CN34 - Management of immunotherapy toxicities: A new challenge

Background

Advances in oncologic treatment have significantly improved survival. Immunotherapy is becoming one of the main options of treatment in many tumors, but at the cost of adverse events that differ from those of cytotoxic chemotherapy. These adverse events are related to the immune system (1). To control and manage these events, an interdisciplinary approach to the patient is essential, and it is the expert nurse who can provide specific care for the control and management of the symptoms with an exhaustive follow-up during the ambulatory and hospital process. (3,4).

Methods

A bibliographic review of relevant primary research and clinical guidelines in oncology was carried out with the key words: cancer treatment, immunotherapy, oncology, nursing care, immunotherapy-related adverse events, toxicities. An interdisciplinary working group was set up consisting of oncologists, internists and nurses, with a schedule of weekly meetings of approximately 60 minutes during the months of January and March of 2020.

Results

An algorithm has been developed for each most common toxicity to allow nursing staffto detect early signs/symptoms of the patient and classify them according to the degree of toxicity, depending on the organ affected (2) and according to the CTCAE (Common Terminology Criteria for Adverse Events) classification. At the same time, these algorithms allow prescribing the necessary treatment for grade I and II adverse events. For grades III and IV, specific care plans were established. Therefore, nursing can carry out autonomous interventions to detect potential risk situations prevent possible complications.

Conclusions

The algorithm of multidisciplinary action provides an improvement in the approach in the different stages of the oncological process. It involves outpatient (consultation, Call Center, Immediate Care Consultation, Day Hospital) and hospitalization units. We believe its application can improve assessment, detection and treatment of the patient according to defined criteria, thus optimizing time and resources, improving quality of care, patient satisfaction and safety, and achieving excellence in care. It also promotes the autonomous role of the nurse and its value.

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.