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

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A new immuno-oncology toxicity (IOTOX) clinic significantly reduced wait times for patients with immunotherapy-related thyroid dysfunction (irTD). This specialized clinic expedited thyroid function test normalization, improving patient care for immune-related adverse events.

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Area of Science:

  • Endocrinology
  • Oncology
  • Quality Improvement

Background:

  • Cancer immunotherapy is increasing, leading to more immune-related adverse events (irAEs).
  • Immunotherapy-related thyroid dysfunction (irTD) is common, causing endocrine consultation delays.
  • Timely management of irTD is crucial for patient outcomes.

Purpose of the Study:

  • To decrease consultation wait times for patients with irTD.
  • To reduce the time for thyroid function test (TFT) normalization in irTD patients.
  • To implement a quality improvement project using the Plan-Do-Study-Act framework.

Main Methods:

  • Established a dedicated immuno-oncology toxicity (IOTOX) clinic.
  • Staffed the clinic with advanced practice providers (APPs) and physician support.
  • Utilized standardized algorithms for irTD evaluation and treatment.

Main Results:

  • Median consultation wait time decreased from 21 to 9 days (P = .01).
  • Median time to follow-up improved from 180 to 58 days (P < .001).
  • Median time to thyroid-stimulating hormone normalization reduced from 102 to 38 days (P < .001).

Conclusions:

  • The IOTOX clinic model effectively improved patient access and expedited TFT normalization.
  • APP-led clinics with standardized protocols enhance care for irAEs.
  • This model can be adapted by other institutions to manage irAEs.