To evaluate the implementation and impact of an Immuno-Oncology (I-O) Cancer Nurse Coordinator (CNC) role for oncology patients receiving immunotherapy.
As part of a 12 month pilot study, a six month evaluation was conducted in one tertiary referral metropolitan hospital. Patients treated with checkpoint immunotherapy were included. Melanoma patients were excluded due to established CNC support. Data collected included: patient and staff surveys; day unit (DTU) length of stay (LoS); medical officer referrals; CNC consultations; and adverse events. Medical records; the CNC database; DTU records; and incident monitoring databases were reviewed.
Over the six month period 34 patients received immunotherapy. The CNC undertook 374 episodes of patient care, 37% occurring in the DTU with a mean of three interventions per episode. Interventions included education, assessment, referrals and phone support. Mean consultation time was 23 minutes. Mean DTU LoS for patients receiving anti PD-1 therapy reduced by 63 minutes compared to pre CNC implementation. Emergency department avoidance occurred for four patients and DTU avoidance occurred on 14 occasions due to pre-treatment CNC review. I-O related adverse events reduced from two to one compared to the preceding six months. The patient survey response was 60% (n=12; n=4 lost to follow up) of which 66.6% (n=8) reported that first point of care contact was the CNC instead of the ED, GP or oncologist. Medical registrars (n=4) reported that the CNC role reduced their DTU workload burden by 25-50%. The DTU nurse survey response was 70.6% (n=12); 83.3% (n=10) of nurses perceived that the role had reduced their workload and 83.3% (n=10) reported that they now consulted the CNC instead of the registrar.
Initial results suggest that an Immuno-Oncology Cancer Nurse Coordinator role is valuable in reducing the workload burden of medical staff, enhancing patient flow and preventing ED attendance.