The evolution of the roles and responsibilities of nurses in the delivery of chimeric antigen receptor T-cell (CAR-T) therapy at a single academic oncology center was described in an article published in Lancet Haematology.
Two participating nurses provided commentary that traced the history of CAR-T therapy at the Dana-Farber Cancer Institute (DFCI) in Boston, Massachusetts, from February 29, 2016, where a single transplant nurse was assigned to coordinate patient care for the first patient treated with this novel approach through to the present where more than 150 nurses are involved in an established program for patients undergoing CAR-T therapy at DFCI.
With a focus on administration of CAR-T therapy in the setting of clinical trials, 10 additional patients, treated one at a time, subsequently received this type of treatment in the year following the inauguration of this approach at the DFCI. This was followed by the creation of a dedicated CAR-T therapy program in 2017, with appointments made for program medical director, technical director, nurse practitioner, and CAR-T nurse navigator.
At the time of the creation of the CAR-T therapy program, “the nurse practitioner and nurse navigator roles were developed to focus exclusively on ensuring that safe, high-quality care was provided to these patients through the entire treatment trajectory,” the authors explained.
In particular, the authors described the nurse navigator as a “constant” in the life of the patient, from the time that CAR-T therapy was first discussed through the delivery of treatment, the management of CAR-T related adverse effects, and the assessment of response.
Following approval of 2 CAR-T therapies for patients with non-Hodgkin lymphoma and/or acute lymphoblastic leukemia in late 2017, the focus of the CAR-T nurse navigator role was restricted to the high volume of patients receiving commercially available CAR-T therapy.
Nevertheless, as the need to more broadly educate nurses who cared for patients receiving CAR-T therapy became increasingly evident, it was concluded that nurses performing apheresis procedures, delivering outpatient infusion, as well as those working in emergency room and hospital settings — the inpatient oncology nurse, in particular — also required in-depth knowledge on approaches for mitigating toxicity associated with CAR-T therapy.
“Although nurse practitioners and nurse navigators began as hands-on roles, at the bedside, through every step, time and experience allowed these positions to step back into a resource and coordinator role for the patients and our nursing staff,” the authors noted.
McDermott K, Spendley L. Nursing impact on the CAR-T cell landscape. Lancet Haematol. 2020;7(3):e192.