Nurses Key in Catching Early IO Toxicities, Supporting Follow-Up

In a discussion on improving toxicity management, Brittany Dulmage, MD, physician and associate professor at The Ohio State University, emphasized the importance of early symptom recognition and sustained follow-up for patients receiving immunotherapy.

Dulmage highlighted that oncology nurses play a critical role in identifying low-grade toxicities before they escalate. She encouraged nurses to consistently ask about new hair, skin or nail changes, as well as itching, at every patient visit. She noted that new or worsening rashes should be closely monitored, along with skin pain, which may signal emerging immune-related adverse events. Dulmage also underscored the importance of assessing mucosal surfaces, explaining that symptoms such as sores or pain in the mouth or genital area are often overlooked but fall within the spectrum of these toxicities.

Beyond early detection, Dulmage stressed that immune-related adverse events can persist well beyond the end of immunotherapy. She pointed to new-onset psoriasis as an example of a condition that may develop during treatment and continue after therapy has stopped. Because of this, she said it is essential for patients to remain engaged with their care teams even after completing treatment.

She added that nursing teams can support long-term management by reinforcing that these toxicities are not limited to the treatment period and by helping coordinate care with primary care providers or dermatologists as patients transition out of active oncology care.

Transcript

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

Encouraging nurses at each visit to ask patients about new hair, skin or nail changes, and itching, like we discussed, is a big one. Any new rash that is developing, or worsening of existing rashes, is important to note. Skin pain is another key symptom, and it is important to remember that mucosal surfaces are part of the spectrum of immune-related adverse events. So, skin pain, as well as sores or pain inside the mouth or genital area, are often overlooked.

I think one of the biggest things is that immune-related adverse events do not stop when immunotherapy stops. Many that develop during treatment can unfortunately continue long after immunotherapy ends. A great example is new-onset psoriasis that develops in the setting of immunotherapy, which does not stop when treatment stops. So, encouraging patients to continue engaging with their care teams, especially those who develop a new immune-related adverse event, is critical. This helps ensure they do not view these events as only associated with the time they are on therapy, and allows for better coordination with their primary care team or a dermatologist for long-term management after immunotherapy.