Integration of advanced practice nurses and telemonitoring in the management of immune-mediated adverse events in patients with lung cancer.

Abstract

e23288 Background: Lung cancer (LC) has a major impact on the healthcare system and on patients’ lives. Care management is becoming increasingly complex, requiring specialized knowledge at each stage of the disease. Advanced practice nurse (APN) navigation is a patient-centered model that focuses on reducing barriers during the patient’s therapeutic journey. Continuous education and telemonitoring are essential tools throughout the process, especially in patients receiving immune checkpoint inhibitors (ICI). The aim of this study is to identify the occurrence of immune-mediated adverse events (EAim) and their management in a cohort of lung cancer patients in Brazil. Methods: This is a cross-sectional, retrospective study, in which patients with PC were analyzed between June 2022 and November 2024 in a private cancer center in Brazil. Clinical, demographic variables and nursing consultation data by the APN were collected during face-to-face care and telemonitoring. AEim were evaluated, graded and managed according to the Common Terminology Criteria for adverse Events (CTCAE) v.5.0. Results: During this period, 107 patients with LC were evaluated, of whom 59 received treatment with ICI (pembrolizumab, durvalumab, nivolumab or atezolizumab) as monotherapy or in combination with chemotherapy. Of these, 81% were elderly, 55% female, 75% NSCLC, 86% smokers, 83% with TNM III-IV. All patients underwent nursing consultations for education, guidance, identification and evaluation of EAim. Telemonitoring consisted of telephone contact on D3, D10 and D17 after ICI treatment. EAim occurred in 83% of patients. Of these 88% with grades 1 and 2, 5% grade 3 and 7% grade 4. Hospital and systemic management consisted of 5% and 22%, respectively. Discontinuation occurred in 7%, and there were no fatal events. The main EAim were: fatigue, rash, pruritus, diarrhea, cough, dyspnea, arthralgia, and myalgia. Management was mostly performed by telemonitoring, notifying the medical team and, when necessary, referring to the interdisciplinary team. Conclusions: APN navigation combined with telemonitoring allowed early identification and management of EAim and consequently a lower incidence of treatment discontinuation in patients with LC compared to data in the literature. Constant surveillance of EAim is essential for more assertive results, especially due to their higher prevalence in elderly patients in our population. Our data demonstrate that the inclusion of APN in the patient journey contributed to better care management, identification and management of EAim, and better clinical outcomes.