CN61 - Recognizing and managing immune checkpoint: Related symptoms with expert advice from dedicated oncology nurse

Background

In order for oncological treatment with immune checkpoint inhibitors (ICI) to go as planned, a tight patient – care giver bond should be established. Patients (pts) are advised to contact dedicated oncology nurse in case of symptom worsening or adverse events (AEs) emerging. Telephone consultations are recorded as passive monitoring in order to keep track of the pts difficulties. Furthermore, an active monitoring from the dedicated nurse is made halfway between 1^st and 2^nd ICI cycle to check the pt status.

Methods

We retrospectively analysed active and passive consultations with pts with advanced non-small cell lung cancer, receiving ICI, their complaints, further referrals, ICI discontinuation and / or immunosuppressive treatment prescribed and the final outcomes.

Results

Three hundred and fifty-seven pts started ICI treatment from Jan 1^st, 2018, to Dec 31^st, 2022, and in that time-period we recorded 112 phone calls from 70 different pts with median age of 66 yrs and 61% being male. All of the patients were further referred to their general practitioner, emergency room or to a prior check-up with their oncologist at 78%, 13% and 9%, respectively. Almost half of the complaints (45%) were assessed as disease symptoms worsening, 33% needed temporary ICI discontinuation due to G1/2 ICI AEs, 20% both ICI discontinuation and immunosuppressive therapy due to G2/3 AEs and 3% of patients had life threatening AEs that led to in-hospital management. From June 2020 active monitoring resulted in 281 active inquiries, with 47 newly recognised complaints, 51% due to poor cancer symptoms management and 49% as possible ICI AEs. Out of latter, symptoms were mostly managed with professional advice about supportive treatment, although 8 (17%) of complaints resulted in temporary ICI cessation and immunosupressive treatment. None of the pts in either cohort died due to an AE complication.

Conclusions

About one fifth of pts on ICI therapy experience intractable concerns that need professional guidance and since half of those were later recognized as AE of ICI therapy, it is essential to accept the role of dedicated oncology nurses with special knowledge that can prevent severe complications by swift recognition of pts concerns.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.