Nurses at the Forefront of the Continuing Success Story of Immunotherapy in NSCLC: Best Practices for Guiding and Supporting Patients Through Treatment and Survivorship

Simple Summaries of Significant Studies
CheckMate -816 Study of Nivolumab Plus Chemotherapy Before Surgery for NSCLC1
Full abbreviations, accreditation, and disclosure information available at PeerView.com/CFM40
Plain language summaries (also called layperson summaries, lay language summaries,
simple summaries, and trial results summaries) have been introduced to communicate research
and clinical trial results in an understandable way to a broader audience, and they are intended
to make the clinical results of these studies understandable and accessible to healthcare
providers, researchers, patients, caregivers, and the general public
What Are Plain Language Summaries of Research and Clinical Trial Results?
The following pages include a simple infographic summary of the CheckMate -816 trial
for use as a printable resource
The following additional resources explaining the CheckMate -816 trial are also available
• Brief video summary: www.nejm.org/do/10.1056/NEJMdo006524/full
• Plain-language summary: https://www.futuremedicine.com/doi/epdf/10.2217/fon-2023-0007

358 people from 14 different countries
The researchers
created 2 groups
Who took part in this study?
What treatments were used?
Why is this study important?
Some people with non–small cell lung cancer (NSCLC)
have tumors that can be removed surgically. However,
the cancer often comes back or spreads to other parts
of the body, which may subsequently lead to death.
Taking chemotherapy (chemo) before or after surgery
can reduce the risk of cancer coming back and may
help people live longer. However, this only works for
some people.
Nivolumab (nivo) is an immunotherapy; it works by
activating a person’s immune system to fight back
against cancer cells.
The goal of the CheckMate -816 study was to find out if
nivo plus chemo works better than chemo alone when
given before surgery for NSCLC.
179 people in the
nivo plus chemo
group
179 people
in the chemo
alone group
Average age
64 years
All had tumors (4 centimeters or larger) in the lungs (and in some
cases, the nearby lymph nodes) that could be removed with surgery
IIIA
IIB
IIA
IB
As the number and letter goes
up, this represents a bigger
tumor and/or more spread
Staging is part of the lung cancer diagnosis.
This study included people with stages IB,
IIA, IIB, and IIIA NSCLC
7 in 10 were men 6 in 10 had stage IIIA NSCLC
Each treatment was taken
once every 3 weeks for a
total of 3 times
Surgery planned to
happen within 6 weeks
of the last dose
CheckMate -816 Study: Nivolumab Plus Chemotherapy Given Before Surgery for Non–Small Cell Lung Cancer1,2
1. Provided courtesy of Patrick M. Forde, MD. 2. Forde PM et al. N Engl J Med. 2022;386:1973-1985.

What did the researchers look at?
What were the main results?
Nivo plus
chemo
Nivo plus
chemo
Nivo plus
chemo
Median EFS (number of months
half of the people lived without the
cancer getting worse or spreading)
People who took nivo plus chemo and had a pCR after surgery
lived longer without the cancer getting worse or spreading than
those who did not have a pCR
People alive at 2 years without
the cancer getting worse or
spreading
Chemo
Chemo
Chemo
8 in 10 7-8 in 10
0-1 in 10
2-3 in 10
4-5 in 10
Event-free survival (EFS)
How long did each person
live without the cancer
getting worse or spreading?
PRIMARY
ASSESSMENTS
ADDITIONAL
ASSESSMENTS
Pathological complete response (pCR)
Were there any cancer cells remaining in
the tissue samples obtained from the
lungs and lymph nodes after surgery?
Overall survival
How long did each person
live after starting
treatment?
What adverse events
did people have?
Most people went on to have surgery in both the nivo plus
chemo and chemo groups
People who took nivo plus chemo lived longer without the
cancer getting worse or spreading (EFS)
There was a trend for people who took nivo plus chemo to live
longer overall than those who took chemo alone. This remains to
be confirmed over time in the study.
More people who took nivo plus chemo than who took chemo
alone had no remaining cancer cells in tissue samples obtained
from the lungs and lymph nodes after surgery (pCR)
32
months
21
months

