Aveyard H. Doing a literature review in health and social care: a practical guide.Maidenhead: McGraw-Hill/Open University Press; 2013

Batus M, Waheed S, Ruby C, Petersen L, Bines SD, Kaufman HL. Optimal management of metastatic melanoma: current strategies and future directions. Am J Clin Dermatol. 2013; 14:(3)179-194

Boudjemaa A, Rousseau-Bussac G, Monnet I. Late-onset adrenal insufficiency more than 1 year after stopping pembrolizumab. J Thorac Oncol. 2018; 13:(3)e39-e40

Brahmer JR, Lacchetti C, Thompson JA. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology Clinical Practice Guideline Summary. J Oncol Pract. 2018; 14:(4)247-249

Clatterbridge Cancer Centre. Guidance. Nursing guidance. Acute oncology. 2022. (accessed 12 April 2022)

Cole S, Zibelman M, Bertino E, Yucebay F, Reynolds K. Managing immuno-oncology toxicity: top 10 innovative institutional solutions. Am Soc Clin Oncol Educ Book. 2019; 3:96-104

Das S, Johnson DB. Immune-related adverse events and anti-tumor efficacy of immune checkpoint inhibitors. Journal for Immunotherapy of Cancer. 2019; 7

Haanen J, Ernstoff M, Wang Y Rechallenge patients with immune checkpoint inhibitors following severe immune-related adverse events: review of the literature and suggested prophylactic strategy. J Immunother Cancer. 2020; 8:(1)

Hodi FS, O'Day SJ, McDermott DF Improved survival with ipilimumab in patients with metastatic melanoma. N Engl J Med. 2010; 363:(8)711-723

Larkin J, Chiarion-Sileni V, Gonzalez R Five-year survival with combined nivolumab and ipilimumab in advanced melanoma. N Engl J Med. 2019; 381:(16)1535-1546

National Institute for Health and Care Excellence. NHS England interim treatment options during the COVID-19 pandemic. 2022. (accessed 6 April 2022)

Nursing and Midwifery Council. The code. 2018. (accessed 6 April 2022)

Pennock GK, Waterfield W, Wolchok JD. Patient responses to ipilimumab, a novel immunopotentiator for metastatic melanoma: how different are these from conventional treatment responses?. Am J Clin Oncol. 2012; 35:(6)606-611

Puzanov I, Diab A, Abdallah K Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group. J Immunother Cancer. 2017; 5:(1)

Reynolds KL, Cohen JV, Ryan DP Severe immune-related adverse effects (irAE) requiring hospital admission in patients treated with immune checkpoint inhibitors for advanced malignancy: temporal trends and clinical significance. Journal of Clinical Oncology. 2018; 36

UK Chemotherapy Board. Good practice guidelines for immuno-oncology medicines. 2018. (accessed 6 April 2022)

Upton J. Nurse-led telephone assessments for patients receiving ipilimumab. Cancer Nursing Practice. 2016; 15:(2)30-35

Ventola CL. Cancer immunotherapy, part 2: efficacy, safety, and other clinical considerations. P T. 2017a; 42:(7)452-463

Ventola CL. Cancer immunotherapy, part 3: challenges and future trends. P T. 2017b; 42:(8)514-521

The impact of an immuno-oncology service at a regional cancer centre based in the north west of the UK

21 April 2022
14 min read
Volume 31 · Issue 8


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.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content