Early Recognition and Long-Term Management of irAEs in Oncology Nursing

Proactive assessment and longitudinal care coordination are essential for identifying and managing immune-related adverse events (irAEs) associated with immunotherapy, according to Brittany Dulmage, MD, an oncodermatologist at The Ohio State University Comprehensive Cancer Center.

In an interview, she emphasizes the critical role oncology nurses play in detecting early-grade dermatologic toxicities and ensuring continuity of care beyond active treatment. Routine evaluation of cutaneous, nail, and mucosal changes can facilitate earlier intervention and prevent progression to more severe, treatment-limiting toxicities.

Transcript

What specific assessment frameworks can oncology nurses use to heighten clinical suspicion and catch grade 1 or 2 toxicities before they become potentially treatment-ending? Additionally, how can nursing teams better structure long-term follow-up to educate both patients and primary care providers?

I encourage nurses with each visit to ask patients about new hair, skin, or nail changes. Itch, like we've talked about, is a big one. But any new rash that's developing, or worsening existing rashes, is important. I think skin pain and remembering that mucosal surfaces are part of the spectrum of immune-related adverse events is important, too; skin pain and sores or pain inside the mouth or genital area are often overlooked.

Additionally, I think one of the biggest things is that immune-related adverse events don't stop when immunotherapy stops. A lot of them that develop during the process of receiving immunotherapy can continue, unfortunately, long after immunotherapy is over. A great example is new-onset psoriasis that develops in the setting of immunotherapy; it does not stop when immunotherapy stops.

I think we should encourage patients to continue to engage with their care teams, especially patients who have a new immune-related adverse event, to ensure that they aren't viewing that event as only associated with the time they are on therapy. We need to loop in their primary care team or a dermatologist for the more long-term management that they can transition to after they're done with immunotherapy.

Transcript has been edited for clarity and conciseness.