(23) You’re doing WHAT in the clinic? Initiating dinutuximab in the outpatient oncology setting

Title: You’re doing WHAT in the clinic? Initiating dinutuximab in the outpatient oncology setting

Abstract : Patients with high-risk, relapsed, or refractory neuroblastoma are likely to receive GD2 directed monoclonal antibody dinutuximab as part of their cancer therapy. Dinutuximab has a side effect profile that requires close monitoring and supportive care in an inpatient setting. Patients are admitted the night prior to starting this immunotherapy, which is typically given daily for four days as an intravenous infusion. At a time when many inpatient units are overflowing with patients, these long admissions may put additional strain on hospital systems already under stress. At the Children’s Hospital of Philadelphia, a large, urban, pediatric medical center, we proposed, developed, and implemented a new pathway for initiating dinutuximab in the outpatient setting prior to hospital admission. An interprofessional team—including an advanced practice nurse, pharmacists, nurse navigators, information services specialists, and nurses—designed the pathway and workflow to shorten inpatient length of stay in response to a consistently high hospital census. The project also served as a pilot, empowering nurses to activate chemo/immunotherapy orders via the electronic order entry system. Eligible patients completed laboratory testing and serial screenings to confirm readiness to proceed with therapy. Once cleared to start dinutuximab, nursing released orders and initiated therapy in the outpatient clinic. The team addressed logistical challenges regarding supply availability, emergency preparedness, and patient transport as well as provided comprehensive education to nurses. Over the last year, two patients safely started a total of five dinutuximab-containing cycles in the outpatient setting. Strict eligibility criteria have kept the number of patients following the pathway low. Those who followed the new pathway experienced shorter hospital stays and expressed increased satisfaction with care. The team hopes to broaden eligibility criteria to allow more patients to follow the pathway in the future.