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BackgroundAn oncology hospitalist is a physician specializing in the inpatient care of hospitalized patients with cancer. The hospitalist model emerged in the mid-1990s as an alternative to primary care physicians managing their own patients both in and out of the hospital. The number of hospitalists has increased substantially, with more than 30 000 hospitalists staffing approximately 70% of US hospitals, driven by a variety of factors. The factors contributing to the hospitalist model include:- Increasing pressure to improve quality and safety,- Limits on house staff working hours,- Positive outcome data,- Increasing support of the model by primary care physicians and specialists.Similar forces are promoting hospital-focused specialty practices.Traditionally seen as u201cgeneralistsu201d, hospitalists, physicians trained in internal medicine who provide care to hospitalized patients, have expanded beyond general internal medicine, and have moved into specialties such as neurology, orthopedic surgery, pediatrics, general surgery, and oncology.The emerging role of hospitalists in cancer care reflects several trends in medicine:- Cancer care is becoming increasingly outpatient-based,- Cancer care is becoming increasingly complex, in and out of the hospital, - A growing aging population, with a greater incidence of cancer patients and cancer survivors,- A shortage of oncologists, - Acute hospital care is the largest component of spending in patients with advanced cancer.According to the American Society of Clinical Oncology (ASCO), the projected number of new cancer cases in the United States will increase by 42% by 2025.During the same period, the number of oncologists will increase by only 28%, leading to a projected shortage of 1487 oncologists. Hospitalists can help accommodate the patient load. Hospitalist-led inpatient care has demonstrated to be high-quality care, efficient, and less costly; this improved efficiency has been observed in teaching and non-teaching institutions.These conditions, along with increasing complexity in the management of the oncological patient have created the need for a physician with expertise in the management of the cancer patient in the hospital. These new demands create the need for training of the future oncology hospitalist. MethodsThe Oncologic Hospital Medicine fellowship program at MD Anderson Cancer Center, the first and only of its kind provides advanced training in the management of complex medical problems of the hospitalized cancer patient. The main goal of the program is to facilitate expertise in the diagnosis, treatment, and multidisciplinary management of the hospitalized cancer patient, as well as to advance scholarship in the growing sub-discipline of oncology hospital medicine. The duration of the program is 12 months.At the completion of the first year of training, the fellow is expected to be knowledgeable about appropriate diagnostic and therapeutic approaches to cancer patients who are admitted to the hospital for acute care. As a result of this training, the fellow will be recognized as an expert in the emerging discipline of oncologic hospital medicine. ResultsThe fellowshipu200bu200b is in its first year of implementation. ConclusionsOncology Hospitalists focus on the comprehensive care of hospitalized cancer patients.Oncology Hospitalist provides value to the patients and their outpatient providers and the health care system as a whole by applying the principles of patient safety, quality improvement, safe transitions of care, team approach and multidisciplinary care and risk management. The creation of an Oncologic hospital medicine fellowship program aims at training the future generation of experts in the emerging discipline of oncologic hospital medicine.Future areas of research and development for oncology hospitalists include healthcare services delivery, investigations into the most severe side effects of novel therapies, such as immunotherapies and tyrosine kinase inhibitors that require hospitalization, and improvement in palliative care delivery.

CASE PRESENTATIONA 65-year-old female with metastatic esophageal adenocarcinoma to lymph nodes and liver. The patient received multiple cycles of FOLFOX, followed by ramucirumab/paclitaxel, and most recently, on a clinical trial with a combination of an icos agonist with a PD-1 inhibitor, status post 2 doses. She began noticing scleral icterus two weeks later and was admitted to the hospital 21-days after her second dose of these agents with symptomatic hypotension and hypoxemia. The initial evaluation confirmed jaundice and hepatomegaly, and laboratory data demonstrated normocytic anemia (hemoglobin 5.8), thrombocytopenia (platelets 39), elevated LDH (> 7000), indirect hyperbilirubinemia, reticulocyte count of 14 and reticulocyte index of 7, suggestive of a hemolytic process. DAT negative. ADAMTS13 activity was low at 56% (normal value: u2265 70). Presumed to have developed immune-related hemolytic anemia, T-cell mediated, she was promptly initiated on methylprednisolone 1 mg/kg IV every 12 hours, along with best supportive care. She continued to rapidly decline with tachypnea, tachycardia, hypoxemia, and hepatomegaly and did not respond to treatment including transfusion of 4 units of packed red blood cells, steroids, and best supportive measures. She developed frank hypoxemic respiratory failure necessitating high flow oxygen, and elevated troponins as the result of a supply-demand mismatch secondary to the acute anemia. The blood smear showed anisopoikilocytosis, many spherocytes, and schistocytes, teardrop forms, nucleated RBCs, burr cells, bands, metamyelocytes; no blasts and no hypo or hypersegmented neutrophils were seen. These findings were consistent with Thrombotic microangiopathy (TMA). Her condition continued to deteriorate despite maximum efforts. Goals of care and code status were revisited, opting for comfort measures and no further escalation of therapies. The patientu200b succumbed five days after admission. The autopsy demonstrated

