Because the treatment of symptoms, side effects, and adverse events associated with immunotherapies can differ greatly from the standard of care, the American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN)—along with experts from ONS staff and membership—collaborated to develop guidelines to inform clinicians about managing immune-related adverse events associated with checkpoint inhibitor therapy.

Checkpoint inhibitors carry unique side-effect profiles, and healthcare providers must be equipped with the latest information to provide safe, timely care for their patients. ONS member Kelly Brassil, PhD, RN, AOCNS®, ACNS-BC, director of nursing programs at the University of Texas M.D. Anderson Cancer Center, along with ONS’s Pamela Ginex, EdD, MPH, RN, OCN®, senior manager of evidence-based practice and inquiry, were selected to serve on the expert panel for developing the ASCO/NCCN checkpoint inhibitor guidelines.

“In our capacity, we each served on writing teams, mine focusing on developing content related to dermatologic toxicities,” Brassil says. “We reviewed and provided feedback and edits on the larger guideline document, and we coauthored the section on patient and clinician communication.”

Providing Crucial Information for Oncology Nurses

Brassil notes the importance of understanding best practices for managing checkpoint inhibitor adverse events. The guidelines offer in-depth information to inform nursing practice.

“The guidelines focus on the clinical management of toxicities, including when to hold or discontinue treatment, along with the recommended management for toxicities by system,” Brassil notes “But it’s more than just informational for nurses—it highlights the types of toxicities to be aware of, the presenting symptoms to assess for, the grading of these toxicities, and, ultimately, the management guidelines. Being aware of and understanding the guidelines are pivotal to our ability to partner with patients and providers to ensure the early identification and management of these toxicities.”

Brassil says that she hopes the new guidelines serve as a guidepost for oncology nurses and other providers to educate themselves on the treatment of immune-related toxicities associated with checkpoint inhibitors.

Addressing the Growing Need for Checkpoint Inhibitor Management

As the U.S. Food and Drug Administration continues to approve immunotherapy treatments for new indications, providers will have to stay up to date on the latest information. Checkpoint inhibitors are being used more frequently for many treatment protocols.

“Immunotherapy approaches are continually emerging in the context of both research studies and clinical care,” Brassil says. “And checkpoint inhibitors, such as nivolumab and pembrolizumab, are increasingly becoming standard of care for an expanding diversity of indications. As research has continued to evaluate and establish new indications—including disease types to which the agents can be applied and the combination of agents to exponentiate a therapeutic effect—the toxicities unique to the agents, both alone or in combination, needed to be addressed.”

Checkpoint Inhibitor Resources for Oncology Nurses

In coordination with new guidelines’ release, ONS developed resources to support oncology nurses and their patients as they navigate checkpoint inhibitor therapy treatments.

“We were very happy to be involved in the resources section of the guidelines, because that’s often what directly impacts the patients, “Ginex says. “One crucial resource ONS contributed was an immunotherapy wallet card that patients can carry with them. On the wallet card, patients can include what their treatment was, when they received it, and more details about their specific treatments. The wallet card is so important, because we’re always concerned about continuity of care. When patients go to different providers, they may not remember the details of their immunotherapy.”

The ONS wallet card was designed to provide patients with an easy-to-complete, on-hand reference to share with their various healthcare providers to inform them of ongoing immunotherapy treatments. ONS also produced two infographics for nurses and their patients, outlining the how checkpoint inhibitors function and the important education information patients should know about checkpoint inhibitors.

Advocating for the Expert Perspective of Oncology Nursing

Brassil and Ginex acknowledge ONS’s role in identifying the need for a nursing perspective and ensuring that nurses had a seat at the table.

“ONS plays a big role in advocating for the inclusion of nurses in initiatives like the ASCO/NCCN guidelines,” Brassil says. “Their efforts to promote the nursing voice in immunotherapy care and to be in front of developing and providing resources in this field are instrumental to ensuring that nurses practice with the most current evidence to support safe and effective patient care.”

With new and emerging information of immunotherapy treatments, Brassil says that oncology nurses need to use national organizations, like ONS, to stay current on best practices for immunotherapy treatments and cancer care.

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