Non-melanoma skin cancers (NMSC) are common. Fortunately, they tend to have excellent survival and cure rates, but some of the more locally advanced and metastatic forms do not. Fortunately, the high tumor-mutational burden of NMSCs has made them particularly responsive to immunotherapy with PD-1/PD-L1 signal disruption. Despite the benefit these agents bring to patients, they can serve as a source of challenge to oncology nurses when it comes to what they are, how they work, why they are given, how they are administered, and their side effects.  If this sounds like you, there are resources and educational activities to help!
As an oncology nurse, you likely handle and administer multiple classes of anti-cancer agents, including cytotoxic chemotherapy, oncolytic vaccines, immune checkpoint inhibitors, cellular therapies, and others. Where does immunotherapy fit in all of this, particularly when treating advanced and metastatic skin cancer? According to the Oncology Nursing Society (ONS), nurses have reported simplifying the increasingly complex treatment milieu by lumping them all in the category of “chemotherapy”— convenient, but confusing… to everyone.  If you are having trouble differentiating between what’s what of the cancer therapy world, consider this wallet card, developed by ONS, the next time you have a patient on immunotherapy. And what drugs exactly are immunotherapies for skin cancer? You can find out here and here.
Immunotherapies are associated with a unique range of side effects that require the special care of an attentive and knowledgeable nurse. But they can also look like normal everyday comorbidities (think, Type 1 diabetes and other autoimmune diseases). Some are not that serious, and some are life threatening. Some will go away when the medication is stopped, and some will require life-long management. So when is it colitis versus just diarrhea? When is it pneumonitis versus just shortness of breath? When do you treat it with steroids versus stopping the medication altogether? Want more information on what side effects from immunotherapy look like, when they occur, why they happen, and how they are managed? You can find all of that and more by clicking here and here.
The ONS convened an immunotherapy summit in 2018 with the goal of identifying key areas of need and challenges for nursing practice as it relates to immuno-oncologic therapeutics.  We are on a mission to bridge those gaps. We hope you will join us!
Click here to end the confusion.
Galioto M, Mucenski J. Clin J Oncol Nurs. 2019;23(3):E60-E65.
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