What were the adverse events?
What do these findings mean?
A serious adverse event is one that is life-threatening, requires going to
the hospital, or results in death
In CheckMate -816, people who took nivo plus chemo instead of
chemo alone before their surgery:
Lived longer without
the cancer getting worse
or spreading
Were more likely to have
lungs and lymph nodes
clear of cancer cells
after surgery
Had a trend to live longer
in general, which needs
more time to be confirmed
Did not have more
adverse events
About 1 in 10 people
in each group had a
serious adverse events
from treatment
Most adverse events from surgery were mild or moderate
Most adverse events
from treatment
were mild or
moderate
No people in the nivo plus chemo group died because of serious adverse events or serious surgery-related adverse events due to the treatment
Chemo
Nivo plus
chemo
1–2 in 10
1 in 10
Few people had severe or life-threatening adverse events from surgery
Nivo plus chemo is now an
approved treatment in the
United States for adults
with NSCLC whose tumors
are 4 centimeters or larger
or have spread to nearby
lymph nodes
Watch a brief video summary of the CheckMate -816 study: www.nejm.org/do/10.1056/NEJMdo006524/full
For more details on CheckMate -816, including a plain-language summary, visit:
https://www.futuremedicine.com/doi/epdf/10.2217/fon-2023-0007

Patient Education and Survivorship in the Era of Immunotherapy
Guidance and Resources for Oncology Nurses
Patients resources are available online!
Nurses and the rest of the clinical team should educate and engage patients and
their families/caregivers in shared decision-making to determine if immunotherapy is
the right choice for them, develop a treatment and monitoring plan, and discuss what
to expect during and after treatment
Education can help patients become well-informed, engaged participants in their care
Patient communication and education is critical!
What immunotherapies are and how they work
What factors determine if the patient is/is not a good candidate for immunotherapy
What to expect during and after treatment
What irAEs are, when they can occur, and the importance of close monitoring and early
detection, diagnosis, and management
Educate your patients about
Remind your patients to
Carry a wallet card with information on current/prior immunotherapy at all times
Notify their healthcare provider if they develop any new/unusual symptoms or are
admitted to a facility
• Oncology Nursing Society
https://www.ons.org/node/3761
• ASCO
https://www.cancer.net/sites/cancer.net/files/
asco_answers_immunotherapy.pdf
• NCCN
https://www.nccn.org/images/pdf/Immunotherapy_Infographic.pdf
• AIM with Immunotherapy
https://aimwithimmunotherapy.org/patient-action-plans/
• SITC
https://www.sitcancer.org/connectedold/p/patient

Survivorship Care in the Immunotherapy Era1-3
What are the central components of survivorship care?
Prevention strategies for new and recurrent cancers and other late effects
Surveillance for cancer spread or recurrence or second cancers
Assessment of late psychosocial and physical effects
Intervention for consequences of cancer and treatment
Coordination of care between primary care providers and specialists to ensure that all
of the survivor’s health needs are met
What do oncology nurses and nurse navigators need to know about caring for cancer survivors in the IO era?
Important to maintain relationships during and after the conclusion of immunotherapy
Immunotherapy is still a fairly new treatment with little evidence on long-term outcomes and implications à
nurses/navigators should monitor and address anxiety arising in survivors due to uncertainty about their future, eg:
No consensus on optimal duration of immunotherapy and implications of stopping early à can cause anxiety
in patients who worry that their cancer may return if they stop therapy; however, staying on treatment longer
may increase the risk of developing irAEs
irAEs can develop after stopping therapy à important to educate patients about this possibility and need to
continue to monitor and report unusual symptoms
Not clear whether immunotherapy impacts fertility or ability to conceive a healthy child à refer younger patients
to specialists to provide counseling, testing, and guidance
Number of post-immunotherapy cancer survivors will continue to grow as immunotherapy treatments move into earlier
(curable) disease settings à increased need for nurses/navigators to provide survivorship care and education

