Assistant Dean for GME & Residency Program Director University of Toledo Toledo, Ohio
Disclosure(s): No financial relationships to disclose
Disclosure(s):
Matthew Graber, MD PhD FAAEM: No financial relationships to disclose
This session will guide you through a real-world yet literature based approach to cancer patients receiving immunotherapy who present to your ED. Gain confidence when your patient starts with, “I’m on a -mab”. When we hear ‘cancer patient currently receiving treatment’ most of us think of chemotherapy and the adverse events related to that modality. Immunotherapy is a whole new ballgame, not only regarding treatment success, but also regarding the presentations and treatments of adverse events. We start with a simple comparison of the mechanisms behind chemotherapy compared to immunotherapy and use that foundation to understand how the adverse events related to each differ substantially. If we think of patients on chemotherapy as ‘immunosuppressed’, how should we think about patients on immunotherapy? We then delve into cases with common ED presentations for patients on immunotherapy. With your new found understanding of this treatment modality the presentations, sometimes the complete opposite of what we’d expect for those on chemotherapy, start to become clear. Can I give steroids? Should I call the oncologist (probably)? Which patients require admission? What should scare the bejesus out of me? What’s the next step? And what return precautions should I give those who I send home? We’ll address these questions and what you need to know in the ED and when you talk to the oncologist with a straightforward, logical approach.
Learning Objectives:
Describe the different mechanisms of chemotherapy vs immunotherapy. Don’t worry, we’ll keep it straightforward and promise not to draw out immune mediated pathways.
List the common adverse events related to immunotherapy that your patients will present with as well as develop an approach to managing patients with adverse events related to immunotherapy.
Summarize when other specialists should be involved, when patients can be discharged home vs admitted and what are the appropriate return instructions.
