A pilot investigation of a nurse-led oncology fast-track clinic (OFTC) for outpatient management of children following treatment with chemotherapy showed promising results. The findings from this study were reported in Supportive Care in Cancer.
Febrile neutropenia, mucositis, diarrhea, and fatigue are among a number of common complications/side effects following treatment with chemotherapy. Symptoms and/or concerns related to these complications/side effects in pediatric outpatients have historically been managed either through emergency department (ED) visits, visits to general practitioners, or by waiting until the next scheduled oncology clinic visit. Disadvantages of these approaches include assessments performed by clinicians less familiar with the cancer history of the patient and/or delayed interventions.
Based on the success of similar outpatient programs developed for adult patients with cancer, a pilot program was designed for the management of children with cancer currently receiving chemotherapy who were stable but required an urgent review. This program involved establishing an outpatient OFTC within The Children’s Cancer Centre, The Royal Children’s Hospital, Melbourne, Australia, that was led by senior oncology nurse specialists. A nurse-staffed telephone triage service was used to assess patient eligibility for the OFTC pathway.
Patient outcomes, as well as patient/parent satisfaction, for 99 of the first 100 children prospectively assigned to receive care at the OFTC were compared with data derived retrospectively from medical records of a historical control group of 196 children treated with chemotherapy who presented to the ED between 9 am and 5 pm. This latter group of patients was determined to have met criterion used for referral to the OFTC.
Some key study findings included a shorter average time spent in the OFTC (2.2 hours) compared with the ED (5.11 hours). This finding was observed for patients admitted to the hospital (6.47 hours [ED] vs 4.18 hours [OFTC]) as well as for those not requiring hospital admission (3.4 hours [ED] vs 0.81 hour [OFTC]).
Patients seen in the OFTC who were not admitted to the hospital underwent fewer interventions (n=1.7) than patients evaluated in the ED (n=2.1), although this difference did not reach statistical significance (P =.0828). In addition, fewer blood tubes were used per patient in the group receiving care at the OFTC (n=1.9) compared with the ED (n=3.2), even in the subgroup of patients admitted to the hospital from the OFTC (n=2.9; P =.0027).
The latter finding suggested that patients are managed with “a more specialized and targeted approach when seen by the senior oncology nurse specialist in the OFTC,” the study authors noted.
Fewer patients seen at the OFTC (6.4%) were admitted to the hospital for less than 1 day compared with those evaluated in the ED (16.3%), leading the study authors to comment that “the nurse-led clinic has also increased the accuracy of identifying which patients require hospital admissions.”
Based on feedback provided through surveys administered prior to and following the receipt of care at the OFTC, approximately 90% or more of patients/parents expressed satisfaction with the initial triage assessment and advice provided to them over the telephone, as well as the care received at the OFTC.
Limitations of this study identified by the study authors included the potential for bias in the selection of patients included in the historical cohort, although all medical records were reviewed by a single clinician. In addition, the sample sizes of patients attending the OFTC and comprising the historical cohort were small.
“Our pilot study implementing an OFTC for the triage and assessment of chemotherapy-related complications has proven successful from an operational and consumer perspective,” the study authors noted in their concluding remarks. “The clinic improved care by ensuring expedited review, more streamlined interventions, and less overall hospital admissions.”
Wong A, Glogolia M, Lange PW, et al. A nurse-led paediatric oncology fast-track clinic proves a successful ambulatory intervention for patients [published online January 9, 2020]. Support Care Cancer. doi: 10.1007/s00520-019-05250-w