QIM21-090: The Expanding Role of an Oncology Urgent Care Clinic for the Management of Immune-Related Adverse Events

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  • 1 Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
  • | 2 Johns Hopkins Bayview Medical Center, Baltimore, MD
  • | 3 Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University, Baltimore, MD

Introduction: With the increasing prevalence of patients receiving oncologic therapy and immune checkpoint inhibitors (ICI) there is a growing burden on the health care system to provide care for their associated toxicities and complications. Our objective was to evaluate clinical features and outcomes of patients who presented to a dedicated oncology urgent care clinic for the management of acute medical needs. Methods: Patients who utilized our institution’s Oncology Urgent Care Clinic from July 1, 2018 to June 30, 2019 were identified. Patient demographic characteristics, cancer diagnosis, systemic therapy history, diagnostics and disposition data from the clinic were collected retrospectively. Study data were summarized using descriptive statistics. Odds ratios for various factors (race, age, gender, ECOG PS, treatment, and reason for urgent care visit) associated with hospitalization after urgent care evaluation were calculated. Results: Through our database, 496 unique urgent care encounters (304 individual patients) were identified. The most common presenting urgent care reasons were for respiratory (25%) and gastroenterological (24%) complaints. Diagnostics and interventions performed during these visits included imaging (30%), intravenous fluids (29%), antimicrobial therapy (10%), and systemic steroids (8%). Thirty-four percent of the encounters (n=170) included patients on ICI therapy and of these encounters 36% (n=61) were for suspected immune related adverse events (irAEs) with 51% (n=31) being confirmed and treated as irAEs. Following evaluation in the urgent care clinic, of those with confirmed irAE, the majority (n=20; 65%) were discharged home. Five patients (16%) were directly admitted and six patients (19%) were sent to the ED and then subsequently admitted. In respect to all encounters, patients with a higher ECOG PS (OR 1.84, 95% CI 1.18-2.85; p=0.007) or who were treated for irAE (OR 4.67, 95% CI 2.11-10.32, P<0.0001) were more likely to be admitted. Conclusion: The majority of urgent care visits for patients with confirmed irAEs were able to be managed on an outpatient basis and resulted in discharges home without an ED or hospital admission. Patients with poorer baseline performance status and requiring treatment for irAE were associated with an increased risk of hospitalization. Understanding of risk factors for irAE hospitalization may provide utility for educating outpatient oncology providers and for resource allocation.

Corresponding Author: Kai-li Liang, MD