Evolving Education Initiative Keeps Nurses Up-to-Date on CAR T Cell Therapy Best Practices

DENVER — Use of a multidisciplinary education initiative effectively prepared nursing and clinical staff for the challenges of managing care and follow-up of patients undergoing chimeric antigen receptor T cell (CAR-T) therapy across multiple institutions, according to a presentation at the 2017 Oncology Nursing Society Annual Congress.

The use of CAR-T therapy, a subset of engineered cell therapy, has increased exponentially at Dana Farber Cancer Institute and Brigham and Women’s Hospital, both in Boston. CAR-T treatment involves coordination of care and services among multiple disciplines, requiring recognition and intervention related to the unique adverse effects of this therapy at several entry and reentry points where patients may present for care, such as inpatient units, emergency departments (EDs), intensive care units, and ambulatory follow-up clinics, explained Kerry Hennessy, RN, MSN, AOCN, of Dana Farber, in her presentation.

Nurses, physicians, and support care staff at both institutions needed to be educated on the CAR-T cell therapy process, the signs and symptoms of potential adverse effects, and treatment protocols for this modality. To achieve this, a team of nurse educators, managers, and clinical specialists developed an education initiative for nursing and other clinical staff, as well as support staff. The initiative includes a module in the institution’s e-learning system consisting of 2 videotaped presentations, a review of patient education materials, and a posttest.

All nurses in the ambulatory settings and nurses on designated inpatient units were assigned to the education initiative. ED staff were educated on the treatment protocol, and nurses were alerted to the importance of early recognition and action on key symptoms — cytokine release syndrome (CRS); B cell aplasia, if therapy targeted pan-B cell antigens; tumor lysis syndrome (TLS), and neurotoxicity — and the crucial protocol regarding contacting the appropriate physician and immediate steps in managing these symptoms.

Treatment protocols for CRS and the importance of early recognition of neurologic toxicity are established, and T cell vaccines are available in the outpatient setting. In addition, updates to our information were needed as recent study findings suggest that use of fludarabine may increase the potential for cytokine storm and our latest observations indicated symptom profiles vary based on the source of the T cells, processing techniques, or combining this therapy with other immunotherapies (such as checkpoint inhibitors).

Therefore, the nursing plan of care had to reflect our increasing experience, including updated treatment protocols. Our current nursing plan includes monitor the patient for seizures and neurotoxicity; watch for signs and symptoms of CRS, TLS, B cell aplasia; maintain strict charting of input/output, vital signs, daily weights; and rule out febrile and neutropenia with fever spikes.

Important concepts in nursing care of patients undergoing CAR-T cell therapy are reinforced by continuously updating teaching materials created from current protocols. “Our education initiative continues to evolve, maintaining best practices and updates as more knowledge is acquired,” said Ms Hennessy.

Read more of Oncology Nurse Advisor‘s coverage of the 2017 American Society of Clinical Oncology Annual Meeting by visiting the conference page.

Reference

1. Hennessy K, Mazeika T, Renard M. The challenges for nursing education with the implementation of an engineered cell therapies program. Oral presentation at: 2017 Oncology Nursing Society Annual Congress; May 4-7, 2017; Denver, CO.