NICSO National Study: Physician - Nurse Monitoring Project About Oncological Adverse Events

The lacking adherence to guidelines on prevention and treatment of different chemotherapy, targeted therapy, and immunotherapy induced toxicities is the reason why there are a potential incidence and duration increase of adverse events. It is clear the need of a collateral effect early recognition for an adequate clinical management and for limiting their intensity and duration.

A better toxicity management can have a positive impact on a correct treatments dose-intensity. Scientific community debate on toxicity assessment ways and means is still open. The most debated questions concern:

• Physician and/or patient reporting adverse events;
• Nurse role in the adverse events assessment;
• How much assessment methods (assessment frequency, who's involved in adverse events monitoring) means for:

• Time spent with toxicity and intensity reduction;
• Treatment adherence. Some literature evidence is avaiable and support the need of intensive monitoring of patients in terms of adverse events. However, there is the need for a multicentre randomized clinical study in specific therapeutical settings (chemotherapy, target therapy, immunotherapy) assessing the impact of planned and ongoing patients' monitoring by nurses.

This is a multi-centric, randomized, open comparative study design, between a planned and consecutive monitoring nurse intervention in addition to the chemotherapy toxicity prevention and cure standard therapy package insert (chemotherapy, target therapy, immunotherapy), and the only use of the cancer therapy toxicity prevention and cure standard therapy package insert (chemotherapy, target therapy, immunotherapy).

The study involves All the patients with a solid tumor on treatment with adjuvant chemotherapy or receiving target therapy or immunotherapy for the first time in their cancer history.

This study design will last 24 months. Patient recruitment will last 18 months from the beginning of the study. The study period will be 4 months for the group on treatment with immunotherapy and target therapy and at least 6 months for the group on treatment with adjuvant chemotherapy. The study could be interrupted when there is a therapy withdrawal because of cancer progression, severe toxicity or for the informed consent for withdrawal, or because of death. If there is a temporary interruption or a treatment withdrawal period, patients still are in under monitoring, according to their group. The study will end with the end of the planned period monitoring, which is the last call to the enlisted patients.

Inclusion criteria

• Patients aged >18;
• Solid cancer histological diagnosis on treatment with one of the listed medicines, defined by treatment type:

• Adjuvant chemotherapy:

• anthracyclines and cyclophosphamide ± taxanes (breast cancer)
• oxaliplatin e fluoropyrimidine (colon cancer)
• combination of platin or its derivate (lung cancer)
• First line oral target therapy:

• sunitinib, pazopanib (renal cancer)
• gefitinib, erlotinib,afatinib, crizotinib (lung cancer)
• vemurafenib ± comimetinib, dabrafenib±trametinib (Melanoma)
• everolimus ± exemestane (breast cancer)
• vandetanib o lenvatinib (thyroid cancer)
• vismodegib (skin basal cell carcinoma)
• imatinib (GIST)
• Immunotherapy:

• drugs anti CTLA4
• drugs antiPD1/PDL-1
• their combination
• sign of informed consent form;
• phone call availability and accessibility;
• life expectancy higher than 6 months.

Exclusion criteria

• Presence of cerebral symptomatic metastasis;
• Presence of neurological or psychiatric disease or other conditions that stop the protocol procedure compliance;
• Previous systemic cancer treatment. These exclusion criteria are justified because usually a systemic cancer treatment cause changes in toxicity profile. This means that these patients have higher attention on their toxicities and probably receive codified preventive treatments already.
• Participation in other clinical studies