cancer, 21 other types of cancers) in early 2018 and assessed the documentation of different types of irAEs, the grading of symptom severity, and how often irAEs led to a visit to an urgent care, ER, or inpatient hospital visit. 37% of patients developed a suspected irAE; the severity of symptoms was documented in 57% of charts; 27% of patients developed irAEs that required care in an ER or hospital. In July 2018, members of the cancer care team held a workshop to discuss their findings and identify opportunities to improve the identification and management of irAEs. Using Plan-Do-Study-Act (PDSA) cycles for improvement, the team at SJO developed and implemented the following process changes: 1) a patient education video explaining irAEs (made in English and Spanish) that is delivered by infusion nurses when patients start ICI therapy; 2) continued use of immunotherapy wallet cards for patients; 3) improving awareness among infusion nurses about irAEs; 4) updates to survivorship care plans to highlight how delayed irAEs may occur after active cancer treatment is completed.

    Result
    

    The project remains ongoing at the time of abstract submission. The patient education video was approved by the oncology council and launched in Jan 2019. The infusion nurses report that patients who watch the video are highly engaged and asking questions about irAEs. Changes to the survivorship care plans were finalized at the end of 2018 and were focused on patients receiving ICI therapy for curative intent (eg, adjuvant melanoma and lung cancer).

    Conclusion
    

    Since serious irAEs may occur at any time, a proactive approach is required to improve the identification and management of irAEs and ensure optimal patient outcomes. This project demonstrates how one community cancer center developed feasible interventions based on identified needs.

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