Review Article

Immune-Related Adverse Events From Immunotherapy: Incorporating Care Step Pathways to Improve Management Across Tumor Types

Laura S. Wood, RN, MSN, OCN®

Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio

Author’s disclosures of conflicts of interest are found at the end of this article.

Laura S. Wood, RN, MSN, OCN®, Cleveland Clinic Cancer Taussig Cancer Center, 10201 Carnegie Avenue, Cleveland, OH 44195. E-mail: woodl@ccf.org


J Adv Pract Oncol 2019;10(suppl 1):47–62 | https://doi.org/10.6004/jadpro.2019.10.2.13 | © 2019 Harborside™


  

ABSTRACT

This article is a part of a JADPRO certified supplement, Immuno-Oncology Therapy Essentials: Proactive Management of Immune-Related Adverse Events

Table of Contents

  1. Immuno-Oncology Essentials: An Overview
  2. Meeting the Challenge of Immune-Related Adverse Events With Optimized Telephone Triage and Dedicated Oncology Acute Care
  3. PD-1/PD-L1 Inhibitors for Non–Small Cell Lung Cancer: Incorporating Care Step Pathways for Effective Side-Effect Management
  4. Checkpoint Inhibitor Immunotherapy for Head and Neck Cancer: Incorporating Care Step Pathways for Effective Side-Effect Management
  5. Immune-Related Adverse Events From Immunotherapy: Incorporating Care Step Pathways to Improve Management Across Tumor Types (current article)
  6. Appendix: Care Step Pathway Tools for Immune-Related Adverse Event Assessment and Management

Abstract

Immune checkpoint inhibitor (ICI) therapy provides a valuable treatment option for many cancer patients but is associated with immune-related adverse events (irAEs) that can involve any organ system. Managing irAEs can be a challenge, as these AEs differ from those associated with conventional chemotherapy in both appearance and care. Prompt and successful irAE management is important for patient health and the maintenance of effective therapy.

A group of advanced practice providers has developed Care Step Pathways (CSPs) to improve the management of irAEs (see Appendix and aimwithimmunotherapy.org. These CSPs, which combine established guidelines with practical experience, provide information on assessing, grading, and managing irAEs. Proactive strategies, implementation tactics, patient education points, and “red flags” are also featured.

This article provides a brief summary of ICI therapies currently used in oncology and an overview of irAEs that may occur during treatment. The importance of medication reconciliation and a thorough baseline assessment is stressed, and detailed information on baseline clinical and laboratory tests is provided. Specific CSPs for several irAEs, such as gastrointestinal toxicity, adrenal insufficiency, nephritis, and neuropathy, are reviewed in detail. As these CSPs illustrate, advanced practice providers are well positioned to play a key role in collaborative care for oncology patients, particularly with respect to providing in-depth patient education and “owning” AE management.


How to Earn Credit

To qualify for CE credit, you must read all 6 articles in this supplement. To access the learning assessment and evaluation form online, visit
https://education.annenberg.net/5686

Statement of Credit: Participants who successfully complete this activity (including scoring of a minimum of 70% on the learning assessment) and complete and submit the evaluation form will be able to download a statement of credit.




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