Evaluation of emergency departments visits in patients treated with immune checkpoint inhibitors

Güven, Deniz Can; Şahin, Taha Koray; Aksun, Melek Seren; Taban, Hakan; Aktepe, Oktay Halit; Aksu, Nalan Metin; Akkaş, Meltem; Erman, Mustafa; Kılıçkap, Saadettin; Dizdar, Ömer; Aksoy, Sercan

doi:10.1007/s00520-020-05702-8

Cited by 8 publications

(8 citation statements)

References 41 publications

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“…This situation is similar to the literature; our patient population, where non-small cell lung cancer is predominant, generally applied with complaints related to the underlying cancer and received malignancy-related diagnoses [8]. ED visit rates and numbers in our study are higher than in previous studies [7,13].…”

Section: Discussionsupporting

confidence: 87%

“…Immune checkpoint inhibitors (ICI) enable T lymphocytes to recognize cancer cells by blocking CTLA-4 and PD-1 in cancer cells [6]. Their use for this purpose has become widespread and provides good results in many types of cancer, such as non-small cell lung cancer, malign melanoma, lymphoma, and renal cell cancer [7,8]. In our country, nivolumab is the most used agent as an ICI due to its payment conditions and easy access [7].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of emergency department visits and immune-related adverse effects (irAEs) in patients treated with nivolumab

Kudu,

Akdag,

Yildirim

2023

Preprint

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Introduction : One of the most important innovations in cancer treatment is the development of immune checkpoint inhibitors (ICI) in the last decade. Nivolumab which is one of ICI is used in many cancer treatments. As with any drug, this drug also have some side effects including the class-spesific immune-related adverse effects (irAEs). Although irAE is not rare, it is challenging to diagnose. Therefore, we examined the emergency department (ED) visits of patients receiving nivolumab therapy. In addition to previous studies, this study aims to evaluate the irAE management, diagnostic difficulties and outcome of irAEs in the ED. Material and Methods A retrospective cohort study was conducted on adult patients who received nivolumab therapy for any cancer between 1 April 2018 and 31 March 2023 at a large, urban tertiary care center. In this study we evaluated the ED visits of patients receiving nivolumab. In adddition to previous studies, we evaluated irAEs in detail (percentage, recognizability, risk factors, reasons for late recognition and outcome). Patient data was collected from electronic medical records and patient’s medical files. The anamnesis, laboratory, and imaging results, ED management, and consultation notes were examined separately for each ED visit. Logistic regression models were used to identify significant univariable predictors of ED visit and irAEs. Results One hundred ninety-nine patients were included in the study. All patients had metastatic cancer, and 154 patients (77.4%) received nivolumab therapy for non-small cell lung cancer. Most patients (71.9%, n = 143) had at least one additional comorbidity. One hundred and eleven patients (55.8%) presented to the ED. Hypertension (OR: 2.425, 95% CI: 1.226–4.795, p = 0.011) and chronic obstructive pulmonary disease (OR: 2.489, 95% CI: 1.133–5.468, p = 0.023) are risk factors for presenting ED. Twenty-one visits were diagnosed (14 in ED, 6 in the oncology clinic, and 1 in the ward) as irAEs. The univariate analysis found no association between irAE diagnosis and any factors. Conclusion A significant part of the patients treated with nivolumab for advanced cancer presents to ED for ICI-related adverse events, although most cases were unrelated to irAEs. Close collaboration between ED physicians and oncologist is paramount to management of patients with cancer in the ED.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Evaluation of emergency department visits and immune-related adverse effects (irAEs) in patients treated with nivolumab

Kudu,

Akdag,

Yildirim

2023

Preprint

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“…Three studies investigated immunotherapy and ED utilization. 34 , 38 , 40 , 45 Up to 70% had ED visits, with approximately 3 visits per patient and a mean LOS of 23 days. 40 , 47 …”

Section: Resultsmentioning

confidence: 99%

“… 34 , 38 Three studies reported that up to 16.3% of patients with immune-related events and 35.8% of all toxicities led to treatment cessation. 34 , 38 , 45 …”

Section: Resultsmentioning

confidence: 99%

“…In fact, one study found that less than 10% of oncology visits could be attributed to immunotherapy adverse events, including pain, dyspnea, and pneumonia. 43 , 45 Patients on immunotherapy tend to get admitted following their ED visit (56.6% had multiple admissions within a year of initiation) and experience extended admissions, with a mean LOS of 23 days. These limited data suggest that immunotherapy-related ED visits, when they do occur, may not be preventable.…”

Section: Discussionmentioning

confidence: 99%

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Drivers of Emergency Department Use Among Oncology Patients in the Era of Novel Cancer Therapeutics: A Systematic Review

et al. 2023

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Background Patients diagnosed with cancer are frequent users of the emergency department (ED). While many visits are unavoidable, a significant portion may be potentially preventable ED visits (PPEDs). Cancer treatments have greatly advanced, whereby patients may present with unique toxicities from targeted therapies and are often living longer with advanced disease. Prior work focused on patients undergoing cytotoxic chemotherapy, and often excluded those on supportive care alone. Other contributors to ED visits in oncology, such as patient-level variables, are less well-established. Finally, prior studies focused on ED diagnoses to describe trends and did not evaluate PPEDs. An updated systematic review was completed to focus on PPEDs, novel cancer therapies, and patient-level variables, including those on supportive care alone. Methods Three online databases were used. Included publications were in English, from 2012-2022, with sample sizes of ≥50, and reported predictors of ED presentation or ED diagnoses in oncology. Results 45 studies were included. Six studies highlighted PPEDs with variable definitions. Common reasons for ED visits included pain (66%) or chemotherapy toxicities (69.1%). PPEDs were most frequent amongst breast cancer patients (13.4%) or patients receiving cytotoxic chemotherapy (20%). Three manuscripts included immunotherapy agents, and only one focused on end-of-life patients. Conclusion This updated systematic review highlights variability in oncology ED visits during the last decade. There is limited work on the concept of PPEDs, patient-level variables and patients on supportive care alone. Overall, pain and chemotherapy toxicities remain key drivers of ED visits in cancer patients. Further work is needed in this realm.

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Evaluation of early unplanned readmissions and predisposing factors in an oncology clinic

Güven

Ceylan

Cakir

et al. 2021

Support Care Cancer

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Evaluation of emergency departments visits in patients treated with immune checkpoint inhibitors

Cited by 8 publications

References 41 publications

Evaluation of emergency department visits and immune-related adverse effects (irAEs) in patients treated with nivolumab

Evaluation of emergency department visits and immune-related adverse effects (irAEs) in patients treated with nivolumab

Drivers of Emergency Department Use Among Oncology Patients in the Era of Novel Cancer Therapeutics: A Systematic Review

Evaluation of early unplanned readmissions and predisposing factors in an oncology clinic

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