IntroductionImmune-checkpoint inhibitors are revolutionizing clinical immunotherapy by inducing tumor responses in various tumor types. Unfortunately, their application is also associated with a spectrum of immune-related adverse events (irAEs)ObjectivesTo learn to promptly recognize and manage serious immunotherapy-related thyroiditisMethodsDirect patient care and literature review ResultsThis is a 61 years-old gentleman with esophageal adenocarcinoma metastatic to the liver, left adrenal gland, and lymph nodes, who received his first cycle of nivolumab-ipilimumab 21 days prior to the development of atrial fibrillation with a u200brapid ventricular response. He was admitted to the hospital with progressive dysphagia, nausea, vomiting, and diarrhea, for which he underwent percutaneous gastrostomy tube placement. The following morning, the patient developed near syncope, lightheadedness, and diaphoresis. He was found to have an irregularly irregular tachyarrhythmia with heart rates exceeding 170, requiring emergent IV metoprolol, IV digoxin and IV diltiazem. Acute coronary syndrome and acute pulmonary embolism were ruled out, as well as hypophysitis and adrenalitis. Thyroid function tests showed a very elevated free T4, greater than 7.77, and a very elevated total T3 at 360. Additional workup confirmed the diagnosis of immunotherapy-related thyroiditis. Anti-TSI antibodies were negative, anti-TPO antibodies were positive. The patient was successfully managed with beta-blockers for symptomatic and heart rate control. No corticosteroids were necessary. Following the hyperthyroid phase, the patient became euthyroid and then hypothyroid.ConclusionsIn immunotherapy-related thyroiditis, hyperthyroidism is produced by destruction of follicular thyroid cells with consequent liberation of thyroid hormones. In clinical trials with immune checkpoint inhibitors, the incidence of thyroiditis is as high as 10% with a single agent and 13% with combinations. Prompt recognition and assertive management are key to ensure best outcomes.

Purpose: Immune checkpoint inhibitor-related pneumonitis (ICI-P) is a condition associated with high mortality, necessitating prompt recognition and treatment initiation. This study aimed to assess the impact of implementing a clinical care pathway algorithm on reducing the time to treatment for ICI-P., Methods: Patients with lung cancer and suspected ICI-P were enrolled, and a multi-modal intervention promoting algorithm use was implemented in two phases. Pre- and post-intervention analyses were conducted to evaluate the primary outcome of time from ICI-P diagnosis to treatment initiation., Results: Of the 82 patients admitted with suspected ICI-P, 73.17% were confirmed to have ICI-P, predominantly associated with non-small cell lung cancer (91.67%) and stage IV disease (95%). Pembrolizumab was the most commonly used immune checkpoint inhibitor (55%). The mean times to treatment were 2.37 days in the pre-intervention phase and, 3.07 days ( p =0.46), and 1.27 days ( p =0.40) in the post-intervention phases 1 and 2, respectively. Utilization of the immunotoxicity order set significantly increased from 0% to 27.27% (p = 0.04) after phase 2. While there were no significant changes in ICU admissions or inpatient mortality, outpatient pulmonology follow-ups increased statistically significantly, demonstrating enhanced continuity of care. The overall mortality for patients with ICI-P was 22%, underscoring the urgency of optimizing management strategies. Notably, all patients discharged on high-dose corticosteroids received appropriate gastrointestinal prophylaxis and prophylaxis against Pneumocystis jirovecii pneumonia infections at the end of phase 2., Conclusion: Implementing a clinical care pathway algorithm for ICI-P management standardizes care practices and enhances patient outcomes, underscoring the importance of structured approaches., Competing Interests: Competing Interests Maggie Lu has the following declarations outside the submitted work: holds stock with Amgen. All other authors have no relevant financial or non-financial interests to disclose.