SAN ANTONIO, Tex.—An oncology nurse-led team approach can reduce treatment delays and hospitalizations and improve quality of care for patients with head and neck cancer, a program presented at the ONS 41st Annual Congress has shown.1

Patients with head and neck malignancies often have complex psychosocial and medical issues; therefore, it is imperative that clinicians provide continuous evaluation and resources to this high-risk population.

In April 2014, oncology nurses at Steward Saint Anne’s Regional Cancer Center in Fall River, Massachusetts, identified potential treatment-related sequelae that resulted in significant treatment delays when patients were receiving concomitant chemoradiotherapy.

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“We found that our patients were not receiving proper education and care after treatment, because they were not being referred for speech and swallow, resulting in increased infection rates and hospitalizations,” said Helena Viveiros, RN, BSN, OCN.

Their concerns were validated during a nursing-initiated 1.5 year review of their institution’s morbidity and mortality records. Specifically, they found that these issues result in a 59% risk of significant treatment delay with or without hospitalization.

Because previous research has demonstrated that nursing interventions can help minimize treatment delays and hospitalizations, oncology nurses at Saint Anne’s created a multidisciplinary team that included social workers, dieticians, speech therapists, palliative care nurses, surgeons, radiation therapists, and the treating physicians, with the purpose of identifying interventions to limit treatment delays and interruptions.

The team developed and implemented an algorithm with the nursing staff in the surgery department to ensure timely referral to home care services for gastric tube management and early referral for swallow and speech therapy.

“Gastric tubes were put in by the surgeon, but there was no follow-up or just 1 teaching session for patients,” Viveiros said. “We needed to support our patients better.”

“We collaborated with the gastrointestinal physicians and home care services to provide aggressive supportive care,” Viveiros said. Aggressive supportive care measures were performed both during and after treatment.

Further, the team developed detailed educational materials for oral care and symptom management for distribution to patients and their caregivers.

They also established a protocol for biweekly oncology nursing visits during radiation to evaluate and quickly manage adverse events. If there were no adverse effects from treatment, the plan of care was continued; if adverse effects were present, the physician was notified and nursing interventions were initiated.

Following a 6-month review of 28 patients after implementing these interventions, the researchers found that hospitalizations and treatment delays were reduced by 34%. The team continues to meet monthly and performs chart reviews every 3 months to further improve this oncology nurse-led team approach.

“Oncology nurses can have a significant impact on patient outcomes, allowing patients to complete their prescribed course of treatment with minimal delay of treatment and hospitalization,” Viveiros concluded.


1. O’Brien S, Viveiros H, Rosa Y. Taking it head on: an oncology nurse-led team approach to decrease treatment delays and hospitalizations in our head and neck cancer patients. Oral presentation at: 2016 Oncology Nursing Society Annual Congress; April 28-May 1, 2016; San Antonio, TX.