Risk Factors for Emergency Room and Hospital Care Among Patients With Solid Tumors on Immune Checkpoint Inhibitor Therapy.

OBJECTIVES Immune checkpoint inhibitors (ICIs) are being increasingly used across cancer types. Emergency room (ER) and inpatient (IP) care, common in patients with cancer, remain poorly defined in this specific population, and risk factors for such care are unknown. METHODS We retrospectively reviewed charts for patients with solid tumors who received >1 ICI dose at 1 of 2 sites from January 1, 2011 to April 28, 2017. Demographics, medical history, cancer diagnosis/therapy/toxicity details, and outcomes were recorded. Descriptive data detailing ER/IP care at the 2 associated hospitals during ICI therapy (from first dose to 3 mo after last dose) were collected. The Fisher exact test and multivariate regression analysis was used to study differences between patients with versus without ER/IP care during ICI treatment. RESULTS Among 345 patients studied, 50% had at least 1 ER visit during ICI treatment and 43% had at least 1 IP admission. Six percent of ER/IP visits eventually required intensive care. A total of 12% of ER/IP visits were associated with suspected or confirmed immune-related adverse events. Predictors of ER care were African-American race (odds ratio [OR]: 3.83, P=0.001), Hispanic ethnicity (OR: 3.12, P=0.007), and coronary artery disease (OR: 2.43, P=0.006). Predictors of IP care were African-American race (OR: 2.38, P=0.024), Hispanic ethnicity (OR: 2.29, P=0.045), chronic kidney disease (OR: 3.89, P=0.006), angiotensin converting enzyme inhibitor/angiotensin receptor blocker medication use (OR: 0.44, P=0.009), and liver metastasis (OR: 2.32, P=0.003). CONCLUSIONS Understanding demographic and clinical risk factors for ER/IP care among patients on ICIs can help highlight disparities, prospectively identify high-risk patients, and inform preventive programs aimed at reducing such care.

[1]  P. Kantoff,et al.  Survival of African-American and Caucasian men after sipuleucel-T immunotherapy: outcomes from the PROCEED registry , 2020, Prostate Cancer and Prostatic Diseases.

[2]  Characteristics of hospitalizations among patients receiving immune checkpoint inhibitors at a community teaching hospital , 2020, Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners.

[3]  C. Friese,et al.  Racial and Ethnic Disparities in Emergency Department Care and Health Outcomes Among Children in the United States , 2019, Front. Pediatr..

[4]  L. Newby,et al.  Chronic Kidney Disease and Coronary Artery Disease: JACC State-of-the-Art Review. , 2019, Journal of the American College of Cardiology.

[5]  G. Coukos,et al.  Adverse effects of immune-checkpoint inhibitors: epidemiology, management and surveillance , 2019, Nature Reviews Clinical Oncology.

[6]  M. Paasche-Orlow,et al.  Association of Race/Ethnicity With Emergency Department Destination of Emergency Medical Services Transport , 2019, JAMA network open.

[7]  T. Owonikoko,et al.  Sites of metastasis and association with clinical outcome in advanced stage cancer patients treated with immunotherapy , 2019, BMC Cancer.

[8]  R. Mehra,et al.  Immune-Related Adverse Events Requiring Hospitalization: Spectrum of Toxicity, Treatment, and Outcomes. , 2019, Journal of oncology practice.

[9]  Xin Wang,et al.  Treatment-Related Adverse Events of PD-1 and PD-L1 Inhibitors in Clinical Trials: A Systematic Review and Meta-analysis. , 2019, JAMA oncology.

[10]  E. B. Butler,et al.  Racial and Socioeconomic Disparities in the Delivery of Immunotherapy for Metastatic Melanoma in the United States , 2019, Journal of immunotherapy.

[11]  S. Sridhar,et al.  Prognostic Significance of Liver Metastasis in Durvalumab-Treated Lung Cancer Patients. , 2019, Clinical lung cancer.

[12]  D. Francis,et al.  Mortality From Ischemic Heart Disease , 2019, Circulation. Cardiovascular quality and outcomes.

[13]  T. Owonikoko,et al.  Enrollment of Racial Minorities in Clinical Trials: Old Problem Assumes New Urgency in the Age of Immunotherapy. , 2019, American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting.

[14]  Vinay Prasad,et al.  Estimation of the Percentage of US Patients With Cancer Who Are Eligible for and Respond to Checkpoint Inhibitor Immunotherapy Drugs , 2019, JAMA network open.

