Background: Ipilimumab is an anti-CTLA-4 monoconal antibody that improves survival of patients with metastatic melanoma. It can result in mild to severe, even life threatening autoimmune adverse effects affecting the gastrointestinal tract, liver, skin and endocrine system. Ipilimumab became accessible to patients off trial in 2013 and thus available outside specialist cancer centers. As nurses are often the first point of contact for patients they need to be aware of signs of serious adverse effects and of appropriate interventions to respond to them.
Aim: To describe the nature and frequency of problems and side effects (SE) experienced by patients and the nursing interventions initiated to manage these issues.
Sample: 31 patients commencing Ipilimumab between August 1st and December 31st 2013.
Method: SE and nursing intervention data were recorded on a standardised template by a specialist melanoma nurse at each contact initiated by a patient or at a specific follow up time point by the nurse. Outcome data from prescribed interventions were also recorded. Data have been analysed descriptively.
Results: 31 patients receiving a total of 77 doses of Ipilimumab are included in the analysis (range 1-4). Mean number of contacts 4.2 (range 1-8). Total number of SE reported was 389 and included fatigue (n=84, 22%), general weakness (n=47, 12%), skin changes (n=30, 8%) and decreased appetite (n=31, 8%). Autoimmune events occurred in 5 patients, 2 stopped treatment prematurely. Nursing interventions included arranging mobility aids, commencing topical emollients and antihistamines, advising on eating practices and arranging medical assessments. The greatest risk to patients is the nurses’ inability to recognize such common SE may be related to Ipilimumab.
Conclusions: Nurses with appropriate knowledge and expertise play a vital role in identification and timely initiation of interventions for Ipilimumab-related SE that may otherwise be life-threatening.