Background: Immune checkpoint inhibitors, such as nivolumab, have rapidly gained in popularity and use since their development and subsequent FDA approval. With an ever burgeoning list of indications for its use, we evaluated its use within our tertiary care center as well as its impact on our healthcare system to investigate the quality of care these patients received as well as the extent of the benefit that they received from this novel therapy. Methods: Charts were collected of patients at SUNY Upstate Cancer Center who were started on treatment with Nivolumab between March 4, 2015 and June 1, 2016. This returned a total of 88 (eighty-eight) patients who underwent chart review process for this IRB-exempt retrospective study. Patients who were lost to follow-up or received their oncology care outside of the Upstate Regional Cancer Center were excluded from the final analysis, leaving 83 (eighty-three) patients on whom the final analyses were performed. Statistical analyses were performed using Microsoft Excel and Apple Numbers. Results: Nivolumab was predominantly used as second or third line therapy (45% and 34%) respectively; while it was used as first line therapy in 4% of patients. Performance status was only documented in 53% of patients within two weeks of Nivolumab initiation. Fifty-eight percent of our patients were admitted to the hospital after Nivolumab initiation. Only 50% of those patients received a palliative care consultation. Twenty-six percent of our patients were admitted with an adverse effect to Nivolumab. Nearly 25% of our patients had multiple hospitalizations. Nivolumab was discontinued in 67% of our patients after an average of eight cycles. Conclusions: Nivolumab has been a relatively well tolerated novel treatment for a multitude of malignancies. However, constant re-evaluation of patients for appropriateness of treatment is needed. It is unclear how much quality of life these patients are gaining, as many patients had to discontinue therapy and had numerous hospitalizations. Palliative care remains an important intervention in this patient population that is under-utilized.