Enhance
comprehension
and retention
Deliver
patient-centered
education
Understand
the learner
Communicate
clearly and effectively
Address
health literacy and cultural
competence
Teaching and
Education
goals
Use a question list so that
patients can ask questions,
and providers can
answer them
Talk to—not at—patients
Find out what patients
already know before
providing information
New communication skills
require practice; structured skill
development exercises may be
helpful for providers
Ask patients, “Do you need
help understanding
health information?”
Adequate
preparation for
teaching and
learning
Repeat the most important
information and increase the
frequency of the message
exposure through several
repetitions
Practice empathy,
especially when the
patient’s view differs from
that of the provider
Be aware of nonverbal
messages, including
gestures, body language,
and dress, when
communicating verbally
Present the most important
information first; emphasize
one to three key points;
focus on one issue at a time;
present the information in
logical blocks; use concrete
instructions
Supplement verbal education
with simple written and
visual materials; however,
the materials should
reinforce and not replace
verbal instructions or directions
Good teaching
methods
Ask patients to repeat
information in their
own words
Ask patients about
their life experiences
and use them
to teach; use metaphors
comparing patients’ care
and their life situation
Determine patients
barriers to health
literacy; assessing
the ability to learn may
include interview or
observation
Use easy-to-understand
language
(avoid medical jargon)
Use an interpreter if a patient
requires one due to language
or disability; avoid technical
terminology or medical jargon
Overcoming
barriers
to learning
Provide information in
several ways to ensure
patient understanding;
audiotapes of patient
consultations can help
patient recall of
verbal education
Pay attention to and try
to dispel patients’
worries and
fears
Family members often
require education (eg, on
pain management)
Give patients an opportunity
to ask questions and time
to speak prior to discharge
Using a scripted tool may
help providers verbalize
clearer and more
understandable patient
education
Teaching as
an interactive
process
Use the teach-back method
Ask patients to state
their goals of medical
care to begin
a discussion
Realize that patients
may not be aware
that they do not
understand what is being
communicated to them
Audiotapes of patient
consultations can help patient
recall of verbal education
Do not just ask the patient,
“Do you understand?”
Many patients answer
“yes” even when they don’t
understand
Assessment of
learning
Remember: EDUCATE to help patients become
informed and engaged participants in their care!4
1. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology: Survivorship. Version 1.2023. https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf. 2. Institute of Medicine and National Research Council. From Cancer Patient to Cancer
Survivor:LostinTransition. Washington, DC: The National Academies Press; 2006. 3. http://www.jons-online.com/issues/2016/august-2016-vol-7-no-7/1471-game-changing-immunotherapy-presents-unique-challenges-for-navigation. 4. Marcus C. HealthPsycholBehavMed. 2014;2:482-495.

NSCLC Treatment Algorithm1
NSCLC treatment algorithm
Stage and workup based on stage
•
cT1abc, N0: PFT, bronch, mediastinal staging, PET
•
cT2a-4, N0-3, M0-1: PFT, bronch, mediastinal staging, PET, brain MRI, and biomarker/mutation testing
Stage IA
Surgical candidate?
Lobectomy (preferred)
or
segmentectomy/wedge
resection (in select cases)
SBRT
or
conventionally
fractionated RT
Surgical resection
Mutational testing
EGFR ex19del/ex21 L858R present?
Surgical resection
T1
N0
M0
Operable disease
Yes
Yes
Yes
No
No
No
Multidisciplinary discussion for neoadjuvant candidacy
Stage IB-IIIA (resectable)
T1–2, N1–2, M0
T3–4, N0–1, M0
Neoadjuvant chemoimmunotherapy
Nivolumab + platinum-based chemotherapy x 3 cycles
CheckMate -816: Nivo + chemo vs chemo
mEFS: 31.6 vs 20.8 mo (HR, 0.63)
Adjuvant chemotherapy
Platinum-based chemotherapy
LACE Meta-analysis: 5-y OS improvement of 5.4% vs no chemo
Adjuvant immunotherapy (stage II-IIIA)
Atezolizumab x 16 cycles
StageII-IIIA,PD-L1≥1%
(seeFDAapproval)
Atezolizumab x 16 cycles
IMpower010: Atezo vs BSC
mDFS: NR vs 35.3 mo (HR, 0.66)
Pembrolizumab x 1 y
Stage IB (T2a ≥4 cm), II, or IIIA,
regardless of PD-L1 expression
(see FDA approval)
Pembrolizumab x 1 y
PEARLS/KEYNOTE-091: Pembro vs
placebo
mDFS: 53.6 vs 42.0 mo (HR, 0.76)
Adjuvant targeted therapy
Osimertinib x 3 y
ADAURA: Osimertinib vs placebo
2-y DFS (stage II-IIIA): 90% vs 44% (HR, 0.17)

