1. Glucose levels must be monitored in patients receiving steroids for immunotherapy-related toxicity
Title: Subtitle
Risk Assessment of Hyperglycaemia Induced by Steroid Use for Immunotherapy Toxicity in Non-Small Cell Lung Cancer (NSCLC) Patients
Islam Elkonaissi, May Low, Mary O’Brien
INTRODUCTION
Immune checkpoint inhibitors (ICPis) are associated with an immune-related spectrum of side effects. High dose and prolonged courses of steroids are the mainstay of management which can precipitate hyperglycaemia. Poor glycaemic control has been linked with poor cancer prognosis and reduced quality of life in observational studies.
AIM
To determine if the risk assessment of hyperglycaemia induced by steroid use for ICPis toxicity in NSCLC is completed according to Trust clinical practice and the Joint British Diabetes Societies (JBDS) guidelines.
METHOD
Using electronic data records, a retrospective evaluation of NSCLC patients receiving ICPis was conducted from May 2018 to Jan All patients who received steroids for the management of immune-related adverse events were included. Clinical trials were excluded.
Expected sample size with immunotherapy toxicity requiring steroid management n=35 (expected to obtain from n=100 population). Using 35 patients, expected proportion to meet target 90%, with 95% CI of (80 – 100%).
RESULTS
125 NSCLC patients treated with ICPis from May 2018 to Jan 2019.
36/125 patients (29%; CI: 22-37%) received steroids for immunotherapy-related toxicities.
18/36 patients experienced a new grade 1 hyperglycaemia which may have required an intervention.
HbA1c was always measured alongside a baseline glucose level.
There was no risk assessment carried out using the JBDS assessment criteria to identify patients at higher risk.
The level of laboratory glucose measurements shows that hyperglycaemia is taken into consideration in clinic reviews.
DISCUSSION
This is a baseline audit to practice.
Findings highlight that current practice requires improvement and draws attention to this area. A major factor to consider is awareness to guidelines as the substantial increase in the complexity of management in NSCLC in recent years, has made this challenging.
LIMITATIONS
Data was retrospectively collected without considering the overall standard of the consultation.
RECOMMENDATIONS
Share findings with relevant teams
Develop a local diabetes risk assessment tool for this cohort
Improve efforts in education and communication
Re-audit in 9 months’ time.
Criteria and standards
Target
Actual
Proportion of patients with baseline HbA1c and glucose (BM) measured at steroid initiation
90%
22%
Proportion of patients with baseline glucose (BM) measured at steroid initiation
44%
Proportion of patients who had random glucose monitoring whilst on treatment
64%
Proportion of patients with assessment of risk of diabetes as per assessment criteria by JBDS 0%
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