Nurses must understand CAR T-cell therapy and be able to recognize what to do when encountering patients who have received it, according to Danielle Nasello, RN, MSN, NP-C.
“In addition to hematologic malignancies, there are more trials testing CAR T-cell therapy in solid tumors, so pretty much the landscape of cancer has changed,” said Nasello, Department of Malignant Hematology, Moffitt Cancer Center, during a presentation at the 3rd Annual School of Nursing Oncology
“We are seeing more targeted therapies, more immunotherapies, and we have to really have a good grasp of it because this is going to become the norm.”
From a multidisciplinary approach, it is key for the healthcare team to work together through all stages of CAR T-cell therapy administration – from consultation and work-up, to pre-treatment, to infusion and the first 30 days, and finally during follow-up.
To start, Nasello recommends for nurses to have a plan in place, especially during the follow-up period. “Safety has to be at the forefront of care,” she explained. “So, they should be given education handouts pretty much from day 1 and on as to what needs to go on. After they are discharged from the hospital, they need to understand they have to have a card with them that says: This is who I need to call. This is my point of care contact. If I can’t get a hold of this person, who is next in line and what do I need to know.”
With this plan, the nursing staff must also have a triage plan for toxicities, this way there is staff in place who are trained to take calls or know who and when to call if there is an emerging side effect from CAR T-cell therapy. In conjunction with this, Nasello recommends for these team members to always recommend for a patient to return, either after the emergency room or an Urgent Care visti, to the institution they were treated at. “We know the patients well and they know us well.”
Lastly, Nasello noted that paying attention to a patient’s psychosocial status is key. “I think any nurse who has ever dealt with any oncology patient understands that anxiety is probably the biggest thing we treat because just having cancer creates anxiety. The unknown of having a cure creates even greater anxiety.”
She emphasized that nurses need to let patients know they have someone who has their back and is going to support them.
“Nurses do that. Nurses listen. They help to get things done,” Nasello said. “So, I applaud each and every one of you for the help you provide for each of your patients because I know for a fact and I have heard what an impact all of you have on your patients and their care.”
“Thank you also for providing that bridge that gives us physical therapy; occupational therapy; the commentary with the doctors; education on appropriate precautions; and education to patients on who to contact in case of an emergency,” she added.
Nasello D. CAR T Therapy Nursing Considerations for Management Toxicities. Presented at: 3rd Annual School of Nursing Oncology; August 2-3, 2019; San Diego, CA.