Sculpting nursing resilience: Transforming lives, nurturing ethics in chimeric antigen receptor T‐cell therapy

Revolutionizing cancer care, chimeric antigen receptor (CAR) T-cell therapy is an immunotherapy anticancer treatment that uses genetically modified T-cells to combat cancer. Nurses have a key role in fostering resilience in patients and caregivers undergoing this therapy, and in navigating ethical and legal issues and safeguarding their rights and interests. Unlike haematological malignancies, solid tumours have more diverse and heterogeneous tumour-associated antigens (TAAs), which can lead to off-target toxicity or antigen escape.1 Resilience enables the adversity to rebound from stress and trauma even amid faced with uncertainties risks and side effects including cytokine release syndrome, hypogammaglobulinemia, neurotoxicity, infection, prolonged cytopenias, and organ damage, and can lead to life-threatening in some cases (See Figure 1). It is a complex and multifaceted issue as there are many aspects and perspectives to be considered especially immunotherapy for hematologic malignancies, where family caregivers often experience high levels of care burden, stress, and disruption of their own well-being. Consequently, caregivers should be empowered by healthcare professionals to manage the impact of their responsibilities.2 Providing illuminating treatment, expected risks, signs, and offering counselling. This can foster decision-making and ensure the well-being of individuals seeking medical intervention.3 Elevating quality of life (QOL) in those who receive new and intensive treatments such as CAR T-cell therapy. Several studies have explored the QOL outcome of CAR T-cell therapy using Patient Reported Outcome Measures (PROM), such as the Functional Assessment of Cancer Therapy Lymphoma (FACT -Lym) and the EuroQol 5-dimension 5-Level (EQ-5D-5L) questionnaires. Studies have shown that CAR T-cell therapy is associated with a transient decline in QOL in the first week after the infusion followed by significant and sustained improvement in QOL over time reaching or exceeding the baseline level by 6 months either they achieved a partial or complete remission reported higher QOL score.4 By understanding the experience PROM illuminates patients' treatment, guiding clinicians and researchers to deliver therapy and enhance QOL outcomes (See Figure 2). This therapy involves using the patient's own cells to fight cancer cells, that is, a personalized approach which raises some ethical and legal issues. For example—how can a patient consent to such complex and risky therapy? How can providers weigh its potential benefits and risks? How can policymakers allocate it fairly? So, addressing these challenges by accountability for responsibility (A4R) approach, ensures transparent and democratic decision-making when there are disagreements or uncertainties about the principles. A4R involves four elements: relevance, publicity, appeals and enforcement. By using the A4R approach, healthcare stakeholders can foster trust, legitimacy, and fairness in the decision-making process.4 This therapy is significant for cancer treatment as it leverages the patient's own immune system to recognise and eliminate specific cancer cells in a personalised manner. However, challenges remain challenging the need to be overcome to make this therapy more effective, safe, and accessible for a wider range of cancers. Recent advancement includes a computational approach where tumour cells are targeted with peptide-centric CAR T-cell (a new class of engineered T cells that can recognize and eradicate),5 synthetic gene circuits,6 traffickings and infiltration of CAR T-cells into solid tumours by engineering them with chemokine receptors, integrins, or enzymes that can degrade the extracellular matrix6 and for such complex treatment regimens a nurse who is well trained, knowledgeable and skilful has a crucial integral role in providing comprehensive nursing health service to patients.7-10 Mr. Bende contributed to preparing and collecting original literature and figures and writing and editing the manuscript. The author would like to thank TMH Cancer Hospital, Mumbai for finding an innovative interesting treatment which is on a trial basis but where nurses play a crucial role The author declares no conflict of interest. Not applicable.