Increasing Access and Quality Care for Immune Checkpoint Inhibitor-Related Thyroid Dysfunction

The use of immunotherapy for cancer treatment is becoming increasingly prevalent, resulting in a growing number of patients experiencing immune-related adverse events (irAEs). Given the frequency of immunotherapy-related thyroid dysfunction (irTD), there is a growing demand for endocrine consultations, which has led to scheduling delays. This quality improvement project aimed to decrease the time to consultation and normalization of thyroid function tests (TFTs) in patients with irTD.

Using the Plan-Do-Study-Act framework, a clinic dedicated to the evaluation and treatment of irTD was created. The immuno-oncology toxicity (IOTOX) clinic is staffed by advanced practice providers (APPs) using standardized algorithms and physician support.

After implementation, a prospective analysis of 46 patients from the IOTOX clinic was compared with 67 historical control patients seen before implementation. The median consultation wait time improved from 21 to 9 days (P = .01), and the median time to follow-up decreased from 180 to 58 days (P < .001). Notably, the median time to thyroid-stimulating hormone normalization was reduced from 102 to 38 days (P < .001).

These findings suggest that an IOTOX clinic staffed by APPs using standardized algorithms with physician support effectively improved patient access to consultation and expedited the time to normalization of TFTs. This approach can serve as a framework for addressing other irAEs at our institution and has the potential to be implemented or adapted by other institutions to improve the care of patients with irAEs.