Nurse-Led Symptom Management Interventions in Patients Receiving Immune Checkpoint Inhibitors: A Systematic Review

Background: Immune checkpoint inhibitors (ICIs) have transformed oncologic therapeutics across multiple malignancies. However, ICI therapy is associated with a distinct spectrum of immune-related adverse events (irAEs) affecting virtually any organ system, with all-grade incidence rates of approximately 40% for monotherapy and exceeding 55% with combination regimens. Unlike conventional cytotoxic toxicities, irAEs are unpredictable in onset, autoimmune in pathophysiology, and potentially life-threatening if not promptly recognized. Oncology nurses occupy a frontline role in symptom surveillance, patient education, and toxicity triage for ICI-treated patients, yet the evidence base for nurse-led interventions within this specific population has not been systematically consolidated.
Objective: To systematically identify, appraise, and synthesize the available evidence on nurse-led symptom management interventions in patients receiving ICI therapy, including intervention designs, components, outcomes, and effectiveness.
Methods: A systematic review was conducted following the PRISMA 2020 guidelines. PubMed/MEDLINE, CINAHL, Embase, Cochrane Library, and Web of Science were searched from inception through March 2026. Eligible studies included any design evaluating nurse-led or nurse-delivered interventions targeting symptom monitoring, management, or education in adult cancer patients receiving ICIs. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Narrative synthesis was performed given the heterogeneity of study designs, interventions, and outcomes.
Results: Eighteen studies met inclusion criteria, encompassing 2,941 patients across at least 7 discrete countries plus three additional multinational syntheses. Interventions were categorized into four domains: (1) nurse-led telephone triage and proactive monitoring (n = 5); (2) electronic patient-reported outcome (ePRO) programs with nurse-mediated alerts (n = 5); (3) structured patient education and self-management support (n = 4); and (4) nurse-led clinic models and multidisciplinary team-based nursing (n = 4). Nurse-led interventions were associated with improved symptom detection, earlier irAE identification, reduced emergency department utilization, enhanced health-related quality of life, and greater patient satisfaction. The certainty of evidence was low to moderate, limited by heterogeneity and predominantly small sample sizes.
Conclusions: Nurse-led symptom management interventions demonstrate promise in improving irAE detection and patient outcomes during ICI therapy. High-quality randomized trials with standardized frameworks and ICI-specific outcome measures are needed. Integration of validated tools such as the MDASI-ICI and PRO-CTCAE into nurse-led workflows is warranted.