Implementing Evidence Based Guidelines For Immune Checkpoint Inhibitors In A Community Oncology Clinic

Abstract

Aim: Improve patient safety for patient's receiving immune checkpoint inhibitor therapy by implementing evidenced based guidelinesBackground: Immuno-oncology (I/O) is a growing field in oncology. Immune checkpoint inhibitors (ICIs) are the most common type of I/O. Side effects from ICI differ from chemotherapy. Incidence of immune mediated adverse events (irAEs) have been documented as high as 90%, with severe toxicities being reported as high as 48% in clinical trials. National published guidelines are available for assessment and treatment of irAEs, however, are not routinely implemented in community oncology clinics. Methods: Using the RE-AIM framework, this project’s aim was to improve the safety for patients receiving ICI therapy at a community oncology clinic by: establishing baseline patient assessment prior to the start of ICI therapy; providing ICI specific patient education; issuing ICI patient wallet card and updating ICI oncology modules to meet current guidelines. Results: During project implementation 9/15-12/15/20: 92% of patients starting ICI therapy had a baseline assessment; received ICI specific education and were issued a wallet card. Ninety-four percent of ICI oncology modules were updated meeting current guidelines. In addition, staff found to the project to be sustainable, useful, of high quality, easy to follow and met clinic needs. Implications: Immunotherapy is a growing field in oncology and many tertiary/academic cancer centers have dedicated I/O clinics. Community oncology (where the majority of patients are treated) are unable to support I/O clinics such as these. Implementation of evidenced based guidelines in a community setting ultimately improves the quality of care and safety of patients receiving ICI therapy.