Text Message Questionnaire Could Help Screen for ICI Toxic Effects

By Leah Lawrence - Last Updated: September 10, 2022

A text message-based questionnaire accurately identified patients with solid tumors who were not experiencing symptoms of immune checkpoint inhibitors (ICIs) toxic effects, according to a recent study.

“The current care model consists largely of in-person visits to assess clinical status and treatment-related toxic effects,” the researchers wrote. “However many patients treated with immune checkpoint inhibitors (ICIs) do not experience toxic effects.”

The researchers performed a single-center study to evaluate whether a text message-based triage instrument could accurately identify patient-reported ICI toxic effects compared with the standard in-person clinician assessment in the electronic medical record.

Included patients were receiving single-agent ICI for a solid tumor. The study instrument had 16 questions adapted from the National Cancer Institute’s Professional Common Terminology Criteria for Adverse Events. The questionnaire was given once to patients during their treatment course.

Forty-five patients completed the study instrument. Median age was 68 years old, and the majority of patients were White (88%).

Most patients who participated had been treated with single-agent pembrolizumab (54%) or nivolumab (34%) for palliative management of genitourinary or skin cancers.

The prevalence of a documented ICI toxic effects in the electronic medical record was 57.8%. The questionnaire instrument had a 100% sensitivity corresponding to a 0% false negative rate, 47% specificity, and a negative predictive value of 100%.

“This implies that such patients with normal laboratory parameters can likely bypass the usual pretreatment office visit and proceed directly to ICI infusion with minimal risk of missing an immune-related adverse event,” the researchers wrote.

The study noted that the instrument’s modest specificity “implies that the tool erroneously detects ICI toxic effects in some patients, this approach still offers the potential to reduce up to 20% of office visits.”

Both visual impairment and limited access to a smartphone were barriers to completion.

“Further work is needed to integrate a text message-based triage system into routine care and understand its impact on the patient experience,” the researchers concluded.



Accuracy of a Text Intervention to Minimize the Burden of Cancer Care Among Patients Treated With Immune Checkpoint Inhibitors