Nurses Emerge as Key Players in Taming Targeted Cancer Therapy Side Effects

A sweeping map of the scientific literature has concluded that nurses occupy a central, yet often under-studied, position in helping adults with cancer tolerate the targeted drugs that have transformed modern oncology. The analysis, a scoping review published in Frontiers in Pharmacology, systematically charted how nursing interventions are used to prevent, monitor, and manage the adverse effects of molecularly targeted anti-tumor therapies, including tyrosine kinase inhibitors, antibody-drug conjugates, and immune checkpoint inhibitors used in combination regimens. The review was conducted by a team led by Omar Alqaisi and Suhair Al-Ghabeesh of Al-Zaytoonah University in Jordan, together with colleagues from An-Najah National University in Palestine and Salina Regional Health Center in the United States.

The motivation for the review lies in a clinical paradox. Targeted therapies selectively interfere with the molecular pathways that drive tumor growth, proliferation, and metastasis, and they have produced significant improvements in overall survival, progression-free survival, and response rates across non-small cell lung cancer, colorectal cancer, breast cancer, melanoma, and hematologic malignancies. Yet although fatal adverse reactions are less common than with conventional cytotoxic chemotherapy, the prolonged or indefinite use of targeted agents leads to a high cumulative burden of toxicity, reaching up to 80 percent for certain drug classes. A retrospective multicenter study of 485 cancer patients receiving targeted therapy found that 61 percent experienced at least one adverse drug reaction, with skin toxicities, fatigue, mucosal damage, hypertension, and gastrointestinal discomfort among the most frequent complications.

Some of these toxicities are strikingly predictable. Epidermal growth factor receptor inhibitors, a mainstay in lung cancer treatment, cause papulopustular, acne-like rash in 60 to 90 percent of patients, along with dry skin, inflammation around the nails, and hair alterations, because the drug blocks EGFR signaling in basal keratinocytes as a side effect of its anti-tumor action. mTOR inhibitors frequently induce aphthous-like oral ulcers known as mTOR inhibitor-associated stomatitis, which differ in presentation and underlying biology from conventional chemotherapy mucositis. Immune checkpoint inhibitors, when paired with targeted agents, can trigger immune-related adverse events affecting nearly any organ system, from skin and gut to liver, endocrine glands, lungs, nerves, and blood.

The consequences ripple far beyond physical discomfort. In a prospective study of 144 patients receiving targeted therapy in ambulatory settings, patients reported an average of four adverse events over a three-month period, and roughly 20.7 percent of those events were never communicated to any healthcare professional. Patients who experienced adverse drug reactions were more likely to discontinue medication, alter their regimens, or miss doses, and they showed higher rates of cancer recurrence and metastasis than patients without such reactions. Research on patients with EGFR inhibitor-related skin reactions has also identified four psychosocial impact domains that standard clinical toxicity grading tools such as CTCAE fail to capture: limited self-management capacity, psychological distress, barriers to social participation, and unmet support needs.

To map how nursing care addresses this burden, the reviewers searched PubMed/MEDLINE, Scopus, ScienceDirect, and CINAHL, later adding a Web of Science search, and screened 742 records. After duplicate removal and full-text assessment, 14 studies published between 2015 and 2025 met the inclusion criteria. The evidence base was heterogeneous: two quasi-experimental studies, one randomized controlled trial protocol, two cohort studies, seven narrative or integrative reviews, and two clinical practice guidelines. The authors deliberately included the narrative reviews and guidelines because dedicated interventional trials were unavailable for several clinically important domains, particularly antibody-drug conjugate-induced peripheral neuropathy and immune-related adverse event management, and they distinguished primary studies from secondary sources throughout their synthesis.

Five principal intervention categories emerged from the analysis. Patient education and self-management support appeared in 11 of the 14 studies, typically delivered through face-to-face sessions, printed materials, electronic resources, and platforms such as WeChat, covering treatment mechanisms, anticipated toxicities, early warning signs, and self-care behaviors. Nurse-led oral targeted-drug management and continuity-of-care programs, studied mainly in patients taking the EGFR inhibitor icotinib, incorporated individualized medication plans, medication record cards, adverse-reaction registration forms, weekly text-message health guidance, and re-examination reminders. Home-based multidisciplinary interventions, telephone- and telehealth-based toxicity monitoring, and symptom-specific supportive-care strategies rounded out the taxonomy.

