South East Wales Immunotherapy Toxicity Service
Velindre Cancer Centre, Velindre University NHS Trust
Introduction:
The South East Wales (SEW) Immunotherapy Toxicity Service was launched to address the growing risk of serious immune-related adverse events (irAEs) from cancer immunotherapy. These side effects can lead to hospitalisation, long-term harm, or death if not recognised early. The service aimed to reduce IO-related emergency admissions by 50% and support 500+ patients by March 2025 through ambulatory care.
Methods:
Funded via Welsh Government’s Same Day Emergency Care programme, the multidisciplinary team (MDT) - comprising oncologists, CNSs, and admin support - used PDSA cycles to test and embed improvements. These included nurse-led clinics, weekly MDTs, referral pathways, and education for healthcare professionals. A hub-and-spoke model ensured consistency across SE Wales. Over 800 patients have now accessed the service.
Outcomes:
The service achieved a 65% reduction in IO-related emergency admissions, saving an estimated £615,000. Hospital stays for severe cases reduced from 14 to 9 days. Patients reported improved care continuity, faster access to treatment, and reduced disruption to their cancer journey. Staff confidence, morale, and multi-disciplinary collaboration improved. The service is now seen as a national model of best practice.
Learnings:
Key learning included the need for early data collection, strong governance, and protected leadership time. Structured testing and stakeholder involvement helped drive measurable improvements. Challenges included initial under-resourcing and lack of formal infrastructure for data capture and digital integration. However, the phased approach enabled sustained change and scale.
What next?
The service is now entering a strategic phase to expand to a £800k regional model by 2027. Priorities include supporting other health boards to replicate the model, integrating digital tools, enhancing data systems, and embedding the service within Wales’ cancer care pathways. The team aims to inform IO toxicity care nationally while supporting similar innovations in high-risk cancer treatments like CAR-T.
