ASTRO 2015
Nurse-led head and neck cancer clinic helps reduce post-treatment symptoms, emergency visits and hospitalisations
Bridgett Harr - Cleveland Clinic, Cleveland, USA
We studied patients in an APN clinic; we particularly did high risk head and neck cancer patients. We showed that with more intensive follow up we can decrease adverse events or emergency room visits and hospitalisations in patients. Typically we would see patients beginning at four to six weeks and then see them again for a three month for restaging. In the APN clinic we saw people at two weeks post-radiation and then every two weeks thereafter until their symptoms stabilised. In doing so the standard follow up group had 60% adverse events and the APN clinic group only had 16.7.
Can you tell us about the advance nurse clinic, how typical is this of current practice?
It’s rather new in radiation oncology, we’re still trying to find our niche where we need to be. It’s a very good place for us to have that niche because we can provide consistent proactive symptom management and catch these problems before they have to go to the emergency room or they have to be admitted because it costs a lot of money for the patients too.
Do you have similar clinics for supporting patients with other tumour types?
Right now it’s just in head and neck cancer patients. It’s a primary group that we focus on because that’s what I treat mostly.
What did you do in the study?
We had 25 patients that were standard follow up from prior to when the clinic was started and then we took 24 patients in the clinic group that we saw that were high risk. They had limited social support, they resided in a nursing facility, they had multiple hydrations during treatment that weren’t planned where they had a feeding tube placed, where they had stereotactic radiation, stereotactic body radiation, SBRT. We considered those patients to be high risk and we looked at the outcomes, the endpoint basically being that emergency room visits and hospitalisation, if they had one of those they were positive for an adverse event.
What are the wider implications for clinical practice?
It shows that intensive follow-up in this patient group can lead to better outcomes for patients as far as less emergency room visits, less hospitalisations. It shows how APNs can work with patients providing consistent symptom management and help to keep these patients out of the hospital or the emergency rooms.
What about the cost implications of having a more dedicated nursing team?
I don’t know the specific numbers for cost but definitely emergency room visits, hospitalisations, readmissions in general are very expensive for the patient and the healthcare system as a whole. So by decreasing that we’re going to help take the burden off the patient and ourselves too.
Any practical pointers for others that may not have the same facilities as the Cleveland Clinic?
Just seeing patients, physically seeing patients, every couple of weeks, every week initially after treatment. You can talk to people on the phone and they can go, ‘Yes, I’m fine,’ but actually seeing them and being able to communicate with them is priceless because you can actually get more out and make sure they’re actually doing OK.
