Effectiveness of immunotherapy given to cancer patients in the hospitalized setting.

Abstract

74 Background: Immunotherapy is a type of cancer treatment that uses an individual’s immune system to fight cancer. Most clinical trials involving immunotherapy have been done on healthy patients, thus excluding many hospitalized patients. Many oncologists feel there are less significant toxicities to immunotherapy and thus may give them to sicker patients. This may delay discussions regarding goals of care and contribute to increased costs at end of life. This exploratory study focuses specifically on the use of immune checkpoint inhibitors in hospitalized patients to determine outcomes of patients treated in the inpatient setting. Methods: This is a retrospective chart-review study. Data on patients from the Hartford Healthcare system was extracted from EPIC. Patients were eligible if they had received at least one dose of a PD1 or PDL1 inhibitor (pembrolizumab, nivolumab, atezolizumab) during a hospital stay. The number of doses received in total, side effects, as well as discharge status was also recorded. Results: A total of 74 patients received at least one dose of a PD1 or PDL1 inhibitor during a hospital stay. 46% of the total patients treated either died in the hospital (16.2%) or were discharged to hospice (29.3%). 54 percent of patients were discharged with a plan to continue with therapy. For the subgroup of the 27 patients whose treatment was initiated in the hospital, 48% of them received only one cycle of treatment and 74% received less than 4 treatments total. The average number of cycles was 5.3. The percentage of patients who died in the hospital was 11.1% and the percentage of patients discharged to hospice was 33.3%. 55.5% were successfully discharged with a plan to continue with therapy. Conclusions: For patients who receive immunotherapy in the hospital setting there is a questionable benefit with more than 45% dying in the hospital or being discharged to hospice. Further evaluation can be done looking at increasing the cost, delaying palliative care, and patient/family satisfaction with their end of life care by giving immunotherapy in the hospital. A new quality measure looking at time from last immunotherapy to hospice enrollment or death may need to be followed in the future due to these poor outcomes in the hospitalized setting. [Table: see text]