Stage IIIA (unresectable) or IIIB/C
Definitive chemoradiation → durvalumab
Concurrent platinum-based chemotherapy and radiation with
consolidation durvalumab
PACIFIC: Durvalumab vs placebo
mPFS: 16.8 vs 5.6 mo (HR, 0.52)
BRAF V600E
Dabrafenib + trametiniba
BRF113928: Dabrafenib + trametinib single arm
ORR: 64% (95% CI, 46-79)
2L: KRAS G12C
Sotorasib
CodeBreaK100: Sotorasib single arm
ORR: 37.1% (95% CI, 29-46); mPFS: 6.8 mo
ALK
Alectiniba
ALEX: Alectinib vs crizotinib
1-y PFS: 68.4% vs 48.7% (HR, 0.47)
Brigatiniba
ALTA-1L: Brigatinib vs crizotinib
mPFS: 24 vs 11.1 mo (HR, 0.48)
Lorlatiniba
CROWN: Lorlatinib vs crizotinib
mPFS: NR vs 9.3 mo, (HR, 0.28); 1-y PFS: 78% vs 39%
Ceritinib
ASCEND-4: Ceritinib vs chemo
mPFS: 16.6 vs 8.1 mo (HR, 0.55)
Crizotinib
PROFILE 1007: Crizotinib vs chemo
mPFS: 7.7 vs 3 mo (HR, 0.49)
NTRK
Larotrecteniba
Entrectiniba
ALKA/STARTRK: Entrectinib single arm
ORR: 70% (NSCLC)
RET
Selpercatiniba
LIBRETTO-001: Selpercatinib single arm
ORR: 64%; mDOR: 17.5 mo
Pralsetiniba
ARROW: Pralsetinib single arm
ORR: 61% (95% CI, 50–71)
2L: EGFR (ex20)
Amivantamab
CHRYSALIS: Amivantamab single arm
CBR: 74% (95%CI, 63-83); mPFS: 8.3 mo
Mobocertinib
AP32788-15-101: Mobocertinib single arm
DCR: 78% (95% CI, 69-85); mPFS: 7.3 mo
ROS1
Crizotiniba
PROFILE 1001: Crizotinib single arm
ORR: 72% (95% CI, 58-84)
Entrectiniba
ALKA STARTRK: Entrectinib single arm
ORR: 67.1%; mPFS: 19 mo
Ceritinib
YONSEI: Ceritinib single arm
ORR: 67% (95% CI, 48-81)
EGFR (ex19 del or L858R)
Osimertiniba
FLAURA: Osimertinib vs erlotinib/gefitinib
mPFS: 18.9 vs 10.2 mo (HR, 0.46)
Erlotinib
EURTAC: Erlotinib vs chemo
mPFS: 9.7 vs 5.2 mo (HR, 0.37)
Afatinib
LUX-Lung 3: Afatinib vs cis/pemetrexed
mPFS: 13.6 vs 6.9 mo (HR, 0.47)
Gefitinib
IFUM: Gefitinib single arm
mPFS: 9.7 mo
Dacomitinib
ARCHER 1050: Dacomitinib vs gefitinib
mOS: 34.1 vs 27 mo (HR, 0.75)
Erlotinib + ramucirumab
RELAY: Erlotinib + ramucirumab vs erlotinib
mPFS: 19.4 vs 12.4 mo (HR, 0.59)
Erlotinib + bevacizumab
ARTEMIS-CTONG1509: Erlotinib + bevacizumab vs erlotinib
mPFS: 17.9 vs 11.2 mo (HR, 0.55)
MET (exon 14)
Capmatiniba
GEOMETRY mono-1: Capmatinib single arm
mPFS: 12.4 mo
Tepotiniba
VISION: Tepotinib single arm
mPFS: 8.5–11 mo
2L: HER2
Trastuzumab deruxtecan
DESTINY-Lung01
T-DXd single arm
ORR: 55% (95% CI, 44-65); mPFS: 8.2 mo
T1-2, N2–3, M0
T3, N1–3, M0
T4, N0–3, M0
Tx
Nx
M1
Actionable mutation detected
• EGFR (ex19, ex20ins)
• ALK
• ROS1
• BRAF V600E
• RET
• MET (ex14)
• HER2
• NTRK1/2/3
• KRAS G12C
Mutation (minimum EGFR; broad NGS if possible) and PD-L1 testing
NSCLC treatment algorithm
Stage and workup based on stage
•
cT1abc, N0: PFT, bronch, mediastinal staging, PET
•
cT2a-4, N0-3, M0-1: PFT, bronch, mediastinal staging, PET, brain MRI, and biomarker/mutation testing
Please see the next page for recommendations if no actionable mutation is detected
Stage IV
Adagrasib
KRYSTAL-1: Adagrasib single arm
ORR: 43% (95% CI, 34-53); mDOR: 8.5 mo

