Research Is Needed to Better Understand Combination Immunotherapy Side Effects
Combination immunotherapy treatments are revolutionizing the way cancer care is delivered. As an ongoing evolution of care, nurses are administering different treatment modalities on a regular basis. Treatments include using multiple immunotherapy drugs in tandem, combining chemotherapy with immunotherapy, using targeted therapies with immunotherapy, and even involving radiation with immunotherapy. The move toward multiple-drug modalities will continue to change nursing practice, and nurses must have a basis of knowledge and evidence from which to work.
Combination treatments, in some instances, can elicit more frequent adverse events in patients with cancer. In a study (https://doi.org/10.1056/NEJMoa1302369) of combination therapy with ipilimumab and nivolumab for advanced melanoma, adverse events occurred more often: nearly 53% of patients experienced a grade 3–4 event. Regular assessment for symptoms, open-line communication, and continual patient education about potential adverse events can help patients and nurses (https://doi.org/10.2147/CMAR.S57550) work together to quickly identify and address any issues during treatment. Recognizing immune-related side effects compared to chemotherapy- or radiation-related side effects requires vigilance throughout the healthcare team. Nurses are key advocates and patient champions, working closely with other specialties to mitigate any potential combination immunotherapy treatment side effects.
Nursing research is key to understanding how combination treatment modalities will affect patient side-effect profiles and which interventions are most successful. Nurses are at the forefront of identifying toxicities and adverse events, and having a body of evidence to work (https://doi.org/10.1188/19.CJON.E60-E65) from is a central need when addressing side effects associated with combination therapy. Nurses are well familiar with chemotherapy and radiation treatments’ known side effects, but they have become less predictable with the advent of immunotherapies and require novel interventions. For example, recommended interventions for chemotherapy-induced diarrhea will differ from immunotherapy-induced diarrhea and pursuing the wrong treatment could be hazardous to patients.
With more combination treatment indications coming to practice every week, nurses must stay informed and educated. Using resources from organizations like ONS, the U.S. Food and Drug Administration, and the American Society of Clinical Oncology can help inform nursing practice. As more combination modalities are approved for practice, oncology nurse researchers will need to explore the science and develop evidence-based recommendations for practice, detailing the most successful ways to implement interventions, patient education, and assessment strategies to drive the future of nursing practice.