The impact of an immuno-oncology service at a regional cancer centre based in the north west of the UK
This article discusses the implementation and development of a centralised immuno-oncology service. As the indications and licensing of oncological immune checkpoint inhibitors (ICIs) expanded rapidly, they brought with them increasing challenges. The article evaluates the impact of an immuno-oncology service, focusing on the following areas: admission rates due to immune-related adverse events (irAEs), number of bed days occupied due to immunotherapy toxicity and the incidence of Grade 3 and 4 (severe and life-threatening) irAEs. The article will also give an overview of patients requiring acute and subsequent management of toxicity as a percentage of the overall patients commenced on immunotherapy. The ultimate aim of the article is to highlight the importance of toxicity management and the overall benefits of a immuno-oncology service. The article will also discuss the impact of COVID-19 on the immuno-oncology service, highlighting the ways in which the team has adapted to the current environment to ensure high standards of patient care have been maintained.
The development of immune checkpoint inhibitors (ICIs) has transformed the treatment of cancer; however, the use of these drugs has led to a group of immune-related adverse events (irAEs) in some patients (Das and Johnson, 2019). Many of these events/toxicities are driven by the same mechanisms that produce the drugs' therapeutic effects. These drugs block the inhibitory mechanisms that suppress the body's immune system and protect tissues from an unconstrained immune response (Puzanov et al, 2017). This unique set of toxicities poses complex challenges for those involved in the delivery of ICIs and the management of patients receiving them. The toxicities associated with chemotherapy are short lived and generally resolve when the drug is stopped, whereas irAEs associated with ICIs are completely different and generally require intervention with immunosuppressive agents, usually in the form of corticosteroids. Immunosuppressive therapy is usually administered over several weeks and close monitoring of patients is vital during this time (Brahmer et al, 2018). This is required in order to adequately resolve the toxicity and prevent recurrence.
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