Nursing Monitoring of Toxicities Related to CAR-T Therapy: A Qualitative Phenomenological Study

Abstract

Introduction. Chimeric Antigen Receptor T-cell (CAR-T) therapy represents a major innovation in the immunotherapy of refractory or relapsed hematologic malignancies. However, it is associated with potentially severe toxicities that require intensive clinical monitoring. In this context, nursing surveillance and monitoring are crucial for the early detection of complications and clinical risk management. Despite the growing use of CAR-T therapy, the available literature provides limited evidence regarding nurses’ experiential perspectives in this field. The aim of this study was to explore the experiences of nurses involved in the surveillance and monitoring of toxicities associated with CAR-T therapy in patients with hematologic malignancies.

Methods. A single-center phenomenological study was conducted in Italy. Participants were recruited through purposive sampling until data saturation was reached. Semi-structured interviews were conducted with ten nurses involved in the care of patients undergoing CAR-T therapy. Interviews were audio-recorded, transcribed, and analyzed by two independent researchers using content analysis following Cohen’s methodology.

Results. Five main themes emerged: (I) approach to the novelty, (II) evaluation of monitoring tools, (III) organizational challenges related to surveillance, (IV) perception of professional identity and role, and (V) the nurse-patient relationship. Participants expressed different opinions regarding the introduction of the therapy, ranging from apprehension to curiosity and enthusiasm. Assessment tools were considered helpful for the early detection of complications, although participants highlighted the need for more comprehensive training. One of the main perceived organizational challenges concerned the management of complications during night shifts. Participants also emphasized awareness of nursing competencies and roles within the multidisciplinary team and the importance of a nurse-patient relationship based on effective communication.

Discussion and Conclusions. This study provided a comprehensive understanding of nurses’ experiences in the monitoring and surveillance of patients undergoing CAR-T therapy, highlighting the strategic role of nurses in this context. Educational and organizational interventions are needed to improve quality standards of care in CAR-T therapy.