Optimal nurse:patient ratio for patients on IL-2

We administer IL-2 frequently, and due to the potential adverse events, patient acuity can be considered high. The patients are on a med/surg oncology unit or the stem cell unit, neither of which is considered step-down or critical care. Hence, we get a lot of questions from nursing staffing office when we want to assign nurses to these patients as a one-to-one or a one-to-two. What is the best practice recommendation for nurse-to-patient ratio for patients receiving IL-2? —Diana Sullivan, RN, BSN

Use of high-dose IL-2 therapy has waned with the advent of CTLA-4 and PD-1 check point inhibitor availability, aldesleukin still has a role in treating malignancies such as metastatic melanoma. It is also indicated for metastatic renal cell cancer despite the plethora of small molecules and other biologics that have supplanted its use.

The main reason the use continues is due to that approximately 5% rate of long term sustained remissions equating to a cure. Because of serious and frequently occurring side effects of the therapy such as capillary leak syndrome, leading to multiorgan failure, a highly skilled nursing unit is mandatory for high dose Aldesleukin administration. The mortality rate of high-dose IL-2 surpasses autologous stem cell transplantation. The exact amount for the low nurse-to-patient ratio varies but is typically 2:1. I personally feel it depends on the comfort level of the nursing staff. —Donald R. Fleming, MD

SOURCES

1. Dutcher JP, Schwartzentruber DJ, Kaufman HL, et al. High dose interleukin-2 (Aldesleukin) – expert consensus on best management practices-2014. J Immunother Cancer. 2014;2:26.

2. Eisenberg S. Biologic therapy. J Infus Nurs. 2012;35(5):301-313.

3. Yost CS, Daud A, Gropper MA. Implementation of a high-dose Interleukin-2 immunostimulation biotherapy program.

ICU Dir. 2010;1(2):77-81.