The science of evidence-based cancer care has progressed over time and generally includes surgery, radiation, and chemotherapy, alone or in combination. Approximately 10-15 years ago, a fourth treatment option, immunotherapy, emerged to treat melanoma. Since that time, immunotherapy has been investigated as a beneficial treatment for several different cancer types.
Whereas chemotherapy’s mode of action is to destroy rapidly dividing cells, it does not differentiate between healthy and malignant cells and therefore may cause multiple undesirable side effects for patients. Immunotherapy’s mechanism of action is to stimulate the patient’s immune system to fight cancer and has been found to cause different side effects than those patients experience with chemotherapy. As such, nurses must assess patients undergoing immunotherapy differently for untoward side effects than they do patients receiving chemotherapy.
The nursing assessment of a patient undergoing immunotherapy includes evaluating for early signs of adverse events to control symptoms, allowing for the continuation of this life-saving medication. To do so, nurses must assess patients receiving immunotherapy for side effects in a focused, treatment-specific way. Assessment of the patient includes determining if conditions such as colitis, hepatitis, pneumonitis, dermatitis, and arthritis, as well as other potential complications have developed. Despite the rapid evolution of immunotherapy, the nursing assessment tool in use in the outpatient infusion areas focused on the side effects of chemotherapy such as neutropenia, alopecia, nausea, and vomiting rather than potential adverse events specific to immunotherapy.
A task force comprised of the Sylvester outpatient oncology nurse educators, the infusion clinical practice team, and an oncology APRN content expert on the topic, convened to create a revised nursing assessment tool. The National Comprehensive Cancer Network recommendations were utilized to identify potential adverse events of immunotherapy and construct the nursing assessment tool. Internal immunotherapy experts, including physicians and Advanced Practice Providers, assisted in affirming the criteria in the assessment tool and providing feedback on the information they would want the nurses in the infusion suite to document and relay to them. “The collaborative efforts to developing the new assessment tool was a wonderful display of the collegiality and commitment we share in Infusion Services,” said Lauren Nicole Gallegos, BSN, RN, Director of Clinical Practice, Infusion Services.
A draft of the newly developed immunotherapy nursing assessment tool was distributed to novice and senior nurses for feedback and recommendations at four of the nine UHealth infusion sites. The feedback was carefully reviewed and an evidence-based education plan about immunotherapy and the therapy’s potential adverse events was implemented. Finally, three nurses at two infusion sites piloted the tool for nearly three weeks for the patients receiving immunotherapy. An evaluation of the tool’s ease of use, length, and comprehensiveness followed the pilot phase.
The results of the pilot were exceedingly positive, and the Information Technology team is adapting the tool for use with the electronic health record. The newly developed immunotherapy assessment tool will be available as a standardized tool for all infusion sites in November 2021.