Inpatient and ED Use Among Melanoma and Lung Cancer Patients Receiving Immune Checkpoint Inhibitors (GP133)

• Published in: Journal of pain and symptom management 2024-05, Vol.67 (5), p.e826-e827
• Main Authors: Tay, Djin L., Dubose, Kline, Meeks, Huong, Guo, Jia-Wen, Feldner, Katie, Alekhina, Natalya, Sheng, Xiaoming, Chipman, Jonathan, Ellington, Lee, Hashibe, Mia
• Format: Article
• Language: English
• ISSN: 0885-3924
• DOI: 10.1016/j.jpainsymman.2024.02.524

1. Understand the prevalence of high-intensity healthcare utilization among individuals with advanced-stage melanoma and lung cancer receiving ICIs. 2. Recognize 2-3 patient characteristics that may influence high-intensity healthcare utilization among individuals with advanced-stage melanoma and lung cancer receiving ICIs. Immune checkpoint inhibitor receipt was associated with increased emergency department and inpatient encounters among individuals with advanced lung cancer and melanoma diagnosed between 2013-2018 and followed to 2021. Over 13% of individuals who died within the study period had inpatient emergency department encounters within the last six months of life. Immune checkpoint inhibitors (ICI) have become standard of care in advanced melanoma and lung cancers. ICIs have lower toxicities than chemotherapy but adverse effects are common. Around 4-28% of ICI patients experience severe adverse events requiring inpatient care, making this patient population at potentially greater risk for high intensity care utilization. We examined the risk of all-cause inpatient and emergency department visits among melanoma and lung cancer ICI patients, hypothesizing that ICI receipt would be associated with greater healthcare utilization. Patients diagnosed between 2013-2018 were identified with the Utah Cancer Registry and ICI receipt and health encounters were identified with the Utah All-Payers Claims Database and statewide inpatient and emergency department records. Bivariate tests and multivariable Poisson Regression Models were conducted in R (p < 0.05). 415 patients with melanoma (n=137, 33%) and lung cancer (n=278, 67%) received a PD-1/PD-L1 or CTLA-4 ICI between 2013 and 2021. Most were diagnosed at distant stages of disease (68.9%) and had a median of 2 (IQR=1-3) inpatient stays and 1 (IQR= 0-3) emergency department visits. Accounting for demographics, socioeconomic characteristics, rurality, cancer stage, and non-cancer comorbidities, ICI receipt was associated with increased emergency department visits among melanoma (aIRR= 1.71, 95% CI=1.48-1.98, p< 0.001) and lung cancer patients (aIRR=1.37, 95% CI=1.24-1.51, p< 0.001). ICI receipt was also associated with increased inpatient stays (melanoma aIRR=1.47, 95% CI= 1.27-1.71, p< 0.001; lung cancer aIRR=1.37, 95% CI=1.25-1.50, p< 0.001). Of the 302 ICI patients who died within the study period, 41 (13.6%) had inpatient or emergency department encounters in the last six months of life. Patients receiv