a
Denotes NCCN-preferred regimens.
1. Created by Aakash Desai, MBBS, MPH, and Matthew Ho, MD, PhD. Used with permission from the authors.
PD-L1 1%
IMMUNOTHERAPY + CHEMOTHERAPY
SQUAMOUS:
• Pembrolizumab + chemotherapya
(carboplatin + paclitaxel/nab-paclitaxel)
KEYNOTE-407: Pembro + chemo vs chemo
mPFS: 6.4 vs 4.8 mo (HR, 0.56); mOS: 15.9 vs 11.3 mo (HR, 0.64)
NONSQUAMOUS:
• Pembrolizumab + chemotherapy (carboplatin + pemetrexed)a
mPFS: 8.8 vs 4.9 mo (HR, 0.52); 12-mo OS: 69% vs 49% (HR, 0.49)
• Atezolizumab + chemotherapy (carboplatin + paclitaxel + bevacizumab)
IMpower150: Atezo + chemo vs chemo
mPFS: 8.3 vs 6.8 mo (HR, 0.62)
DUAL IMMUNOTHERAPY + CHEMOTHERAPY
Nivolumab + ipilimumab + chemo (2 cycles)
CheckMate -9LA: Nivo/ipi + chemo vs chemo
mOS: 14.1 vs 10.7 mo
Durvalumab + tremelimumab + chemo (4 cycles)
POSEIDON: Durva/treme + chemo vs chemo
mOS: 14 vs 11.7 mo (HR, 0.77)
DUAL IMMUNOTHERAPY
Nivolumab + ipilimumab
CheckMate -227: Nivo/ipi vs chemo
mOS: 17.1 vs 14.9 mo
mOS: 14.1 vs 10.7 mo
mOS: 14 vs 11.7 mo (HR, 0.77)
IMMUNOTHERAPY MONOTHERAPY
Pembrolizumab
KEYNOTE-042: Pembro vs plat-based chemo
mOS: 16.7 vs 12.1 mo (HR, 0.81)
Ramucirumab + docetaxela
REVEL: Ram/docetaxel vs docetaxel; mOS: 10.5 vs 9.1 mo (HR, 0.86)
Docetaxela
TAX320: Docetaxel vs vinorelbine/ifosfamide; 1-y OS: 32% vs 19%
Gemcitabine
DUAL IMMUNOTHERAPY
Nivolumab + ipilimumab
CheckMate -227: Nivo/ipi vs chemo
mOS: 17.1 vs 14.9 mo
OS: 14.1 vs 10.7 mo
mOS: 14 vs 11.7 mo (HR, 0.77)
PD-L1 1%-49%
SQUAMOUS:
• Pembrolizumab+chemotherapya
(carboplatin+paclitaxel/nab-paclitaxel)
NONSQUAMOUS:
• Pembrolizumab + chemotherapy (carboplatin + pemetrexed)a
IMpower150 : Atezo + chemo vs chemo
mPFS: 8.3 vs 6.8 mo (HR, 0.62)
• Cemiplimab + chemotherapy (carboplatin + pemetrexed)
EMPOWER-Lung 3: Cemi + chemo vs chemo
mOS: 21.9 vs 13 mo (HR, 0.7)
PD-L1 ≥50%
IMMUNOTHERAPY MONOTHERAPY
Pembrolizumaba
KEYNOTE-024: Pembro vs platinum-based chemo
mPFS: 10.3 vs 6 mo (HR, 0.50)
Atezolizumaba
IMpower110: Atezo vs platinum-based chemo
mOS: 20.1 vs 13.1 mo (HR, 0.59)
Cemiplimaba
EMPOWER-Lung1: Cemi vs platinum-based chemo
mPFS: 8.2 vs 5.7 mo; mOS: NR vs 14.2 mo (HR, 0.57)
SQUAMOUS:
(carboplatin + paclitaxel/nab-paclitaxel)
NONSQUAMOUS:
(carboplatin + pemetrexed)
IMpower150: Atezo + chemo vs chemo
mPFS: 8.3 vs 6.8 mo (HR, 0.62)
No actionable mutation detected (stratify based on PD-L1 staining %)
Second-line therapy

