Advanced practice RNs (APRNs), especially those with Doctorate of Nursing Practice degrees, in clinics across the country must not only focus on managing care for patients on novel therapies like immunotherapy but must also look at toxicities and adverse events from a population perspective. APRNs should look across all patients and disease types receiving the same novel treatments and recognize toxicity patterns to determine best practices for patient management.
Because novel therapies like checkpoint inhibitors and CAR T cells are still so new, clinical trials have examined only the clinical effectiveness in treating specific diseases. As of yet, no randomized clinical trials have determined best practices for managing associated toxicities. This is an area of opportunity for oncology nurse scientists to create new patient-centered studies to inform practice, and then APRNs can interpret and move the evidence from research to practice. APRNs should also identify needs and gaps in evidence, share that with their nurse scientist colleagues, and inform the research agenda based on this experience.
Tools for grading and assessing toxicities that are used in practice have been based on practice knowledge about cytotoxic agents, so most have yet to integrate the unique qualities of emerging treatments like immunotherapies. Right now, this is the biggest gap in practice. APRNs and their nurse scientist colleagues must work together to take practice knowledge to the next level to assess and treat adverse events associated with novel therapies. Questions such as how to develop new tools and guidelines for practice, what those tools look like, and how technology can help assist patients and providers managing adverse events are ripe with possibility for future nurse scientist inquiry.
For current practice, nurses should refer to ONS’s Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice to learn more about the management of this patient population. Ultimately, oncology nurses need to be leaders in practice to help recognize, synthesize, and develop new studies, tools, and evidence-based practice to provide the best support for patients receiving novel treatments.
Additionally, the National Comprehensive Cancer Network has guidelines for managing immune-related adverse events. The American Society of Clinical Oncology and Society for Immunotherapy of Cancer also developed guidelines, and both are based on expert consensus statements.
Immunotherapy is a top priority in ONS’s research agenda and is an excellent example of how clinicians and nurse scientists can collaborate to improve health outcomes for patients. APRNs, through expert experience, should help inform studies through collaboration on the nurse scientist-guided research initiative. APRNs will translate the finding of the research back into practice—coming full circle to provide the best possible care for patients undergoing novel therapies.