Systematic ReviewResearchMedication SafetyPatient Education

Checkpoint inhibitors modestly increased fatigue versus placebo in neoadjuvant and adjuvant settings

Supportive care in cancer (PubMed)Aug 5, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A systematic review of 43 studies found modestly more cancer-related fatigue with neoadjuvant or adjuvant immune checkpoint inhibitor therapy than with placebo, based on both clinician reports and patient-reported outcomes.

What NurseJet pulled from the source

Across trials and prospective cohorts involving several cancer types and checkpoint inhibitors, fatigue was more frequent with immunotherapy than placebo, with a pooled risk ratio of 1.21. Patient-reported fatigue was also slightly higher, while comparison with chemotherapy was imprecise and not statistically significant; risk of bias was high in part because of open-label designs and allocation concerns.

Why this matters for nurses

Oncology nurses routinely assess fatigue, function, sleep, nutrition, mood, and treatment effects during neoadjuvant and adjuvant therapy. Recognizing fatigue as a measurable treatment-related symptom supports earlier evaluation without assuming that every change is expected or benign.

Bedside takeaway

Trend fatigue during checkpoint-inhibitor therapy and evaluate meaningful change instead of labeling it an unavoidable treatment effect.

How This Applies in Practice

Use this when: Assessing a patient receiving neoadjuvant or adjuvant immune checkpoint inhibitor therapy who reports new or worsening fatigue.

On your shift

Measure and trend fatigue with the approved assessment while documenting function, sleep, mood, intake, activity, and the timing relative to treatment.
Screen for accompanying findings required by the oncology pathway, including possible endocrine toxicity, anemia, infection, dehydration, or disease-related causes.
Escalate clinically meaningful change and reinforce the approved symptom-reporting and follow-up plan with the patient and caregiver.

Keep in mind: Fatigue has multiple possible causes and the review does not define one management pathway. Follow the oncology protocol, facility policy, and provider orders.

Key takeaways

The review included 43 prospective cohorts and phase 2 or later trials in neoadjuvant or adjuvant treatment settings.
Fatigue was more frequent with immune checkpoint inhibitors than placebo, with a risk ratio of 1.21 and a 95% confidence interval from 1.08 to 1.35.
Patient-reported outcomes showed a small increase in fatigue, with a standardized mean difference of 0.12.
The chemotherapy comparison was inconclusive, and study-level bias limits confidence about the magnitude and course of fatigue.

Practice implications

Assess fatigue with the approved tool and trend its onset, severity, function, sleep, mood, nutrition, and accompanying symptoms across treatment cycles. Escalate new or worsening fatigue for evaluation of treatment toxicity, endocrine effects, anemia, infection, or other causes according to the oncology pathway.

Limitations & cautions

The included studies spanned different cancers, agents, treatment settings, and fatigue measures. Risk of bias was high because of allocation concealment and open-label designs, the abstract does not define fatigue severity or trajectory consistently, and the comparison with chemotherapy was imprecise.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

Public citations are filtered to exact credible source pages. Homepage-only or invalid links stay in admin review and are not shown here.

Supportive care in cancer (PubMed)

Supportive care in cancer (PubMed). Cancer-related fatigue during treatment with neoadjuvant and/or adjuvant immune checkpoint inhibitors: a systematic review and meta-analysis.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42554880/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

Related briefs

More updates for this clinical area

Back to Discover

Renal failure (PubMed)Sep 7, 2026Research Article

A single-center retrospective cohort found that approximately one quarter of laboratory-defined acute kidney injury cases on internal medicine wards were not documented, particularly when maximal creatinine was lower.

Med-SurgAI summaryReview source

Research ArticleResearchQuality ImprovementAI summary · original source linked below

Among 161 adult hospitalizations meeting serum-creatinine criteria for acute kidney injury, 39 cases (24.2%) were undocumented. Length of stay and in-hospital mortality did not differ significantly by documentation status.

Key takeaways

In the 149 hospitalizations with a demonstrable creatinine change, 33 cases (22.1%) were undocumented.
Higher maximal creatinine was associated with lower adjusted odds of underdocumentation.
The study did not test whether a detection or documentation intervention improves care or outcomes.

Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

Abstract-only summary. This was a retrospective, single-center study of 161 hospitalizations; urine-output criteria and reliable preadmission creatinine values were unavailable, and the reference creatinine method may affect case classification.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Renal failure (PubMed). Underdocumentation of laboratory-defined acute kidney injury in internal medicine wards: a retrospective cohort study.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

European heart journal (PubMed)Sep 6, 2026Research Article

In the pragmatic TARGET-D randomized trial, vitamin D dosing titrated to a serum target did not significantly reduce the composite of death, recurrent myocardial infarction, heart-failure hospitalization, or stroke after myocardial infarction.

Telemetry Med-SurgAI summaryReview source

Research ArticleResearchMedication SafetyPatient EducationAI summary · original source linked below

Among 630 participants followed for an average of 4.2 years, major cardiovascular events occurred in 15.7% with targeted vitamin D management and 18.4% with usual care (hazard ratio 0.85, 95% CI 0.58 to 1.24; P=0.40).

Key takeaways

At baseline, 87% of participants had a 25-hydroxyvitamin D level of 40 ng/mL or lower.
The primary composite outcome and the individual outcomes of death, heart-failure hospitalization, and stroke were not significantly different.
A lower recurrent-MI rate was a secondary finding and should not override the nonsignificant primary result.

Why this matters on shift

The trial cautions against presenting targeted vitamin D supplementation as a proven strategy for reducing major cardiovascular events after myocardial infarction.

Bedside takeaway

Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

Limitations & cautions

Abstract-only summary. The trial included 630 participants, 78.1% were men, the primary confidence interval included benefit and no benefit, and individual secondary outcomes were not the primary endpoint.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European heart journal (PubMed). Targeted vitamin D supplementation and major adverse cardiovascular events after myocardial infarction: the TARGET-D trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Supportive care in cancer (PubMed)Sep 5, 2026Research Article

A small randomized trial found larger one-month reductions in reported supportive-care needs among colorectal cancer caregivers who received smartphone-based education than with routine care.

OncologyAI summaryReview source

Research ArticleResearchPatient EducationAI summary · original source linked below

Eighty family caregivers at two teaching hospitals in Tehran were randomized. Compared with routine care, the intervention group reported larger reductions in total needs and in health-service, psychological-emotional, work-social, and information domains after four weeks.

Key takeaways

The intervention was designed around family caregivers' supportive-care needs.
All four measured need domains favored the smartphone-education group at four weeks.
The abstract reports statistical significance but does not provide effect sizes or describe the educational content in detail.

Why this matters on shift

Caregiver education is part of oncology care, and mobile delivery may extend structured support beyond brief in-person teaching encounters.

Bedside takeaway

Ask caregivers about unmet information and support needs, then reinforce teaching with approved digital resources.

Nursing implications

Assess what caregivers still need to know and use approved digital education as a supplement to individualized teaching and follow-up.

Limitations & cautions

Abstract-only summary. The trial included 80 caregivers at two hospitals, assessed self-reported needs after only four weeks, and did not report patient outcomes or effect sizes in the abstract.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Supportive care in cancer (PubMed). The effect of a smartphone-based educational intervention on the supportive care needs of family caregivers of patients with colorectal cancer: a randomized controlled trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

One in four laboratory-defined AKI cases went undocumented on medicine wards

Targeted vitamin D did not significantly reduce major cardiovascular events after MI

Smartphone education reduced reported support needs among colorectal cancer caregivers