Immunotherapy

 
KEY NURSING CONSIDERATIONS

Consider the need for assessment, information provision, support or management on the following topics:  

  • Diagnosis understanding 
  • Health literacy 
  • Family history 
  • Molecular profiling 
  • Genomic sequencing 
  • Treatment plan (consider concurrent treatments) 
  • Treatment goals 
  • Expected response to treatment 
  • Quality of life and likely experience with treatment 
  • Symptom management  
  • Treatment induced menopause 
  • Treatment adherence/compliance 
  • Financial implications 
  • Safe sex and contraception 
  • Oncofertility
  • Dental health/oral care 
  • Exercise and physical activity 
  • Social and emotional needs 
  • Transport and accommodation 
  • Employment impacts 
  • Clinical trials 
  • Lymphoedema screening, education, risk and management 
 TUMOUR SPECIFIC CONSIDERATIONS

Ovarian cancers (including fallopian tube & primary peritoneal cancers)

  • Consider referral for multidisciplinary prehabilitation, if service available
  • Assess for chemotherapy-induced peripheral neuropathy (CIPN)
  • Assess and monitor for ascites
  • Assess and provide information and care on bowel management (i.e. diarrhoea, constipation, monitor for bowel obstruction)
  • Assess for nausea and vomiting and potential risk for malnutrition
  • Assess emotional wellbeing, e.g. fear of recurrence
  • Assess need for a central venous access device (CVAD)
  • Refer to Ovarian Cancer Australia Teal Support Program

Uterine cancers (including endometrial cancer)

  • Chemotherapy may be recommended for palliative symptom control
  • Educate on potential impacts of concurrent chemotherapy and radiotherapy
  • Consider referral for multidisciplinary prehabilitation, if service available

Vulval cancer

  • Neoadjuvant treatment typically not used

Cervical cancer

  • Neoadjuvant treatment typically not used

Vaginal cancer

  • Neoadjuvant treatment typically not used

Gestational trophoblastic disease/neoplasia

  • Neoadjuvant treatment typically not used
☀️ LIVING WELL
  • Encourage ongoing GP contact for comorbid condition management, immunisation, screening, chronic disease, mental health care plan, and other health concerns 
  • Offer health promotion and lifestyle maintenance solutions 
  • Facilitate healthy lifestyle modifications 
  • Facilitate advance care planning for patients aged over 75 years of age and support patient-directed advance care planning for patients aged under 75 years 
  • Survivorship Care Plan 
💬 DELIVERY CONSIDERATIONS
  • Need for interpreter services (inc AUSLAN)
  • Hearing status
  • Vision status
  • Preferred learning style
  • Accessibility for priority groups (i.e. disability, CALD, LGBTQI+)
  • Appointment type (face to face/telehealth)
  • Communication with treatment team & GP

More Comprehensive Care Considerations

 

POPULATION SPECIFIC CONSIDERATIONS 

Special considerations for Aboriginal and Torres Strait Islander People

  • Cultural sensitivity regarding Women’s Business
  • Involve and support extended family, kin and community (mob)
  • Ensure culturally safe communication and information (verbal and written)
  • Recognise connection to Country and facilitate care on Country where possible
  • Consider the use of cultural or bush medicine, or traditional healers that may be accessed by the person
  • Seek permission to refer to an Aboriginal or cultural liaison officer, nurse navigator or other support role if available
  • Sensitivity and acknowledgement about Sorry Business

More detail

MORE INFORMATION 
For Nurses
Points for MDT discussion
  • Advocate for patient preferences
  • Consider oncofertility needs
  • Consider clinical trials
  • Facilitate genetics referral (germline and somatic) prior to commencing, if appropriate
  • Consider CVAD
  • Consider goals of treatment (cure vs control, palliative)
Resources for nurses

Liaise with GP/cancer nurse/rural cancer nurse.

Assessment tools

 

For Patients
What is next for the patient? Who needs to know?
  • Communicate with patient and/or carer, family re: date to commence neoadjuvant treatment, orientation to treatment centre, patient education for treatment protocol
  • Facilitate appointment with gynaecological oncologist before/during neoadjuvant treatment
  • Discuss timing of restaging scans (CT, MRI, PET, CA125) and timing of follow-up appointment with local treatment centre post-surgery
  • MDT re-discussion after C3 to discuss suitability for interval debulking surgery
  • Communicate with GP
Common referrals
  • Allied health (dietitian, psychology, social work)
  • Exercise physiology
  • Stoma nurse, if applicable
  • Lymphoedema specialist
  • Continence nurse
  • Ovarian Cancer Australia Teal Support Program
  • Rare Cancers Australia
Resources for patients
PRACTICE RECOMMENDATIONS

Ensure all people (especially young people and their carers) have an awareness and understanding of Human Papillomavirus (HPV) vaccination, assess vaccination status and recommend HPV vaccination

When? For all 12-13 year old people, ideally prior to any sexual activity, in addition to other people at any age who have not been previously vaccinated, with particular attention to priority populations at increased risk of HPV-related disease. 

How? Provide clear age-appropriate information by discussing the purpose of HPV vaccination to prevent HPV infections, reducing the risk of cancer. Offer written information to reinforce understanding. Facilitate vaccination access if indicated. 

Evidence 

National Strategy for the Elimination of Cervical Cancer in Australia

Optimal care pathway for women with cervical cancer 

 

Assess cervical screening status of all women and people with a cervix aged from 25 to 74 years and facilitate screening for those not screened within the past 5 years

When? At initial contact and opportunistically thereafter. 

How? Promote and discuss cervical screening options, provide supporting written information and facilitate screening access if indicated. 

Evidence 

National Strategy for the Elimination of Cervical Cancer in Australia

Optimal care pathway for women with cervical cancer