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Si us plau utilitzeu sempre aquest identificador per citar o enllaçar aquest document: https://hdl.handle.net/2445/229171
Impacte de la infermera oncològica en pacients sotmesos a tractament amb immunoteràpia
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[cat] El càncer constitueix, en l’actualitat, una de les principals causes de morbiditat i mortalitat a escala mundial, i representa un repte de salut pública de gran envergadura. Els avenços científics i tecnològics en les darreres dècades han propiciat una transformació profunda en l’abordatge terapèutic de la malaltia, superant el model tradicional basat exclusivament en la quimioteràpia, radioteràpia o cirurgia, i avançant cap a estratègies més específiques i personalitzades. En aquest nou escenari, la immunoteràpia ha esdevingut una de les innovacions més rellevants, ja que actua estimulant el sistema immunitari del pacient per tal que reconegui i destrueixi les cèl·lules tumorals, oferint respostes llargues i millorant significativament la supervivència en diversos tipus de càncer.
Tot i el seu gran potencial, aquest tipus de tractament comporta noves complexitats en la pràctica clínica, especialment pel que fa a la gestió de les toxicitats immunomediades, que poden afectar diversos òrgans i sistemes. La seva detecció precoç i el maneig adequat són fonamentals per prevenir complicacions greus i garantir la continuïtat del tractament. En aquest escenari, la infermera té un paper clau en la vigilància clínica, el control de símptomes, l’educació sanitària i el suport emocional al pacient i al seu entorn familiar. També és responsable d’identificar i comunicar de manera precoç qualsevol signe de toxicitat, de reforçar l’adherència al tractament i de promoure hàbits de vida saludables.
En aquest context, les infermeres de pràctica avançada (IPA) adquireixen un protagonisme creixent dins dels equips multidisciplinaris. Aquestes professionals, dotades d’un alt nivell de competència clínica, capacitat de presa de decisions complexes i habilitats en lideratge i recerca, contribueixen de manera directa a millorar els resultats de salut. L’evidència científica avala que la seva intervenció redueix significativament els ingressos hospitalaris, les visites a urgències i les interrupcions del tractament, alhora que incrementa la satisfacció dels pacients i la seva qualitat de vida.
Tanmateix, la implantació i el reconeixement dels rols d’IPA no són uniformes en l’àmbit estatal ni internacional, ja que depenen de factors institucionals, legislatius i formatius. A Catalunya, malgrat l’existència de figures com les infermeres gestores de casos en oncologia, encara manca un marc competencial clar i un sistema regulador que n’asseguri la consolidació i el desenvolupament professional.
La immunoteràpia, com a nou paradigma terapèutic, ha transformat també el model d’atenció infermera. El seguiment proper del pacient, la detecció precoç de reaccions adverses, la coordinació amb altres professionals i l’acompanyament continuat situen la infermera en una posició clau per garantir una atenció integral i segura. El lideratge infermer, especialment des de la pràctica avançada, és essencial per optimitzar els processos assistencials, reforçar la continuïtat de les cures i garantir la màxima qualitat en el tractament oncològic amb immunoteràpia.
L’objectiu principal d’aquest estudi és analitzar el paper de les IPA en l’atenció integral dels pacients oncològics que reben immunoteràpia, amb especial atenció a l’estat nutricional, la reducció de la gravetat d’esdeveniments adversos i l’impacte hospitalari i econòmic. Es pretén descriure la prevalença i el risc de desnutrició en pacients amb tumors sòlids avançats en tractament ambulatori, dissenyar una guia de pràctica clínica per millorar l’atenció infermera en immunoteràpia i valorar l’efectivitat de la intervenció infermera en la disminució de visites a urgències per toxicitats immunomediades. Així mateix, s’analitzaran les variacions en les hospitalitzacions, els costos i els temps de resposta, per evidenciar la contribució de la IPA en la millora de la qualitat assistencial i l’eficiència del sistema de salut.
