Evaluation of an Evidence-Based Guideline for the Management of Immune-Mediated Diarrhea/Colitis

Cancer is the second leading cause of death in the United States as well as in Texas. The introduction of Immune checkpoint inhibitors (ICIs) has been extremely promising for cancer treatment in the last decade. Immune-mediated diarrhea and colitis (IMDC) are one of the main toxicities related to ICI treatment. Early diagnosis and proper management of IMDC helps patients to achieve clinical remission, which ultimately helps patients restart their cancer treatment. This quality improvement (QI) project compared outcomes between patients admitted to the inpatient setting with IMDC in 2017 and 2019 after implementing an IMDC practice guideline in 2018 for standardizing the IMDC practice. Baseline demographic and clinical data were obtained through chart review. The final cohort included 126 patients. Consultation to GI was completed in 55 (82%) in 2019 and 31 (53%) of the patients in 2017 during their first hospitalization for IMDC. Endoscopy evaluation was done for 37 (55%) patients in 2019, and for 20 (34%) patients in 2017. The readmission rate was significantly reduced in 2019 compared to 2017: 30 (51%) patients had multiple hospitalizations in 2017 compared to 17 (25%) patients in 2019. The recurrence of IMDC occurred in only 16 (24%) patients in 2019 compared to 29 (49%) patients in 2017. For the 2019 cohort, 34 (51%) patients followed up in the GI clinic compared to 19 (32%) in 2017. As the number of patients with ICI treatment increases, the number of patients with IMDC also increases. Early GI intervention with endoscopic evaluation and medical management and proper follow-up in GI clinic will help in reducing the readmission rate, recurrence rate, and remission rate for IMDC.