The Centre of Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK.
Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.
J Oncol Pharm Pract. 2024 Oct;30(7):1193-1199. doi: 10.1177/10781552231207271. Epub 2023 Oct 17.
The incidence of immune-related adverse events (irAEs) from immune checkpoint inhibitors (ICI) is well described. However, the impact on emergency care services is not. This study investigated the incidence of irAEs out-of-hours, and the management used to mitigate symptoms and side effects.
This retrospective cohort study reviewed all emergency presentations triaged by the acute oncology team between December 2021 and June 2022, between 5 pm and 9 am. Patients were identified from triage audit sheets and remaining data points were retrieved from electronic health records. Inclusion criteria included all adult patients admitted on an ICI at one tertiary centre.
In 7 months, 970 patients called the acute oncology helpline 11% (n = 109) of patients were on an ICI treatment. After clinical review, 78% (n = 70) resulted in hospital admissions, with length of stay cumulating to 496 bed days. 56% (n = 39) of patients delayed reporting symptoms, ranging between 12 hours and 10 days from symptom onset to seeking support. 49% (n = 34) patients received steroids to manage suspected irAEs. Dexamethasone was the most common steroid used in 71% (n = 24) of patients, and variation was found in prescribed doses.
These results underline the urgent need to address patient and staff education on adverse effects related to ICI. Patients require a comprehensive understanding of the symptoms and importance of prompt reporting. Staff education on recognition and treatment management is needed to reduce variation in practice. Further research is needed to identify barriers in symptom reporting and focus on realtime reporting to reduce the out-of-hours burden on services.
免疫检查点抑制剂（ICI）引起的免疫相关不良事件（irAE）的发生率已有详细描述。然而，其对急诊医疗服务的影响尚未可知。本研究调查了非工作时间 irAE 的发生率，以及用于减轻症状和副作用的管理措施。
本回顾性队列研究调查了 2021 年 12 月至 2022 年 6 月期间，5 点至 9 点之间由急性肿瘤团队分诊的所有急诊就诊情况。通过分诊审核表识别患者，从电子健康记录中检索其余数据点。纳入标准包括在一家三级中心接受 ICI 治疗的所有成年患者。
在 7 个月期间，970 名患者拨打了急性肿瘤热线，11%（n=109）的患者正在接受 ICI 治疗。经过临床审查，78%（n=70）的患者需要住院治疗，累计住院天数为 496 天。56%（n=39）的患者延迟报告症状，从症状出现到寻求支持的时间间隔为 12 小时至 10 天。49%（n=34）的患者接受类固醇治疗以管理疑似 irAE。地塞米松是最常用的类固醇，在 71%（n=24）的患者中使用，且剂量存在差异。
这些结果强调了紧急需要对与 ICI 相关的不良反应对患者和医务人员进行教育。患者需要全面了解症状，并认识到及时报告的重要性。需要对识别和治疗管理进行员工教育，以减少实践中的差异。需要进一步研究以确定症状报告中的障碍，并关注实时报告，以减轻服务的非工作时间负担。
