“At the beginning, like when you first meet someone before they’ve even started anything, kind of get a baseline of ‘What’s your ability to complete your daily activities? How is your coordination? How’s your speech now? How is your writing ability?’ up front before we start anything that could be toxic. And then prior to every treatment, I tend to look at their gait, watch them walk in or walk out of the office, to see if they’re changing at all,” Colleen Erb, MSN, CRNP, ACNP-BC, AOCNP®, hematology and oncology nurse practitioner at Jefferson Health Asplundh Cancer Pavilion in Willow Grove, PA, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about central nervous system toxicity.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome:  Learners will report an increase in knowledge related to CNS toxicities.

Episode Notes 

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.
• Oncology Nursing Podcast episodes:
  • Episode 303: Cancer Symptom Management Basics: Ocular Toxicities
  • Episode 290: Cancer Symptom Management Basics: Peripheral Neuropathy
  • Episode 278: Cancer Symptom Management Basics: Hepatic Complications
  • Episode 269: Cancer Symptom Management Basics: Gastrointestinal Complications
  • Episode 256: Cancer Symptom Management Basics: Hematologic Complications
  • Episode 250: Cancer Symptom Management Basics: Dermatologic Complications
  • Episode 244: Cancer Symptom Management Basics: Cardiovascular Complications
• ONS Voice articles:
  • Cognitive Impairment Is Much More Than “Chemo Brain”
  • When Delirium Is Recognized and Addressed Early, Patient Outcomes Improve
  • An Oncology Nurse’s Guide to Bispecific Antibodies
  • CNS Survivorship Needs More Research, Funding, and Training, Expert Panel Says
• ONS courses:
  • Essentials in Advanced Practice Symptom Management
  • Treatment and Symptom Management—Oncology RN
  • Nursing Considerations for CAR T-Cell Therapy for Patients With Hematologic Malignancies: Patient Education and Symptom Management
• ONS books:
  • Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition)
  • Clinical Manual for the Oncology Advanced Practice Nurse (fourth edition)
  • Core Curriculum for Oncology Nursing (seventh edition)
• Clinical Journal of Oncology Nursing articles:
  • Associated Toxicities: Assessment and Management Related to CAR T-Cell Therapy
  • Dronabinol Therapy: Central Nervous System Adverse Events in Adults With Primary Brain Tumors
  • Primary Central Nervous System Lymphoma: Treatment and Nursing Management of Immunocompetent Patients
• ONS Huddle Card: Immune Effector Cell–Associated Neurotoxicity Syndrome (ICANS)
• American Society of Clinical Oncology (ASCO)
  • Nervous System Side Effects
  • Management of Immune-Related Adverse Events in Patients Treated With Chimeric Antigen Receptor T-Cell Therapy: ASCO Guideline

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email [email protected].

Highlights From This Episode

“Biotherapy, immunotherapy, and cellular therapy can cause changes in cognitive function and personality, even without other signs of obvious neurotoxicity. Things like cytokines, whether it’s infused or as a result of side effects, can bypass the blood-brain barrier and can also alter that vascular permeability to allow other substances to kind of cross the barrier and can also alter your hypothalamic activity.” TS 2:26

“There’s definitely an effect on patients who are older. You know, there’s less pliability, less ability of their nervous system to sort of rebound from an insult in some cases. And I think there’s more exposure. There’s more risk of coexisting conditions, things like diabetes or thyroid issues. There’s also higher risk of impaired liver and renal function or dehydration or polypharmacy-type things. So I think there’s just a lot of sort of inherent risks as people get older and have more coexisting conditions.” TS 5:33

“[Their caregiver says] they used to read all the time—and if you ask the patients, they’re like, “Oh, well, I can’t focus on the words because they all seem too blurry.” … But when you, if you ask them specifically, “Is your vision blurry?” they’ll say no. Then when you really get down to it, that caregiver piece I think is really crucial in this kind of toxicity, because it’s the little things that if you catch them when they’re little things, then won't lead to big things.” TS 11:00