Another significant advance in cancer treatment to arise in the past decade has been the development of chimeric antigen receptor (CAR) T-cells as an immunotherapy tool.19 Since a report described the use of CD19 CAR T-cells in treatment of lymphoma in 2010, other studies have emerged in the treatment of relapsed or refractory B-cell cancers, demonstrating promising results.19 In August 2017, tisagenlecleucel-T was granted FDA approval as a treatment of B-cell acute lymphoblastic leukemia in children and young adults, demonstrating a complete remission rate of 60%.20 This approval was soon followed in October 2017 by the approval of axicabtagene ciloleucel for large B-cell non-Hodgkin lymphoma.20,21 Research also has ventured into the use of CAR T-cells for the treatment of solid tumors, though with results showing more limited success at this time.19,20
CAR T-cell therapies represent a promising new realm of cancer immunotherapy, but their use is not without hazards, such as cytokine release syndrome (CRS) and neurotoxicity.22 These risks vary by type of CAR-T therapy and can require careful management, a responsibility that oncology nurses often carry.22
Looking ahead, a recent review hints at challenges to overcome as the field of cancer immunotherapy matures.23 Some challenges relate to determining personalized approaches to treatment, some to the optimization of immunotherapy combinations, and others to our continually evolving understanding of the complexities of immune response.23 Rapid advancements in immunotherapy and CAR-T therapy highlight the incredible dynamism of oncology as a whole. Each newly approved therapy will carry its own host of benefits and potential issues with safety and tolerability. Caring for patients as they traverse their care has become the domain of oncology nurses, no matter the speed at which the field advances.
Emergence of the Oncology Nurse Navigator
The enactment of the Patient Protection and Affordable Care Act in March 2010 established a role for patient navigation in health care.24 With oncology’s rapidly changing therapeutic landscape, successfully coordinating care for patients across multidisciplinary teams can be supported by an oncology nurse navigator (ONN).25 Patients with cancer may struggle to navigate the healthcare system and experience confusion, trepidation, anxiety, and/or insufficient resources, but assistance from ONNs can partially or totally support overcoming these potential obstacles to optimal care.25 Furthermore, ONNs serve as patient advocates, support and integrate organizational strategies for improved cancer care, and reinforce the use of evidence-based strategies in patient treatment.24,26
Involving ONNs earlier in care of patients, including at screening, can help with coordination of referrals, shorten time to diagnosis and treatment, expand patient and caregiver knowledge, improve adherence to care, and improve assessment of barriers.25,26
According to results from one pilot study, 5 core navigation metrics are applicable across navigation programs and include navigator competencies, navigation caseload, barriers to care, psychosocial distress screening, and interventions.27
Advocates for Clinical Trial Participation
Oncology nurses can help to support patient participation in clinical trials.28 A continued trend of limited patient enrollment in cancer clinical trials is mostly attributed to structural and clinical barriers, but some eligible patients decline to participate or are not informed of their eligiblity.29 In one meta-analysis, eligible patients were found to participate more than half of the time when presented with the opportunity.29
New technologies in the past decade have driven advances in cancer treatments and in the growing use of electronic resources in patient care, and oncology nurses can remain alert to changes and ongoing trends to ensure their patients receive optimal treatment.
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