MON-623 Real-Life Safety Monitoring for Patients with Advanced Thyroid Cancer on Targeted Therapy: A Quality Improvement Project

Abstract S. Hamidi: None. L.E. Castellanos: None. S. Thosani: None. C.J. Best: None. S.I. Sherman: None. R. Dadu: None. A.K. Brinkman: None. M. Khoja: None. M.I. Hu: None. S.G. Waguespack: None. S.P. Weitzman: None. Background: Patients with advanced thyroid cancer (TC) treated with an oral kinase inhibitor (KI) require routine laboratory and cardiac monitoring due to potential drug-induced toxicities. Numerous potential adverse events (AEs) can occur and nearly all patients experience at least one AE. Before this project, toxicity monitoring and documentation of results varied among providers. Therefore, to facilitate timely identification of AEs and improve patient safety, we aimed to implement a standardized monitoring process for patients with TC on KIs at a tertiary cancer center. Methods: Following approval by the Quality Improvement Assessment Board, a multidisciplinary team employed the Plan-Do-Study-Act method from 3/2022 - 10/2023 to implement interventions standardizing the toxicity monitoring process. We focused on the four most prescribed KIs in our center at the start of this project: cabozantinib, dabrafenib, lenvatinib and trametinib. All teams attended educational sessions and were encouraged to use a time-sensitive follow-up order as well as a template for consistent documentation of test results in the electronic medical record. Three of 11 clinical teams piloted a standard operating procedure (SOP) including creation of a weekly remote treatment monitoring (RTM) clinic to systematically track test results, assess AEs and identify patients who had not completed safety monitoring. We then conducted a retrospective chart review of all patients seen by an oncologic endocrinologist during specified time periods before (2/21 – 3/1/2022) and after (12/5 – 12/13/2022) these interventions to identify those treated for advanced TC outside of a clinical trial with one of the above listed KIs. Pre- and post-data include documentation of safety monitoring. To gauge the impact of the RTM clinic, we chose the rate of rescheduling as a surrogate measure of patient safety because incomplete testing within the desired timeframe was the primary reason cited. Results: 18 unique patients were identified in both the pre and post intervention time periods. There was significant improvement in documentation of laboratory test results (100% vs 56%, p < 0.001) and desired testing intervals (67% vs 33%, p=0.043) in the post-intervention versus pre-intervention charts. There was also improvement in the number of patients whose ECG result was documented (77% vs 53%, p=0.167). Regarding the RTM clinic, 29% of appointments (45/153) were rescheduled. Conclusion: Our results suggest that implementation of an SOP, including an RTM clinic, for toxicity monitoring of patients with advanced TC on KIs enhances patient safety by improving timely testing and review of results. Limitations include only partial implementation of the pilot program at the time of analysis. Next steps include rollout of the monitoring process to all endocrine center teams. Monday, June 3, 2024