Here’s Why Oncology Nurses Are Pivotal in Managing Immune-Related Adverse Events

April 29, 2021

Immune checkpoint inhibitors (ICPIs) mobilize the body’s own immune system to target cancer cells. However, the resulting immune-related adverse events (irAEs) vary in severity and may persist for months or years following treatment.

Marianne Davies, DNP, ACNP, FAAN, of the Yale Comprehensive Cancer Center, Smilow Cancer Hospital at Yale New Haven Hospital, and the Yale University School of Nursing, and Laura S. Wood, RN, MSN, OCN®, of Cleveland Clinic Cancer Center, discussed how nurses should assess and manage irAEs.

Grading for Immune-Related Adverse Events

Davies and Wood discussed the application of the Common Terminology Criteria for Adverse Events (CTCAE) for irAEs, which grades symptoms for severity on a 1–4 scale:

Using the example of gastrointestinal AEs, they illustrated how CTCAE grading is used in clinical management strategies.

Early grading and management “decreases the risk for permanent discontinuation of checkpoint inhibitor therapies due to delays in identification and interventions for irAEs,” Wood said.

Other Nursing Considerations and Strategies

To help patients achieve the best outcomes, oncology nurses should establish a dialogue and engage them in managing their irAEs when they begin ICPI treatment. “Prepare patients for therapy expectations, and teach them about supportive interventions to help minimize the onset of irAEs,” Davies said.

The speakers shared additional management strategies for common irAEs:

Wood added, “Early communication with the oncology team regarding the development of potential irAEs allows further assessment and initiation of appropriate interventions to minimize the severity and duration of irAEs.”

Survivorship Care and Beyond

Follow-up and survivorship care after immunotherapy treatment requires interprofessional management because of unpredictable long-term and late-onset irAEs, including: 

Data for long-term effects on psychosocial well-being, neurocognitive function, and quality of life are limited, so this is an area of opportunity for oncology nursing scientists to fill in the gaps. According to Wood, the most important considerations for nurses are “educating patients and caregivers about the importance of continued awareness regarding the potential for new irAEs to develop following discontinuation of immunotherapy, and the need for early communication regarding new symptoms that could be related to their prior treatment.

“Long-term follow up by the oncology or interprofessional team is critical to effectively monitor and manage ongoing irAEs following completion or discontinuation of checkpoint inhibitor treatment,” she added. “Communication between the oncology team, patient, and primary care providers improves long-term outcomes and quality of life.”

Wood closed by discussing how nurses can advocate for patients in survivorship. “Nurses are pivotal in maximizing clinical outcomes through effective patient education, early identification, and management of irAEs. Nurses can lead peer education regarding ICI therapies, application of CTCAE criteria, and best practice strategies for the care of patients receiving immunotherapy,” she said.

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