GLP-1s in Oncology: Nurses Face Paradox in Symptom Management

The rapid integration of GLP-1 receptor agonists (GLP-1 RAs) into oncology care presents a unique clinical paradox for nurses. While new real-world evidence suggests these agents are associated with significant survival benefits, oncology nurses must navigate the complex overlap between drug-induced side effects and cancer-related symptoms.

The nursing paradox: Weight loss vs. anorexia

During the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting, Jessica Paulus, ScD, of Ontada, highlighted that the clinical implementation of GLP-1s is complicated by heterogeneity across different cancers. For oncology nurses, the primary challenge lies in the overlapping gastrointestinal (GI) side effect profiles of GLP-1s and traditional cancer therapies.

“There are GI side effects from GLP-1s [and] there is anorexia that’s associated with cancer, especially in its advanced stages,” Paulus noted. This creates a paradoxical situation for nursing staff: While a patient might benefit from reducing adipose burden to improve long-term outcomes, nurses are simultaneously managing poor oral intake and disease-related cachexia.

Prioritizing patient populations

The nursing approach to GLP-1 management often depends on the stage of the disease. In early-stage breast cancer, where obesity management is critical for long-term survival, the focus may be on metabolic health. Conversely, in advanced non-small cell lung cancer, where symptom burden is high, the introduction of a GLP-1 RA may exacerbate existing anorexia or GI distress.

Nurses should be aware that the majority of patients in this cohort (69%) had a BMI ≥30 kg/m², and 74% were prescribed GLP-1 therapy after their initial cancer diagnosis. Semaglutide was the most utilized agent, accounting for 64% of the study population.

Survival outcomes and real-world evidence

Despite the management challenges, the survival data remains a compelling reason for continued utilization. The study, which analyzed 1,121 GLP-1 users within The US Oncology Network, found a significant improvement in overall survival (OS), with a hazard ratio of 0.58 (95% CI 0.40–0.84; p = 0.0036).

For patients with breast and prostate cancers, the most common malignancies among GLP-1 users in the study, the 24-month OS was 97.9%, compared to 92.6% for non-users. This survival advantage underscores the importance of finding a balance between metabolic therapy and symptom control.

Clinical implications for oncology nurses

As the oncology community awaits more robust research, nurses remain on the front lines of this complicated management landscape. Effective nursing care requires vigilant monitoring of oral intake and GI symptoms to ensure that the benefits of GLP-1 therapy are not outweighed by a decline in the patient's nutritional status or quality of life.

“These are the questions that I was asked by clinicians at ASCO this week,” Paulus said, emphasizing that while the findings are motivating, it is still "early to be able to answer some of these questions" regarding optimal symptom management.

Reference

1. Sruti I, Wentworth C, Marcus AD, Su Z, Paulus J. GLP-1 receptor agonist utilization and survival outcomes in a large U.S. community oncology cohort. J Clin Oncol. 2026;44(suppl 16):Abstract 11017.