Recognizing and Managing Immune-Related Adverse Events Associated
With Immune Checkpoint Inhibitor Therapy
Spectrum of Potential irAEs1-4
irAEs Can Affect ANY Organ System
Are autoimmune/
inflammatory by nature
Are different from toxicities
of chemotherapies and
other cancer therapies
Can affect any organ
system and have an
unpredictable onset
Can be difficult to
differentiate from other
causes—they are
diagnosed by exclusion
Treatment depends on
severity and may require
corticosteroids plus other
immunosuppressive
treatments at times
NB! irAEs:
• Myocarditis, pericarditis, vasculitis, tachycardia, heart failure
• Rash/pruritus, psoriasis, vitiligo, Stevens-Johnson syndrome
• Hypothyroidism, hyperthyroidism, hypophysitis, adrenal
insufficiency, diabetes
• Colitis, diarrhea, ileitis, pancreatitis, gastritis
• Hemolytic anemia, thrombocytopenia, neutropenia, hemophilia
• Hepatitis, elevated LFTs, liver failure
• Meningitis, encephalitis, Guillain-Barré syndrome, myositis,
myelopathy/neuropathy, myasthenia gravis, weakness
• Uveitis/scleritis, conjunctivitis/blepharitis, retinitis, sicca
syndrome
• Amylase/lipase, pancreatitis, hyperglycemia
• Pneumonitis
• Nephritis, proteinuria, acute renal failure
• Pneumonitis, pleuritis, sarcoid
• Arthralgias/myalgias, arthritis, dermatomyositis, joint swelling
Cardiac
Dermatologic
Endocrine
Gastrointestinal
Hematologic
Hepatic
Neurologic
Ocular
Pancreatic
Pulmonary
Renal
Respiratory
Rheumatologic

The Nurse’s Role5
Prevention
• Understand immune toxicity spectrum and identify
immunotherapy champions
• Educate patients on how the immune system works,
what to expect from treatment, about irAEs, and
what signs/symptoms to report
• Assess autoimmune risks and complete a
medication reconciliation, include OTC
medications and herbal supplements
Detection
• Monitor regularly and triage over the phone;
use toxicity management guidelines, rule out other
causes, assess/monitor kinetics of toxicity,
determine need for hospitalization
• Reinforce the need for close communication,
encourage reporting of new signs and symptoms
and if they are seen by another HCP or admitted
to the hospital
Anticipation
• Assess patients: review of systems, physical
exam, evaluate for autoimmune risks, order labs
• Educate patients if any new medications are
prescribed and encourage patients to report
new symptoms
Treatment
• Refer to the latest clinical practice guidelines
from ASCO, NCCN, and SITC on managing
irAEs in patients with NSCLC—see below for
direct links to the guidelines!
Get guidance
on triaging
patients over
the phone on
the next page!
SITC
NCCN
ESMO
ASCO
Clinical Practice Guidelines for Managing irAEs

Provides tool to distinguish which patients can be treated at home and which ones
need to come into the clinic
All staff must be educated in the use and updates of the Telephone Triage guidelines
Early identification of symptoms will minimize severity of AEs and keep patients on
beneficial therapy for a longer period of time
Telephone Triage Guidelines
Patient Considerations
Is the patient a reliable and accurate “historian”?
How reliable is the patient to follow telephone instructions? Comprehension of “sense of urgency”?
Language barriers, cognitive deficits, alcohol and drug use, comorbidities?
How far does the patient live from the clinic? Is there available transportation?
What support or resources does the patient have to follow guidelines?
• Any associated abdominal pain,
cramping, nausea, or vomiting?
• Any blood or mucous in the
stool?
• Secretary notifies clinic
practice nurse
• When did it start?
• How many episodes?
• Any recent sick contacts?
• Is the patient able to drink fluids?
Additional IO-specific
symptom questions
RN returns call; triage
questions
Patient calls with complaint
of diarrhea
If mild (increase of 4 stools/day baseline) and not
interfering with ADLs, patient may hydrate by
mouth and take an antidiarrheal agent
If moderate or severe, not able to maintain fluid
intake or associated with any other symptoms,
patient should come into the clinic for evaluation
1. Haanen JB et al. Ann Oncol. 2017;28:iv19-iv142. 2. Postow MA et al. N Engl J Med. 2018;378:158-168. 3. Gordon R et al. Clin J Oncol Nurs. 2017;21(suppl 2):45-52. 4. Darnell EP et al. Curr Oncol Rep. 2020;22:39. 5. Champiat S et al. Ann Oncol. 2016;27:559-574.

Nurses at the Forefront of the Continuing Success Story of Immunotherapy in NSCLC: Best Practices for Guiding and Supporting Patients Through Treatment and Survivorship

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Nurses at the Forefront of the Continuing Success Story of Immunotherapy in NSCLC: Best Practices for Guiding and Supporting Patients Through Treatment and Survivorship