CN74 Addressing unmet patient needs through an immunotherapy late effects clinic

Abstract

Immunotherapies have changed treatment for melanoma patients with the success of checkpoint inhibitors. Early evidence suggests toxicities caused by these immunotherapies may persist in 15-43% of patients after treatment has stopped, be irreversible or have delayed onset months after treatment completion. These include diabetes, adrenal insufficiency, pneumonitis, colitis, skin reactions, hepatitis, neurological sequelae and persistent cancer-related fatigue that can lead to morbidity & mortality. However, this early evidence is limited to clinical trials and case studies. Real world data is needed. This work aimed to characterise the ongoing effects of immunotherapy via an immunotherapy late effects screening service. In our large regional cancer centre, an opt-in screening service for the late effects of immunotherapy was established in April 2021. Data collection has been included in the design of the service including: Patient self-identified needs using the Sheffield Profile for Assessment and Referral to Care. Prevalence of persistent toxicity Prevalence of psychosocial needs Range and frequency of interventions required. In the first 12 months of the service 54 new patients were seen (46 melanoma, 5 renal, 2 head & neck, 1 bladder). The majority of patients (44, 81%) reported ongoing side effects or symptoms. Most of these required supported self care, but a number (16, 30%) required referrals to rehabilitation services and (7, 13%) required referral to specialist medical teams for further investigations and management. The most common problems reported by patients were fatigue (21, 39%), arthralgia (13, 24%) skin reactions (12, 22%) low mood (10, 19%) and dyspnoea (8, 15%). Traditionally the majority of patient support is provided during the treatment period. We have found that toxicities are not routinely recognised post-treatment and this new service facilitates identification. Screening for ongoing and new toxicities can improve patient experience and quality of life and potentially reduce mortality from the sequalae of treatment. Research is needed to demonstrate whether this early identification translates into improved patient experience, quality of life and reduction of mortality.