Aim: To understand the impact of inpatient care of complications of immunotherapy
Methods: Patient admissions under medical oncology at Fiona Stanley Hospital (FSH) secondary to immunotherapy related adverse events (IRAEs) were audited for patient characteristics, treatment, length of stay and outcomes from January to April in 2022.
Results: Between January and April in 2022, 348 patients were discharged from medical oncology at FSH. Sixteen percent (n=62) of these patients were being treated with immunotherapy at time of admission and 37% of these patients (n=23) were admitted secondary to presumed IRAEs and included in the audit. The most common IRAE was colitis accounting for 35% (n=8) of admissions, followed by pneumonitis and hepatitis accounting for 22% (n=5) of admissions each. The mean length of stay was 8.83 days for patients with colitis (Range: 6-19; Median 6.5); 13 days for pneumonitis (Range: 3-14; Median 7.5) and 6.8 days for hepatitis (Range 3-12, Median 5). Other IRAEs including arthritis and myositis (13%,n=3), neurological IRAEs of meningitis and cerebellitis (9%,n=2) and dermatitis with concurrent uveitis accounted for 4% (n=1). Seventy-four percent of the admissions were secondary to grade 3 severity. Approximately 63% of those patients received intravenous corticosteroids, 37% received oral steroids . Upon discharge, 83% (n=19) of patients’ IRAEs were downgraded by at least 1 grade. Grade 3 Hepatitis and Grade 2 pneumonitis were equally responsible for the 17% (n=4) that did not downgrade in severity prior to discharge. Immunotherapy was ceased in 87% of the patients (n=20). No patients died from IRAEs during their admissions. Four patients (17%) had complications: 2 had steroid induced hyperglycaemia, 1 patient had delirium and 1 had iatrogenic fluid overload.
Conclusion: Our audit showed patients required a significant number of days in hospital. A majority of patients responded to steroids but had persistent symptoms at discharge.