In a recently published report, Kathleen Cunningham, RN, BSN, of the Hospital of the University of Pennsylvania in Philadelphia, and colleagues outline the role of nursing care in treatment of patients with chimeric antigen receptor T-cell (CAR-T) therapy in the outpatient setting, with a focus on the CAR-T therapy tisagenlecleucel. This report was published in Seminars in Oncology Nursing.
CAR-T therapy involves the use of a patient’s immune system to target cancer cells by way of engineering the patient’s T cells. This therapy includes multiple steps and some risks to patient safety.
“Nurses play a crucial role in proper patient care and coordination throughout the entire tisagenlecleucel therapy process, and their expertise is critical for success when treatment takes place in the outpatient setting,” Ms Cunningham and colleagues wrote in their report.
An innovation in CAR-T therapy that was presented by the authors was the creation of a position known as the nurse cellular therapy coordinator (NCTC) at their hospital. A key function of the NCTC is to enhance communication across multidisciplinary staff at the hospital.
Some steps a patient undergoes in the CAR-T therapy process include screening, apheresis preparation, a predonor evaluation, apheresis, preinfusion bridging and lymphodepleting chemotherapy treatments, and infusion of the tisagenlecleucel-engineered T-cells.
The NCTC serves multiple roles throughout these processes, such as reviewing the appropriateness of therapy for a given patient based on criteria, assistance with arranging lodging, and helping to ascertain the appropriate time for apheresis based on patient factors and logistics involved in manufacturing.
Prior to infusion, an NCTC is involved with choosing central vs peripheral venous access. The patient also requires preinfusion care in the form of electrolyte monitoring during apheresis, prophylaxis against infections, and other forms of care. Just before infusion, an NCTC may also provide information to patients and families indicating signs and symptoms of adverse events related to CAR-T therapy.
Certain adverse events of interest with CAR-T therapy include cytokine release syndrome and signs of neurotoxicity. Ms Cunningham and colleagues highlighted safety with CAR-T therapy in the outpatient setting, emphasizing the importance of the tisagenlecleucel-oriented Risk Evaluation and Mitigation Strategy (REMS) in preparing members of the care team, especially with regard to cytokine release syndrome and neurotoxicity.
“Our experience has been that tisagenlecleucel administration in the outpatient setting affords patients with the ability to receive ongoing monitoring in a preferred setting,” the authors concluded in their report. They considered the NCTC role as helpful in collaboration across the multidisciplinary care team, which the authors noted is crucial to enabling individualized treatment.
Cunningham K, DiFilippo H, Henes K, Irwin LL, Napier E, Weber E. Tisagenlecleucel therapy: nursing considerations for the outpatient setting. Semin Oncol Nurs. Published online July 30, 2021. doi:10.1016/j.soncn.2021.151178