The SCN is at the forefront of monitoring and identifying common effects, and pivotal in ensuring adherence to therapies and effective symptom management for the person affected by cancer.
For the SCN, education of the person affected by cancer presents a new challenge to ensure adherence with therapy. The SCN will need to acquire the necessary knowledge to understand the complex processes underlying targeted therapies. Developing an education plan, communicating it effectively, and evaluating an individual's comprehension of this topic is essential. Many of these agents are oral, making them a convenient long term therapy that can be administered in the home setting when supported by effective education and information provision.10, 16
The SCN needs to recognise the unique side effect profiles that targeted therapies present from traditional antineoplastic agents. Adverse effects are usually mild to moderate, and with astute assessment can be controlled through prompt intervention and management. Some agents have effects similar to antineoplastic agents, such as nausea and vomiting, myelosuppression, and diarrhoea. More unique effects are emerging such as:9, 10
- cytokine release syndrome with monoclonal antibodies
- dermatological changes with EGFR inhibitors
- hypertension from VEGF inhibitors
- thromboembolic events with anti-angiogenesis inhibitors.
Specific agents are being identified with rare but serious complications when used alone or in combination with other antineoplastic agents, such as:9
- profound lymphopaenia with alemtuzumab
- cardiovascular toxicity with trastuzumab, bevacizumab, and sunitinib
- haemorrhage and gastrointestinal perforations with bevacizumab.
To effectively manage individuals receiving targeted therapies the SCN needs to: 9, 10
- promote participation of individuals in clinical trials to identify the benefits and risks of a specific agent
- review knowledge, adverse effect profile, and risk factors of the agent to be administered
- educate individuals and their carers on how agents work, what effects they may have, how to manage these at home, and when to report effects to health care professionals
- initiate measures such as premedications to prevent infusion related side effects
- monitor and document effects following administration of biological and molecular targeted agents.
Summarise the information and resources an SCN may provide to a person affected by cancer who is receiving a targeted therapy, as an inpatient and upon discharge.
Many targeted therapies are administered orally requiring increased participation of the individual in their care. Discuss:
- factors that promote adherence to treatment
- factors that may contribute to non-adherence
Discuss processes the SCN may use to ensure up to date knowledge, resources, and practices associated with use of new agents.
Discuss your responsibilities as an SCN with respect to the process of reporting adverse effects of biological and molecular targeted agents.