Aims
With the shift toward oral anti-cancer agents for increasing numbers of patients comes new challenges for effective delivery of health services. Until recently, the focus of research has been on treatment adherence and management of toxicities, but the development and implementation of health services to support prevention of or timely intervention for side-effects, and to enable appropriate self-management of toxicities have received little attention. This study aims to explore unplanned ED presentations and health service utilisation by patients having ambulatory anti-cancer treatment.
Methods
Mixed methods design comprising a longitudinal prospective cohort study and follow-on opt-in semi-structured interview. Eligible participants included patients newly referred for anti-cancer treatment.
Results
Fifty-eight patients were recruited to participate in this study. Health determinants, health literacy, illness perception and financial toxicity measures were collected. Participants self-reported unplanned ED presentation and other health service utilisation during treatment.
Conclusions
With as many as 32% of patients who receive anti-cancer treatment in the outpatient setting making an unplanned ED presentation during treatment (Livingstone, Craike, Considine, 2011), designing efficient services that have potential to deliver early intervention to pre-empt or prevent side-effect escalation, and thus unnecessary hospital presentation, target important quality and safety imperatives.
Oral anti-cancer therapies, often with side-effect profiles that are unique to specific agents are not fully understood. This requires health professionals to be vigilant about potential side-effects and skilled with regard to patient teaching. Innovative services like rapid-assessment nurse-led clinics provide an opportunity for access to readily available specialist nurses who can provide timely assistance with symptom management and enable patient self-management.
Future health services research needs to explore the feasibility of a rapid assessment nurse-led clinic and its ability to support patient vigilance with toxicities, monitoring and reporting, and access to preventive, specialist nursing care.