How detection of immune-related adverse events fails during transfer of patients between medical sectors.

Immune-related adverse events (irAEs) induced by immune checkpoint inhibitors (ICIs) in mono- or combination therapy may be acute or delayed, partly arising long after termination of treatment. They may be reversible or persistent. Treatment duration with ICIs is usually one year in the adjuvant setting of solid tumors, and until progression or inacceptable toxicity in metastatic disease. In the case of a response in the palliative setting, a patient may be on treatment for many years, based on individual decision making. Thus, every patient is at risk of experiencing clinically highly relevant side effects for a very long time when she/he may be transferred between many sectors of acute medicine including intensive care units (ICUs) until later rehabilitation procedures and observation by general practitioners. While actively treating oncologists in hospitals and outpatient departments have already covered a long (and partly harmful) learning curve, most physicians in other sectors like ICUs or rehabilitation hospitals have not seen many patients and these dangerous side effects to a larger extent, and thus have not trained their awareness and clinical knowledge. In most cases, irAEs appeared before the admission of the patients to their institutions, and they are only asked to control preexisting medications. Only intersectoral education and communication can help to safely overcome this gap and lag time until all medical specialties have gained sufficient experience and gone through their learning processes.