Providing Supportive Care Around the Adverse Effects of Immunotherapy for Lung Cancer


In this episode of The Vitals, we speak with an expert who discussed the importance of supportive care and education for patients with lung cancer who are treated with immunotherapy.

The recent advancements in lung cancer treatments, particularly the rise of immunotherapies, have brought new hope but also new challenges in managing side effects.

In this episode of The Vitals, we spoke with Lisa Carter-Bawa, Ph.D., MPH, APRN, ANP-C, FAAN, director of the Cancer Prevention Precision Control Institute at the Center for Discovery and Innovation at Hackensack Meridian Health, to learn more about the common side effects associated with these novel therapies, such as fatigue, skin rashes, gastrointestinal issues, and thyroid dysfunction.

Importantly, she highlighted the crucial role nurses play in educating patients, monitoring for symptoms, and providing tailored support to help patients navigate and cope with these side effects. Carter-Bawa also touched on how the focus on patient-centered care has evolved nursing practices, emphasizing the need for interprofessional collaboration to optimize communication and address the individual needs of each patient with lung cancer undergoing these complex treatment regimens.

What are some of the side effects that are associated with some of the recently approved treatments for lung cancer?

As you know, immunotherapies are one of the most popular categories and they work with the body's immune system to help fight cancer. These types of therapies are a major focus in recent years to treat lung cancer specifically, and there's a slew of research going on, that's currently looking at different combinations of those therapies, with and without chemotherapy.

There are drugs that are known as immune checkpoint inhibitors that actually block the interaction between the proteins on the immune cells as well as the cancer cells, which in turn lowers the immune system's response to the cancer. That said, that's actually where we get the side effects. And these are drugs like Keytruda (pembrolizumab), Tecentriq (atezolizumab), Opdivo (nivolumab), and others. And common side effects of those immunotherapies include things like fatigue, getting a skin rash or itching, GI issues like diarrhea, flu-like symptoms that you see the immune system rub up against, like fever, chills, muscle pain, and joint pain, inflammation of the lung. And also, some people experience thyroid dysfunction, either a thyroid that is overworking itself or underworking itself, and hypo- and hyperthyroidism.

How can nurses in particular help patients navigate and manage these side effects?

Nurses play such a crucial role in helping patients navigate and manage these side effects. They're the critical link, in particular with patients' education about the therapies that they're taking. And they can provide a very comprehensive education to both the patient and their families about the potential side effects of their specific treatment regimen. This includes information on what to expect, how to recognize symptoms, when they should worry and seek care for those symptoms or what's going on with them. But beyond that, nurses are really key in teaching patients strategies to manage common side effects through things like dietary recommendations that may help, how to manage their medications, and maybe some lifestyle modifications that they can try depending on what the symptom is that they're having.

Nurses are — I'm a little biased because I am a nurse and nurse practitioner as well before delving into this whole career line of research — but nurses are frequently that initial touch point in the patient's visit. And they really have that opportunity to regularly assess for common side effects. During the patient's treatment regimen, they can monitor vital signs, look at lab results, and simply talking and listening to the patient about their physical symptoms in order to identify any things that may be changing and to intervene earlier rather than later.

Finally, nurses can provide supportive care through more emotional support and encouraging patients while they're coping with side effects if they have side effects because they really listen to the patient and helps to validate the patient's concern, their experiences, and ultimately provide reassurance and coping strategies.

How can nurses help educate patients on how to monitor themselves for symptoms of side effects and how to cope with them?

I think the first thing is really, the nurses play a central role in understanding — first, what is the patient's understanding about their treatment regimen, as well as potential symptoms and side effects, and then their readiness and ability to cope with those symptoms and side effects. And that can offer them key information that helps them to tailor education based on the patient's specific needs and preferences.

And it's all guided by their specific treatment plan because it is so focused on that individual patient, but also nurses go beyond that. … We are really good at communicating using jargon-free language to explain complex medical information to the patient and their family, which really helps to develop that rapport. So the patient comes back to the nurse to help them problem-solve. And finally, nurses are really good at empowering patients to take an active role in managing their symptoms and side effects.

How has the attention to and training for side effect management for nurses evolved in recent years?

The development of new cancer treatments such as immunotherapy and targeted therapies has really led to a shift in the landscape of side effects. So, nurses have had to stay up to date on the unique side effects of these novel therapies. And they've also had to develop specialized skills to manage them effectively and to help their patients manage them.

There has been an increased emphasis — I always think of nursing as getting this right, but I think it's even more prominent now that there's been an increased emphasis on patient-centered care, which really prioritizes addressing the individual needs, preferences, and goals of the patient and their family. And nurses receive continuing education training to provide this personalized education specific to these different regimens, as well as support that help them to tailor it to the patient's specific circumstances, which ultimately has the potential to enhance the quality of life and the quality of symptom management for their patients.

I would also say that, with new treatments, also comes new levels of complexity, including complexity of the side effect management. So health systems and nursing professional organizations are all emphasizing interprofessional collaboration, not just among nurses, but physicians, pharmacists, social workers, all the members of the healthcare team that have the potential to touch the patient. So this collaborative practice model has the potential to really optimize communication, coordinating care, teamwork, and addressing the patient's needs, which is what we're all here for.

And that idea of patient-centered care, when that kind of mindset is in place, how can patient outcomes change or improve?

Oh, 1,000%. I always think it's interesting because we think we might know best, but when you really come into a healthcare encounter with patient-centered care, you are open to listening to the patient, thinking outside the box that might be specific to that patient, and really focusing on what they are dealing with.

And ultimately, if a patient who's diagnosed with cancer or lung cancer is on a specific treatment regimen, if you engage that patient and develop that patient relationship, you approach it from a perspective of patient-centered care, you're going to have patients that adhere to their treatment and have better outcomes because they're following the regimen that they as well as their clinician have decided is the best course of action for them.

Transcript has been edited for clarity and conciseness.

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