Defining a Nurse Coordinator’s Role During Outpatient CAR T-Cell Therapy

“By playing such an integral role in education and process development, the nurse coordinator ensures the education provided to the patient and caregiver is accurate and up to date," according to the presentation authors.

For patients with cancer receiving CAR T-cell therapy in an outpatient setting, a multidisciplinary approach to their care is integral to achieving the best outcomes, according to the authors of a poster presentation from the 49th Annual Oncology Nursing Society Conference.

This presentation aimed to better define the nurse navigator’s role during outpatient CAR T-cell therapy. Currently, they help to guide the patient and caregiver through the entire treatment process. Specifically, they focus on the education portion so that any information transmitted is efficient and up to date.

Utilizing outpatient settings for patients receiving CAR T-cell therapy can be beneficial for both the patient and treatment centers. A decreased risk of hospital-acquired infections can occur when a patient is in an outpatient setting, and it can also help to reduce financial toxicity. At Atrium Health Levine Cancer, the Stem Cell Transplant and Cellular Therapy Nurse Coordinator is a key player during treatment as knowledge and support are disseminated from clinicians to patients and caregivers.

When patients receive CAR T-cell therapy, they are at an increased risk of adverse effects (AEs), specifically that of cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. For patients to get prompt and correct treatment for these AEs, nurses tend to lean upon patient reporting to identify the onset and to give immediate interventions. Part of the education that nurse navigators provide relates to what to do should symptoms arise and how to report them.

The nurse navigator has many different roles. They can assist clinicians and hospital administration in creating standard operating procedures so that patients receiving CAR T infusions can be monitored in person and through telehealth. They also help to develop safety protocols for monitoring patients after infusions and observing for AEs relating to CAR T products. Additionally, they work to educate patients and caregivers on identifying AEs and how to report them. They also work on monitoring vital signs, infection prevention, medication adherence, and making sure there is compliance with appointments.

The nurse coordinator and team meet regularly to discuss new initiatives for improving standard operating procedures. It was noted that these procedures should be evaluated regularly to make sure everything is safe and that communication is effective in mitigating immune-related AEs. Of note, education should always be reevaluated to make sure the patient has the tools necessary for successful outcomes.

The presentation included an example pathway on how to respond when a patient reports a non–life-threatening AE after hours. It follows how personnel should respond depending on if it was noted during a visit or outside of a visit. The situation then arises as the hematology/oncology fellow is paged, who then notifies the attending of the findings and determines the best course of action.

“A multidisciplinary approach is required for outpatient CAR [T-cell therapy]. The nurse coordinator’s role in guiding the patient and caregiver through the process safely is vital,” concluded authors Melissa Yountz, BSN, RN, BMTCN, and Rebecca Jennings, MSN, RN, BMTCN, OCN. “By playing such an integral role in education and process development, the nurse coordinator ensures the education provided to the patient and caregiver is accurate and up to date.”

Yountz is an oncology nurse and the Stem Cell Transplant and Cellular Therapy Coordinator at Atrium Health Wake Forest Baptist. Jennings is the Program / Quality Manager of the Stem Cell Transplant and Cellular Therapy program at Atrium Health Wake Forest Baptist.

Reference

Yountz M, Jennings R. Outpatient chimeric antigen receptor T-cell program. Presented at the 49th Annual Oncology Nursing Society Conference; April 24-28, 2024; Washington, DC,