The 4 pillars in cancer treatment are chemotherapy, targeted therapy, hormonal therapy, and immunotherapy. Systemic cancer therapies, including chemotherapy, targeted therapy, and hormonal therapy, utilize exogenous agents to slow cancer growth and promote patient survival.
Hormone therapy targets estrogen and androgen pathways in patients with tumors of breast, prostate, uterine, and ovarian origin. Chemotherapy kills a constant fraction of cells rather than a specific number. They target both normal and tumor tissues, have a relatively narrow therapeutic index, and exhibit dose-dependent toxicity and high rates of acquired drug resistance. Targeted therapy refers to small molecules or “biologics,” generally macromolecules such as antibodies or cytokines, that act on specific molecules important in maintaining the malignant state expressed by tumor cells. Immunotherapy modulates T-cell function to recognize and attack human cancers.
Immunotherapy represents a significant advance in cancer treatment. Immunomodulating agents promote tumor destruction by augmenting specific CD4+ and CD8+ T-cell responses, targeting immune checkpoint molecules dysregulated by tumors to evade immune surveillance, and utilizing immunostimulatory monoclonal antibodies as antagonists of immune repressor molecules or agonists of immune-activating receptors.
Clinical studies in various tumor types have shown that these agents stimulate durable and long-lasting antitumor immune response and enhance patient survival. Safety profiles are milder and more manageable than traditional chemotherapy or targeted therapies; however, they present a unique side effect marked by immune-related adverse effects (irAEs). IrAEs require careful, proactive, and prompt identification by patients, healthcare providers, and caregivers to improve the quality of patient care and prevent treatment interruption and delay. Critical factors in optimizing care in this patient population include standardization in nursing assessment, patient identification, patient education, and effective management of irAEs.
A recent study aimed at improving the speed and rate of irAE recognition and intervention leveraged existing electronic medical records (EMRs) and developed an irAE-specific nursing assessment flowsheet, as well as an interactive, web-based patient and caregiver education tool. The nursing assessment flowsheet was developed to standardize irAE assessment and documentation, and the EMR alert was developed to identify patients receiving immunotherapy and presenting to non-oncology sites of care, such as the emergency department. There was also a telephone triage system used throughout the center.
Anticipated outcomes for this study include early identification of irAEs by nurses, decreased number of serious irAEs, standardized patient assessment and documentation, and improved data collection by trending irAEs’ severity longitudinally. The use of technology via EMR alerts should improve patient identification, raise awareness that these patients are at risk of irAEs and require expert management, and ultimately improve safety and streamline irAE management. Innovative and engaging patient education strategies should result in timely symptom recognition and reduced treatment interruption or delay.
Fradkin M, et al. ONS Abstract 31.