e24009 Background: Immunotherapy (IT) has cemented itself as a mainstay in cancer treatment, especially in those with late stage malignancies. Generally, these agents are well tolerated, but there is a known association with immune-related adverse events (iRAE). Due to an underrepresentation of elderly patients in clinical trial data, it is valuable to understand the tolerance of these agents. The primary objective of our study was to evaluate for an association between older age, defined as age 75 and above, and increased risk for iRAE in a real-world population. Methods: We performed a retrospective study utilizing data from elderly patients (pts) who had first received IT (specifically Pembrolizumab, Nivolumab, Atezolizumab, Avelumab, and Durvalumab) from 01/01/2015 through 12/31/2019. This subset of pts were followed until 12/31/2021. Descriptive analyses were performed to identify iRAE patterns. A chi-square test or a Fisher’s exact test was used to test for associations in bivariate comparisons while a two-sample t-test was used to test for differences in continuous variables between age groups > 75 to 79 years (Group 1) and > 80 years (Group 2). Statistical significance was determined by p < 0.05 unless otherwise noted. Results: 103 pts qualified for assessment over the study period. Group 1 had a total of 48 pts with a median age of 77. Group 2 had a total of 55 pts with a median age of 84. The study had 57 males and 46 females. 96 pts were Stage IV and 7 pts were Stage III. The most prevalent malignancies in the study were lung, skin, and renal cancer. Treatment intent was palliative for 96 pts, adjuvant for 6 pts, and neo-adjuvant for 1 pt. Overall, there were 72 pts with reported iRAE and 31 pts without reported iRAE. Of the pts with iRAE: 7 pts required outpatient observation without intervention, 38 pts required outpatient intervention(s), 19 pts were hospitalized, and 8 pts required ICU level of care. There was one death due to complications from encephalitis associated with hypophysitis and hyperthyroidism. Regarding discontinuation of IT for pts: 42 pts transitioned to hospice, 35 pts had progression of disease, 8 pts finished their treatment regimen, 5 pts developed an alternative diagnosis, and 9 pts discontinued due to iRAE. Nine pts in the study required corticosteroids for their iRAE. There was no statistically significant difference in incidence of any iRAE (regardless of type) between the two age groups 75-79 and over 80 years (p-value = 0.3703). Similarly, there was no difference for sub-categories including stage of cancer, type of cancer, treatment intent, and severity of iRAE. Conclusions: Elderly pts over age 75 that received the aforementioned IT were shown to have relatively tolerable safety profiles regardless of their age group and the majority continued with IT despite iRAE. This study reinforces the notion that IT could be used in geriatric pts without fear of exposing this vulnerable age group to substantial rates of negative outcomes.
437 Background: In March 2021, the United States Preventative Services Taskforce updated its lung cancer screening guidelines to improve overall survival rates, decrease disparities and provide a net cost savings to the healthcare system. With many patients having advanced lung cancer at the time of their diagnosis, it is imperative that screening is performed as soon as applicable. The objective of this study was to improve documentation in EPIC to help prompt low-dose CT (LDCT) scan reminders for providers on the EHR. Methods: This was a prospective study that utilized patient data from EPIC from the Baylor Scott & White Healthcare primary care clinic in Round Rock, Texas. Our version of EPIC used the guidelines prior to the 2021 change. To prompt a reminder on EPIC, there needs to be sufficient numerical data in the smoking history entry form to calculate the pack-years for a patient. EPIC will then automatically generate a notification for providers to order screening LDCT scans for patients that fulfill the screening criteria. We utilized “SlicerDicer” on EPIC to create a custom report of patients that qualified for the study in terms of the inclusion and exclusion criteria. From October 2021 to January 2022, we collected a pre-intervention representative sample to assess how well smoking had been documented during this period. We manually reviewed each medical record number (MRN) listed in the report to verify if proper documentation was used. Our intervention was to contact the clinic manager multiple times with specific instructions on proper smoking history charting. This was then distributed to all ancillary clinic staff via team meetings and flyers. We planned an intervention period from February 2022 to May 2022 that involved data totaling 1178 patients with similar abstraction methods as the pre-intervention data set. Results: We were able to increase lung cancer screening reminders on EPIC for this higher risk patient population. Specifically, 37% of patients pre-intervention had complete data compared to 49% of patients post-intervention. Therefore, an absolute difference of 12% (31.80% increase) of proper documentation was achieved to increase LDCT reminders. The most common mistake by staff was documenting smoking history into the free-text portion of the entry-data forms, which EPIC is not able to calculate pack-years from. Conclusions: Following the intervention at the outpatient clinic, we were able to boost LDCT reminders via an already established process. Increased reminders will eventually lead to more screening orders placed, which we plan to assess for in the next phase of our study. This study can be easily replicated at other centers by instilling similar clinical staff information sessions about documentation. Proper documentation by all healthcare providers is a shared responsibility that has both immediate and longer-lasting impacts on an individual and population level.
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