[eng] Cancer currently constitutes one of the main causes of morbidity and mortality worldwide and represents a significant public health challenge. Scientific and technological advances in recent decades have led to a profound transformation in the therapeutic approach to the disease, surpassing the traditional model that was exclusively based on chemotherapy, radiotherapy, or surgery, and moving towards more specific and personalized strategies. In this new scenario, immunotherapy has become one of the most relevant innovations, as it works by stimulating the patient's immune system to recognize and destroy tumour cells, offering long-lasting responses and significantly improving survival in various types of cancer. Despite its great potential, this type of treatment brings new complexities in clinical practice, especially regarding the management of immune-mediated toxicities that can affect various organs and systems. Early detection and proper management are crucial to prevent serious complications and ensure the continuity of treatment. In this context, the nurse plays a key role in clinical surveillance, symptom control, health education, and emotional support for the patient and their family environment. They are also responsible for identifying and communicating any signs of toxicity early, reinforcing adherence to treatment, and promoting healthy lifestyle habits. In this context, advanced practice nurses (APN) are taking on an increasingly prominent role within multidisciplinary teams. These professionals, equipped with a high level of clinical competence, the ability to make complex decisions, and skills in leadership and research, directly contribute to improving health outcomes. Scientific evidence supports that their intervention significantly reduces hospital admissions, emergency visits, and interruptions to treatment while increasing patient satisfaction and quality of life. However, the implementation and recognition of APN roles are not uniform at the international or national level, as they depend on institutional, legislative, and training factors. In Catalonia, despite the existence of roles such as oncology case manager nurses, there is still a lack of a clear competency framework and a regulatory system to ensure their consolidation and professional development. Immunotherapy, as a new therapeutic paradigm, has also transformed the nursing care model. Close patient monitoring, early detection of adverse reactions, coordination with other professionals, and continuous support position the nurse in a key role to ensure comprehensive and safe care. Nurse leadership, especially from advanced practice, is essential to optimize care processes, reinforce continuity of care, and guarantee the highest quality in oncological treatment with immunotherapy. The main objective of this study is to analyse the role of APNs in the comprehensive care of oncological patients receiving immunotherapy, with special attention to nutritional status, reduction in the severity of adverse events, and hospital and economic impact. It aims to describe the prevalence and risk of malnutrition in patients with advanced solid tumours in outpatient treatment, design a clinical practice guideline to improve nursing care in immunotherapy, and assess the effectiveness of nursing intervention in reducing emergency visits for immune-mediated toxicities. Additionally, variations in hospitalizations, costs, and response times will be analysed to highlight the contribution of APNs to improving care quality and the efficiency of the healthcare system.
[eng] Cancer currently constitutes one of the main causes of morbidity and mortality worldwide and represents a significant public health challenge. Scientific and technological advances in recent decades have led to a profound transformation in the therapeutic approach to the disease, surpassing the traditional model that was exclusively based on chemotherapy, radiotherapy, or surgery, and moving towards more specific and personalized strategies. In this new scenario, immunotherapy has become one of the most relevant innovations, as it works by stimulating the patient's immune system to recognize and destroy tumour cells, offering long-lasting responses and significantly improving survival in various types of cancer. Despite its great potential, this type of treatment brings new complexities in clinical practice, especially regarding the management of immune-mediated toxicities that can affect various organs and systems. Early detection and proper management are crucial to prevent serious complications and ensure the continuity of treatment. In this context, the nurse plays a key role in clinical surveillance, symptom control, health education, and emotional support for the patient and their family environment. They are also responsible for identifying and communicating any signs of toxicity early, reinforcing adherence to treatment, and promoting healthy lifestyle habits. In this context, advanced practice nurses (APN) are taking on an increasingly prominent role within multidisciplinary teams. These professionals, equipped with a high level of clinical competence, the ability to make complex decisions, and skills in leadership and research, directly contribute to improving health outcomes. Scientific evidence supports that their intervention significantly reduces hospital admissions, emergency visits, and interruptions to treatment while increasing patient satisfaction and quality of life. However, the implementation and recognition of APN roles are not uniform at the international or national level, as they depend on institutional, legislative, and training factors. In Catalonia, despite the existence of roles such as oncology case manager nurses, there is still a lack of a clear competency framework and a regulatory system to ensure their consolidation and professional development. Immunotherapy, as a new therapeutic paradigm, has also transformed the nursing care model. Close patient monitoring, early detection of adverse reactions, coordination with other professionals, and continuous support position the nurse in a key role to ensure comprehensive and safe care. Nurse leadership, especially from advanced practice, is essential to optimize care processes, reinforce continuity of care, and guarantee the highest quality in oncological treatment with immunotherapy. The main objective of this study is to analyse the role of APNs in the comprehensive care of oncological patients receiving immunotherapy, with special attention to nutritional status, reduction in the severity of adverse events, and hospital and economic impact. It aims to describe the prevalence and risk of malnutrition in patients with advanced solid tumours in outpatient treatment, design a clinical practice guideline to improve nursing care in immunotherapy, and assess the effectiveness of nursing intervention in reducing emergency visits for immune-mediated toxicities. Additionally, variations in hospitalizations, costs, and response times will be analysed to highlight the contribution of APNs to improving care quality and the efficiency of the healthcare system.
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SERRA LÓPEZ, Jorgina. Impacte de la infermera oncològica en pacients sotmesos a tractament amb immunoteràpia. [consulta: 11 de maig de 2026]. Disponible a: https://hdl.handle.net/2445/229171