[15]  Charles R. Thomas,et al.  Analysis of Diagnoses, Symptoms, Medications, and Admissions Among Patients With Cancer Presenting to Emergency Departments , 2019, JAMA network open.

[16]  Joe Y. Chang,et al.  Racial and Insurance-related Disparities in Delivery of Immunotherapy-type Compounds in the United States , 2019, Journal of immunotherapy.

[17]  E. Atenafu,et al.  Hospitalisations and emergency department visits in cancer patients receiving systemic therapy: Systematic review and meta‐analysis , 2018, European journal of cancer care.

[18]  A. Abernethy,et al.  Speed of Adoption of Immune Checkpoint Inhibitors of Programmed Cell Death 1 Protein and Comparison of Patient Ages in Clinical Practice vs Pivotal Clinical Trials , 2018, JAMA oncology.

[19]  Muhammad Masab,et al.  Clinical outcomes of African American patients with advanced or metastatic non-small cell lung cancer on Nivolumab in a single community-based cancer center , 2018, Medical Oncology.

[20]  H. Tiwari,et al.  Adoption rates of immune checkpoint inhibitors in real world oncology practice. , 2018 .

[21]  B. Carr,et al.  Trends in the Contribution of Emergency Departments to the Provision of Hospital-Associated Health Care in the USA , 2018, International journal of health services : planning, administration, evaluation.

[22]  J. Brahmer,et al.  Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline Summary. , 2018, Journal of oncology practice.

[23]  M. Suarez‐Almazor,et al.  Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline. , 2018, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[24]  J. Metsemakers,et al.  Cardiovascular disease patients have increased risk for comorbidity: A cross-sectional study in the Netherlands , 2017, The European journal of general practice.

[25]  N. Chalmers Racial Disparities in Emergency Department Utilization for Dental/Oral Health-Related Conditions in Maryland , 2017, Front. Public Health.

[26]  Susan Halabi,et al.  Meta-Analysis Evaluating the Impact of Site of Metastasis on Overall Survival in Men With Castration-Resistant Prostate Cancer. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[27]  Coral L. Atoria,et al.  ReCAP: Hospitalizations in Older Adults With Advanced Cancer: The Role of Chemotherapy. , 2016, Journal of oncology practice.

[28]  Alejandro Lucia,et al.  Epidemiology of coronary heart disease and acute coronary syndrome. , 2016, Annals of translational medicine.

[29]  J. Wolchok,et al.  Toxicities of the anti-PD-1 and anti-PD-L1 immune checkpoint antibodies. , 2016, Annals of oncology : official journal of the European Society for Medical Oncology.

[30]  J. Wolchok,et al.  Toxicities of the anti-PD-1 and anti-PD-L1 immune checkpoint antibodies. , 2015, Annals of oncology : official journal of the European Society for Medical Oncology.

[31]  E. Atenafu,et al.  Frequency and predictors of hospitalization during chemotherapy: a systematic review. , 2015 .

[32]  T. Bethea,et al.  Health Disparities and Cancer: Racial Disparities in Cancer Mortality in the United States, 2000–2010 , 2015, Front. Public Health.

[33]  N. Cheedella,et al.  Liver Metastases in Prostate Carcinoma Represent a Relatively Aggressive Subtype Refractory to Hormonal Therapy and Short-Duration Response to Docetaxel Monotherapy , 2015, World journal of oncology.

[34]  N. Esnaola,et al.  Racial differences and disparities in cancer care and outcomes: where's the rub? , 2012, Surgical oncology clinics of North America.

[35]  S. Hendren,et al.  Eliminating Disparities in Cancer Screening and Follow-up of Abnormal Results: What Will It Take? , 2011, Journal of health care for the poor and underserved.

[36]  Mary A. Gerend,et al.  Social Determinants of Black-White Disparities in Breast Cancer Mortality: A Review , 2008, Cancer Epidemiology Biomarkers & Prevention.

[37]  C. Gross,et al.  Racial disparities in cancer therapy , 2008, Cancer.

[38]  Roger B. Davis,et al.  Racial and ethnic disparities in cancer screening the importance of foreign birth as a barrier to care , 2003, Journal of General Internal Medicine.

[39]  A. Garg,et al.  Chronic kidney disease and mortality risk: a systematic review. , 2006, Journal of the American Society of Nephrology : JASN.

[40]  Thomas E Novotny,et al.  US Department of Health and Human Services: a need for global health leadership in preparedness and health diplomacy. , 2006, American journal of public health.