Authors (including presenting author) :
Cheung KWA, Chan PC, Tam LK, Li CMJ, Ho PS, Tung Y, Wong CS
Affiliation :
Department of Clinical Oncology, Tuen Mun Hospital
Introduction :
Since October 2018, the Head and Neck Radiotherapy Nurse Clinic (“Nurse Clinic”) has been implemented in the department under the Integrated Model of Specialist Outpatient Services set out by HAHO. Starting from January 2019, the collaboration with Nurse Clinic has been enhanced for patients on radical or high-dose palliative radiotherapy (RT) for head and neck cancers (HNCs), with the follow-up schedule at Oncologist Clinic streamlined: attendance by Oncologists are arranged at weeks 1, 4 and 7, as compared to the conventional departmental routines of Treating Clinics at weeks 1, 4, 5, 6 and 7 for patients on RT alone and weekly Chemotherapy Clinic for those on 3-weekly concurrent chemotherapy. Patients are scheduled to attend Nurse Clinic in the gap weeks along the RT course, extra sessions at Oncologist Clinic are arranged if indicated.
Objectives :
To evaluate the efficacy and safety of the enhanced collaboration model with Nurse Clinic
Methodology :
Patients with a diagnosis of HNC and having undergone radical or high-dose palliative RT during the period from May to July, 2019 were retrospectively identified and reviewed. Among those patients who received RT alone or RT concurrent with 3-weekly chemotherapy, the number of Oncologist Clinic attendances was examined. The severity of RT-related toxicities and the frequency of unplanned emergency department visits and hospital admissions for the management of RT-related toxicities were compared with those treated in May to July, 2018, before the enhanced collaboration model was implemented.
Result & Outcome :
Of the 49 patients treated during the review period, 22 were given RT alone while 20 had 3-weekly concurrent chemotherapy. The number of attendances reduced from 103 to 81 (21.4% reduction) at Treating Clinic, and from 140 to 92 (34.3% reduction) at Chemotherapy Clinic. Upon comparison with patients treated in 2018, the percentage of patients having any grade 3 or above RT-related toxicities was 11.9% (n=5/42) vs 19.0% (n=8/42). Unplanned emergency department visits and hospital admissions for the management of RT-related toxicities were indicated in 7.1% (n=3/42) vs 16.7% (n=7/42). Our results showed that the enhanced collaboration model could help to optimise the use of resources while maintaining safety, apparently a more efficient and leaner service model.
