# Toxicity-management decision support for nurses and pharmacists

Source: https://onco.cc/ideas/idea-data-toxicity-cds-for-nurses/  
OnCo record `idea-data-toxicity-cds-for-nurses` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Give the nurses and pharmacists who take patients' calls a tool that walks them through recognising and managing side effects of modern cancer drugs, including when to escalate.

## Summary

Immunotherapy and targeted therapy toxicities are managed by triage nurses and pharmacists who may see a given drug rarely. Guideline-based toxicity algorithms (ESMO, ASCO, SITC) exist as tables. Encoding them as decision support integrated with ePRO alerts, with drug-specific pathways and escalation triggers, would standardise management and shorten time to steroids or hospital review for serious immune-related events.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Toxicity CDS will reduce time from symptom report to appropriate management and cut hospital admissions for grade 3 or higher immune-related adverse events by a meaningful margin.
- Rationale: Delayed recognition of immune-related adverse events is a documented cause of morbidity; nurse-led triage with structured pathways has reduced admissions in single-centre studies.
- Proposed test: Deploy across a cancer network's triage lines for one year; compare admissions for immune-related events and time to intervention with the prior year and matched networks.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (Knowledge reaches practice too slowly): Morris, Wooding & Grant, The answer is 17 years, what is the question (JRSM 2011): https://doi.org/10.1258/jrsm.2011.110180

## Connected records

- ideas: [Patient-reported symptoms captured as standard structured data in every clinic](https://onco.cc/ideas/idea-data-pro-as-structured-standard/)
- fronts: [AI & Computation](https://onco.cc/fronts/ai-computation/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- terms: [Cytokine release syndrome (CRS)](https://onco.cc/terms/crs/), [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/)
- bottlenecks: [Knowledge reaches practice too slowly](https://onco.cc/bottlenecks/b-knowledge-diffusion/), [Not enough oncologists, nurses, pathologists, physicists](https://onco.cc/bottlenecks/b-workforce/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [The answer is 17 years, what is the question: understanding time lags in translational research](https://onco.cc/key-papers/paper-morris-j-r-soc-med/)

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