Nurse-Specific Assessment and Management of Neurotoxicity Associated With Immunotherapy: An Integrative Literature Review

Background: Precision-based immunotherapy agents are frequently being incorporated into upfront cancer treatment, and neurotoxicities have emerged as potential serious adverse effects. With this realization, nurses must augment their care to adopt a similar personalized, precision approach with unique neurotoxicity monitoring and intervention. This review aims to synthesize the existing body of literature that directs nurse-led neurotoxicity monitoring and intervention specific to immunotherapies. Method: A comprehensive literature search was conducted with a search strategy designed to identify clinical nursing care guidelines for assessment of immunotherapy-associated neurotoxicity in pediatrics and young adult oncology. The search was designed in three tiers to identify articles that addressed domains of (a) pediatric oncology, (b) immunotherapy, and (c) nursing guidelines. Results: Initially, 360 unique articles were identified, and 8 met the inclusion criteria. Most articles were narrative reviews and data-informed commentaries, with some longitudinal studies and a systematic review; all were of moderate to good quality. Many toxicities were discussed under the general terminology of neurotoxicities, with limited description of neurotoxicities specific to agents or classes. Few evidence-based recommendations for nurse-led monitoring and interventions exist. Conclusions: Immunotherapy agents have quickly become incorporated into the standard of care for many pediatric cancers. To appropriately monitor, intervene, and treat these toxicities, nurses must be aware of the neurological side effects specific to each agent and adjust care accordingly to individual patient needs while receiving these agents. Additional research is needed to develop, implement, and test monitoring protocols specific to neurotoxicities with immunotherapy in pediatrics.