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Immunotherapies are ‘paradigm’ shift in oncology nursing

Speaking at the inaugural Cancer Nursing Practice conference in Manchester, Mark Foulkes discusses rising to the challenge of immunotherapies in oncology nursing.

Speaking at the inaugural Cancer Nursing Practice conference in Manchester, Mark Foulkes discusses rising to the challenge of immunotherapies in oncology nursing

Emerging immunotherapies for treating cancer represent a paradigm shift in oncology nursing and means nurses face a range of challenges in delivering patient care, a Macmillan lead cancer nurse told delegates.

All nurses who work across cancer services from chemotherapy nurses to clinical nurse specialists and from acute oncology nurses to nurse consultants will have to rise to the challenge of using immunotherapies, Mark Foulkes of the Royal Berkshire NHS Foundation Trusts acute oncology team, said.

Immunotherapy drugs and targeted therapies are becoming increasingly more likely to be used in oncology as clinicians look to provide more personalised medicines for patients, said Mr Foulkes.

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Speaking at the inaugural Cancer Nursing Practice conference in Manchester, Mark Foulkes discusses rising to the challenge of immunotherapies in oncology nursing


Nurses will have to ‘rise to the challenge’ of using immunotherapies
says Mark Foulkes. Picture: Neil O'Connor

Emerging immunotherapies for treating cancer represent a ‘paradigm’ shift in oncology nursing and means nurses face a range of challenges in delivering patient care, a Macmillan lead cancer nurse told delegates.

All nurses who work across cancer services from chemotherapy nurses to clinical nurse specialists and from acute oncology nurses to nurse consultants will have to ‘rise to the challenge’ of using immunotherapies, Mark Foulkes of the Royal Berkshire NHS Foundation Trust’s acute oncology team, said.

Immunotherapy drugs and targeted therapies are becoming increasingly more likely to be used in oncology as clinicians look to provide more personalised medicines for patients, said Mr Foulkes. However, these drugs are ‘very nursing intensive’ and ‘patients will require information about what happens to them such as when does a side effect become serious’, he added.

‘Most oncology nurses have spent their careers with high awareness of the side effects of cytotoxic therapies and how to manage them, but the new generation of immunotherapies have very different side effects,’ Mr Foulkes cautioned.

He highlighted a range of differences associated with immunotherapies compared to more traditional cytotoxics. These included:

  • patients with the same diagnosis could receive radically different treatments
  • similar agents have different side effects and these can be subtle or dramatic
  • principles of management are different, for example if a cytotoxic therapy is discontinued then any associated side effects generally reduce and improve, but this is not always the case with immunotherapies
  • timing of the onset of side effects can vary with immunotherapies and can continue for many months after treatment is stopped.

Individual cancer nursing sectors will need to ‘rise to the challenge’ of using immunotherapies, Mr Foulkes explained.

Chemotherapy nurses ‘carry the key role in providing patient information and alerting patients to side effects and what to do about them,’ he said. They needed to be alert to infusion reactions and to assess toxicities at each patient visit, he added.

Clinical nurse specialists have the ‘potential to become immunotherapy experts’, Mr Foulkes told the audience. They are a vital link for patients throughout their cancer trajectory and were close to ‘MDT decision making’. He said they ‘could easily become an expert resource’ for staff, but their role would need development as there were ‘huge variations’ in cancer nursing staff involvement with chemotherapy and systemic anti-cancer therapy.

Acute oncology nurses’ role included the management of side effects in the acute setting and so they were ‘vital in recognising immunotherapy side effects and initiating treatment’, Mr Foulkes said. However, acute oncology protocols were crucial and needed to be evidence-based, he added. 

More widely, he said lead cancer nurses and nurse consultants should encourage nursing involvement with immunotherapy, push access to training and education, and encourage nursing autonomy within protocols. In addition, nurse educators need to develop courses specifically dealing with immunotherapy and use technology to do this. 

What attendees of the CNP conference had to say
 Ward sister at Spire Healthcare in Belfast, Rebecca Oxley

‘The speakers have been interesting and informative. I particularly liked the one about dealing with research and how research influences nursing care, how to look after your patients in the community, the transition between primary, secondary and tertiary care of the patients. The sessions have all been different, but all informative.

Because I’m a ward nurse, I do more of the acute stuff, acute oncology, looking after patients in the hospital setting and what we can do to do influence the patient journey from the beginning from diagnosis would be my preference as that’s what I’m involved in.

What I’m going to take home is developing strategies, how to look after patients and how to put systems in place to give patients all the correct information.’

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