Review Article

Meeting the Challenge of Immune-Related Adverse Events With Optimized Telephone Triage and Dedicated Oncology Acute Care

Brianna Hoffner, MSN, ANP-BC, AOCNP®, and Krista M. Rubin, MS, FNP-BC

University of Colorado Cancer Center—Anschutz, Aurora, Colorado; and Massachusetts General Hospital, Boston, Massachusetts

Authors’ disclosures of conflicts of interest are found at the end of this article.

Brianna Hoffner, MSN, ANP-BC, AOCNP®, 1665 Aurora Court, Aurora, CO 80045. E-mail:

© 2019 Harborside™ | | J Adv Pract Oncol 2019;10(suppl 1):9–20



This article is a part of a JADPRO certified supplement, Immuno-Oncology Therapy Essentials: Proactive Management of Immune-Related Adverse Events

Table of Contents

  1. Immuno-Oncology Essentials: An Overview
  2. Meeting the Challenge of Immune-Related Adverse Events With Optimized Telephone Triage and Dedicated Oncology Acute Care (current article)
  3. PD-1/PD-L1 Inhibitors for Non–Small Cell Lung Cancer: Incorporating Care Step Pathways for Effective Side-Effect Management
  4. Checkpoint Inhibitor Immunotherapy for Head and Neck Cancer: Incorporating Care Step Pathways for Effective Side-Effect Management
  5. Immune-Related Adverse Events From Immunotherapy: Incorporating Care Step Pathways to Improve Management Across Tumor Types
  6. Appendix: Care Step Pathway Tools for Immune-Related Adverse Event Assessment and Management


Immune checkpoint inhibitors (ICIs) have improved outcomes for many patients with advanced cancers. However, managing the immune-related adverse events (irAEs) associated with these agents is challenging. Late recognition and/or inadequate irAE management can result in ICI discontinuation or termination, negatively impacting patient outcomes and increasing unplanned emergency department visits, hospital admissions, and costs of care. Improved clinician training and infrastructure development are needed to adequately address irAEs and maximize the potential benefits of ICIs. Advanced practice providers (APPs) are well positioned to drive these improvements. Two aspects of care may reduce the burden of irAE management: improved telephone triage and the implementation of dedicated oncology acute care services. Evidence-based protocols should be used for telephone triage. Protocol development may benefit from an evaluation of current irAE management guidelines together with resources from the Melanoma Nursing Initiative and Immuno-Oncology Essentials. Patients and their caregivers must be educated to recognize and report early symptoms suggestive of an irAE, thereby supporting triage efforts. Advanced practice providers should also advocate for the development of dedicated oncology acute care facilities staffed with clinicians well trained to recognize, grade, and manage irAEs. This manuscript reviews multiple existing models of telephone triage and dedicated oncology acute care. Oncology APPs are poised to lead the staffing, infrastructure, and educational changes necessary to reduce the burden of irAEs in patients receiving ICI therapy.

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