Authors (including presenting author) :
CHAN LT(1), Yik NY(1), LEE KH(1), CHAN SMM(1), CHOY CP(1), HUNG YK(1), HUI P(1), HO WM(1), LAU KHT(1), MAK SSS(1)
Affiliation :
(1)Department of Clinical Oncology, Prince of Wales Hospital
Introduction :
Systemic anti-cancer therapy (SACT) intends to cure or control malignancies. There is growing demand for SACT due to medical advancement. However, SACT requires vigilant monitoring owing to complex cancer trajectories and potential life-threatening treatment toxicities. Internationally, advanced nursing role in SACT review clinic emerges to echo service demand and staff shortage and to provide quality holistic care. Prince of Wales Hospital has developed nurse-led SACT clinic since 2020 as an initiative of integrated-model for patients undergoing SACT. It is timely to share nurse-led service development and its impacts.
Objectives :
To deliberate how nurse-led clinic incorporated into SACT management including service development, skills and qualifications acquisition; and report impacts on patient care outcomes.
Methodology :
Implementation of continual cycle of nurse-led evidence-based SACT review, training, process/outcome evaluation are described. Challenges during implementation are discussed.
Result & Outcome :
SACT nurses develop regimen-based protocols with physicians and other professionals as team-based shared-care, with patients seen alternately by physicians and SACT nurses in subsequent cycles. Nurse clinicians not only initiate SACT according to agreed protocols independently, they also manage symptom and treatment toxicities with access to physicians for care management discussion. Starting from adjuvant trastuzumab, SACT clinic now extends to various anti-cancer regimens, from curative to palliative chemotherapies(7-type) or targeted therapies(3-type) for extensive cancer types(33-type).
Skills and qualifications of SACT nurses are safeguarded by structural institutional and departmental training and assessment, including Post-registration Certificate Course (oncology), chemotherapy-nurse training, and three-tier departmental nurse-clinic training (therapeutic counseling, symptom management, anti-cancer treatment review). Mandatory numbers of clinical attachments and supervised consultations are required, followed by structured competency evaluation.
Nurse-led SACT clinic served 1425 patients saving 5764 physicians’ sessions during 10/2020-6/2022. Mean patient waiting time was 62.8 minutes. Attendees demonstrated excellent treatment scheme compliance(100%) and oral anti-cancer drug adherence(100%). Care quality was reflected by low unplanned AED attendance(4.4%) and hospital admission(9.7%). More importantly, patients and doctors were satisfied with SACT nursing care.
Non-medical prescription, nurse specialist training, recognition and accreditation are challenges identified from SACT practice.
In conclusion, nurse-led SACT review clinic aligns with international models. It streamlines cancer trajectories with safe, efficient and high-quality patient care. SACT is a milestone for nursing to demonstrate its capability and move forward to advanced practitioner care.
