MPNFS Framework for Managing Herpes Zoster and Refractory Pain in an Immunotherapy-Treated Lung Cancer Patient: A Case Report

Patients undergoing treatment with immune checkpoint inhibitors (ICIs) for advanced lung cancer are at increased risk of viral reactivation and severe neuropathic pain. These complications exacerbate the overall symptom burden and psychological distress, underscoring the necessity for integrated nursing interventions aimed at enhancing both physical and psychological well-being. This constitutes a critical priority in contemporary clinical nursing research. We report a 63-year-old woman with stage IV lung adenocarcinoma (cT2aN2M1c, bone metastases) on sindilizumab and anlotinib, who developed severe cervical herpes zoster while carrying an implanted intrathecal drug delivery system (IDDS). She presented with explosive neuropathic pain (NRS 6-7), cancer pain (NRS 5-6), and severe anxiety (GAD-7 = 16). Guided by the Medication-Psychological-Nursing-Family-Support (MPNFS) framework, which underscores that nursing care should extend beyond routine medical management to incorporate integrated interventions, and in alignment with the integrative oncology guidelines from the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO), we implemented a coordinated intervention. It encompassed antiviral therapy, multimodal analgesia, psychological support, family engagement, and structured WeChat follow-up. This led to lesion resolution, significant pain and anxiety reduction (NRS 2-3; GAD-7 = 8), and safe IDDS retention, enabling transition to community for sustained symptom control. This case achieved key outcomes: safe IDDS preservation, effective symptom management, and seamless care continuity. It demonstrates that the MPNFS-guided integrative nursing is a clinical framework for managing complex immunotherapy-related complications, highlighting its vital role in facilitating multidisciplinary coordination and supporting patients through high-risk care transitions.