Immune checkpoint inhibitors prolong survival by harnessing the immune system to fight cancers using various mechanisms of action such as targeting antigen presenting cells, T cells, or natural killer cells.1,2 Oncologists, oncology nurses, and patients need to be increasingly proficient in identifying and managing cancer immunotherapy-related adverse effects. If the patient does not report adverse effects or if the providers do not identify serious adverse effects, it can lead to increased morbidity and mortality. Because exposure to individuals in the emergency department (ED) poses unnecessary risks for immunocompromised patients, oncologists and oncology nurses typically recommend that patients experiencing adverse side effects from cancer immunotherapy present for follow-up at the cancer center instead of the ED. Yet, data from our health system showed an increasing trend in inappropriate ED utilization among patients receiving cancer immunotherapy treatments over the past 2 years. On average, >30% of cancer immunotherapy patients who presented to the ED did so when they experienced common adverse effects of their immunotherapy treatment; presenting at the cancer center would have resulted in more efficient care coordination in a safer setting for immunocompromised patients. The need for patients to present to the cancer center is underscored during the COVID-19 pandemic, with the risk of exposure to patients with COVID-19 being much greater in the ED than the cancer center.

Educational interventions may help cancer patients better understand common adverse effects of immunotherapy treatment and where to present when they experience these adverse effects. Yet, there are few studies on educational interventions for cancer immunotherapy. Using a literature review to extrapolate lessons learned from the adult learning literature, recommendations for educating patients about cancer immunotherapy include considering the patients’ preferred method of learning (eg, visual, auditory, read and/or write, kinesthetic) and barriers to learning (eg, physical and environment factors, language and culture, health literacy).3 Recommended content for immunotherapy education include differences between chemotherapy and immunotherapy, immunotherapies’ mechanisms of action, adverse effects, and management of those effects.3, 4, 5 Although one study aims to inform the development of educational materials for cancer immunotherapy, the study is in progress and—to our knowledge—has only published its planned research methodology.6

In this study, we explored whether a refined patient education program for cancer immunotherapy can (1) improve patient understanding about immunotherapies’ mechanisms of action, adverse effects, and management of those effects including where to present when experiencing adverse effects and (2) reduce inappropriate ED utilization. We had three research questions:

RQ1: What are gaps in patients’ knowledge about immunotherapy?

RQ2: What is the efficacy of an education session in improving cancer patients’ knowledge about immunotherapy?

RQ3: What is the efficacy of an education session in reducing cancer patients’ inappropriate ED visits?