Virtual Toxicity Team: Johns Hopkins University

In 2015, Jarushka Naidoo, MBBCh, joined the Hopkins' team. She and her oncology colleagues, including Joanne Riemer, RN, BSN, senior research nurse with the Upper Aero-digestive Team at Sidney Kimmel Comprehensive Cancer Center, started the Immune-Related Toxicity Team (IR Tox Team) by enlisting the expertise of Hopkins’ rheumatologists to help diagnose and treat patients who were experiencing rheumatic immune-related adverse events (irAEs). This collaboration led the group to publish its first “algorithm” to help providers outside of Hopkins diagnose and manage patients who develop this side effect from immunotherapy.

The IR Tox Team grew from there, adding representatives from eight medical specialties. Over the years, Dr. Naidoo has helped recruit additional specialists, and the team has continued to expand. In addition to medical oncologists and oncology nurses, the Tox Team includes specialists in rheumatology, endocrinology, cardiology, dermatology, neurology, hematology, pulmonology, ophthalmology, gastroenterology, and infectious disease, as well as allied health professionals—including pharmacists, radiologists, and pathologists.

Members of Hopkins’ virtual IR-Tox Team communicate via a password-protected email listserv. “Anybody who is part of the cancer center—any oncologist, oncology nurse, nurse specialist, physician assistant, or trainee—can refer to us,” says Dr. Naidoo. Hopkins’ IR-Tox Team receives up to four referrals per day, totaling approximately 250 to 300 patients per year.