The primary studies offered suggestive, though limited, signals of benefit. In a quasi-experimental study of 80 patients with non-small cell lung cancer taking icotinib, a nurse-led oral drug management program reduced missed medication events, improved adherence, lowered adverse-reaction incidence, and produced better quality of life at six months compared with usual care. A separate quasi-experimental continuous-care study in NSCLC patients on targeted therapy after discharge reported improved scores on validated quality-of-life questionnaires, reduced anxiety and depression, and fewer adverse reactions than routine care. A retrospective cohort of 313 lung cancer patients receiving first-line chemotherapy, with or without targeted agents, linked structured oncology nursing, including toxicity education, scheduled telephone follow-up, early triage, and individualized supportive care plans, to lower rates of grade 2 or higher neutropenia and chemotherapy-induced nausea and vomiting, fewer unplanned emergency visits and treatment delays, reduced anxiety, and higher patient satisfaction.

Other findings remain provisional by design. A randomized controlled trial protocol described a planned 12-week home-based multidisciplinary intervention for EGFR inhibitor-related skin adverse reactions, coordinating oncologists, dermatologists, pharmacists, nutritionists, and specialist nurses through an intensive phase followed by a maintenance phase, but no outcome data were reported, so the intervention’s effectiveness has not been established. The remaining sources were narrative reviews, expert consensus documents, and guidelines, including ASCO guidance specifying that patients and caregivers should receive timely education about immune checkpoint inhibitor mechanisms and potential immune-related adverse events before therapy starts and throughout treatment and survivorship. Expert reviews also outlined nurse-oriented triage algorithms for diarrhea, hypertension, fatigue, and rash in patients receiving axitinib combined with immunotherapy, and nursing frameworks for assessing and managing antibody-drug conjugate-induced peripheral neuropathy using validated scales, gait screening, and fall-prevention counseling.

The review’s authors are candid about the limits of this evidence. No formal risk-of-bias assessment was performed, consistent with scoping review methodology, so the included studies vary widely in rigor. Most intervention studies followed patients for only three to six months, too short to assess long-term clinical outcomes such as progression-free or overall survival. The evidence is heavily concentrated in Chinese tertiary cancer centers and focused predominantly on a single drug class, EGFR inhibitors, a single cancer type, NSCLC, and a single toxicity domain, dermatologic injury, which restricts generalizability to other healthcare systems and therapy classes. Cost-effectiveness data were rarely reported, publication bias cannot be ruled out, and the search was limited to English-language publications in four databases.

Those gaps define the research agenda the authors propose. They call for large-scale, multicenter randomized controlled trials of structured nursing protocols, with particular emphasis on antibody-drug conjugate-induced peripheral neuropathy and immune-related adverse events, where interventional trial data are entirely absent and current frameworks rest on expert consensus rather than empirical testing. They also highlight digital health technologies, including mobile applications, electronic patient-reported outcome platforms, and telehealth monitoring systems, as promising but underexplored components of nurse-led care, and they argue for standardized oncology nursing competency frameworks covering targeted therapy pharmacology, validated toxicity assessment instruments, and international management guidelines. In the meantime, the review suggests that structured nursing involvement, spanning pre-treatment education, proactive surveillance, and coordinated escalation, may help close a practical gap in a treatment landscape where most cancer care has shifted to ambulatory and home settings, and where a substantial fraction of treatment-related toxicity is currently managed, or missed, far from the clinic.

Subject of Research: Nursing interventions for managing adverse effects of targeted anti-tumor cancer therapies

Article Title: Nursing interventions for managing treatment-related adverse effects of targeted anti-tumor therapies in adult cancer patients: a scoping review

Article References: Alqaisi, O., Al-Ghabeesh, S., Dibas, M., Alwaqfi, Y., & Yaghmour, G. (2026). Nursing interventions for managing treatment-related adverse effects of targeted anti-tumor therapies in adult cancer patients: a scoping review. Frontiers in Pharmacology, 17, Article 1936674. https://doi.org/10.3389/fphar.2026.1936674

Image Credits: AI Generated

DOI: 10.3389/fphar.2026.1936674

Keywords: scoping review, targeted therapy, oncology nursing, tyrosine kinase inhibitors, adverse effects, patient education, telehealth monitoring, EGFR inhibitors, immune-related adverse events, peripheral neuropathy, medication adherence, quality of life