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Current lymphoma treatment options are so varied that virtually any possible AEs may occur. Goodrich and colleagues note that common hematologic toxicities, including anemia, neutropenia, and thrombocytopenia are common in patients receiving cytotoxic drugs and molecularly targeted agents. In addition, serious mucocutaneous reactions, fatigue, and gastrointestinal (GI) effects are also common reactions to various therapies.

The researchers suggest that oncology nurses cultivate critical thinking skills, and practice these skills when relating to team members and patients to improve patient outcomes. They contend that utilizing information from the Patient-Reported Outcomes Common Terminology Criteria for Adverse Events (PRO-CTCAE) and managing workflow can provide a greater opportunity for critical thinking.

“Specific to lymphoma, the number of new agents we have today that we did not have 3 years ago or were brand new 3 years ago is staggering. Oral agents are now commonplace in the treatment of lymphomas. Several new therapies have been first in class and thus have unique side effect profiles. Although we have more options available than ever before, our options are not endless, making optimizing each treatment regimen critical. Side effect management is a significant part of that optimization,” Goodrich told Oncology Nurse Advisor.


Building nursing competency in managing AEs requires developing critical thinking skills, enabling nurses to implement best practices decisively and appropriately for each patient, the researchers reported. Research suggests that nurses may grade AEs more accurately than physicians using CTCAE criteria. “The literature has long supported the fact that oncology patients report side effects and problems much more openly to nurses than to physicians. This puts oncology nurses in a unique position to positively impact side effect identification and management,” explained Goodrich.

The keys to critical thinking for oncology nurses involve maintaining flexibility and the ability to ask questions. Another aspect is being on the lookout for unexpected circumstances and to alter preconceived notions on the basis of observations. Critical thinking involves a systematic and orderly approach to all decision making and the ability to embrace the differences in perspective between oneself and other people.

Goodrich said the most important take-home message for oncology nurses is that they recognize they are in a very pivotal position in addressing AEs early. “You are the backbone of oncology care. Keep learning, keep assessing, keep reporting but remember how important it is to use CTCAE-like language in your reporting to make your findings as objective as possible,” said Goodrich.


Goodrich A, Wagner-Johnston N, Delibovi D. Lymphoma therapy and adverse events: nursing strategies for thinking critically and acting decisively. Clin J Oncol Nurs. 2017;21(1):2-12.