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Immunotherapy Checkpoint Inhibitors

This toolkit is designed to prepare, guide and support Registered Nurses (RNs) of British Columbia to provide care to patients receiving immunotherapy, namely checkpoint inhibitors, that carry the potential of immune related adverse events (irAEs).
Immunotherapy, namely checkpoint inhibition, is being increasingly recognised as an effective treatment against cancer. Along with this comes a novel side effect profile, different to that of traditional cytotoxic chemotherapy.

Checkpoint inhibitors like Ipilimumab, Nivolumab, Pembrolizumab, act by reactivating or increasing the body’s own T-cell population, enhancing the immune systems own ability to recognise and fight cancer cells. This mechanism of action can result in side effects termed 'Immune Related Adverse Events' that are inflammatory and autoimmune in nature. Management of such side effects reflect the inflammatory nature, often involving corticosteroids.

Interdisciplinary Management Guidelines have been created to guide health professionals treating patients with mild, moderate or severe immune related adverse events, found as an appendix within each BCCA Chemotherapy Protocol for Immunotherapy.

Nursing

Online learning module: Immunotherapies

Part 1 - Overview of Immunotherapy
Part 2 - Immunotherapy Side Effects and Management
Part 3 - Nursing Process including a case study demonstrating nursing care of a patient receiving immunotherapy
 
Universally available by creating an account with LearningHub
 
It should take the user approximately 60 minutes to complete.


Reading

Rubin, K. M. (2015). Understanding Immune Checkpoint Inhibitors for Effective Patient Care. Clinical Journal of Oncology Nursing, 19(6), 709-717. (available on a health authority networked computer only at http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=111145576&site=ehost-live )

Interdisciplinary Management Algorithms provide a framework for intervention and follow up decisions. These can be found as an appendix within each patients specific Immunotherapy Chemotherapy Protocol.
 
   
Symptom Management Guidelines were designed by nurses, for nurses, to help guide assessment, intervention and follow up of symptoms associated with cancer and cancer treatments. 
If you have any comments, queries or concerns, please do not hesitate to contact the BC Cancer Agency Education Resource Nurses at :
 
 
604 877 6000 Local 672638

Patient Education Resources
'Serious irAEs are infrequent and treatable, but patient education is crucial'

Debra Madden

Points to consider in patient education of Immunotherapies
  • Effective management of irAEs requires prompt recognition and early intervention.
  • irAEs can be life threatening if left untreated - i.e. Diarrhea due to Ipilimumab.
  • Patients should know the importance of presenting their wallet cards (Ipilimumab / Pembrolizumab / Nivolumab) to other health care providers – i.e. emergency department staff. These can be found in the Cancer Drug Manual index.
  • Counsel patients on the expected antitumour response time and concept of pseudo-progression.
Resources
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SOURCE: Immunotherapy Checkpoint Inhibitors ( )
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