Outcomes Evaluation of a Weekly Nurse Practitioner-Managed Symptom Management Clinic for Patients With Head and Neck Cancer Treated With Chemoradiotherapy

Abstract

Purpose/Objectives To determine whether improved monitoring through close follow-up with a nurse practitioner (NP) could enhance treatment compliance and decrease frequency of hospitalizations. Design Retrospective chart review. Setting An academic National Cancer Institute–designated comprehensive cancer center. Sample 151 patients aged 45–65 years diagnosed with stage III or IV oropharyngeal cancer. Methods Patients were nonrandomized to one of two groups: a prechemotherapy clinic group and a weekly NP-led clinic group. After examination of descriptive statistics, multiple linear and logistic regressions were used to compare groups across patient outcomes. Main Research Variables Hospitalization, chemotherapy dose deviations, and chemotherapy treatment completion. Findings The average number of visits during traditional treatment was three and, after initiation of the NP-led clinic, the number was six. The hospitalization rate was 28% in the traditional clinic group compared to 12% in the NP-led group. The rate of chemotherapy dose deviations was 48% in the traditional clinic group compared to 6% in the NP-led clinic group. Forty-six percent of patients in the traditional clinic group received the full seven scheduled doses of chemotherapy compared to 90% of patients seen in the NP-led clinic group. Conclusions A weekly NP-led symptom management clinic reduces rates of hospitalization and chemotherapy dose deviations and increases chemotherapy completion in patients receiving intensive chemoradiotherapy for oropharyngeal cancer. Implications for Nursing Patients receiving chemoradiotherapy benefit from close monitoring for toxicities by NPs to successfully complete their treatment and avoid hospitalization. Knowledge Translation Early interventions to manage toxicities in patients with head and neck cancer can improve outcomes. NPs are in a key position to manage these toxicities and, when symptoms are controlled, costs are reduced.

Symptom-related emergency department visits and hospital admissions during ambulatory cancer treatment

“…We found 4 studies that examined cancer symptom management and EDVs and HAs in: women with gynecologic cancer, 9 ambulatory patients with breast or lung cancer receiving chemotherapy or radiation therapy, 10 patients with head and neck cancer receiving concurrent chemo-radiotherapy, 11 and a sample of patients receiving chemotherapy for the first time. 8 EDV and HA outcomes reported in those studies were mixed, suggesting that further investigation is needed.…”

SymptomCare@Home

“…Similar to features in other systems (see Table 1), SCH has the capacity to (1) monitor patient symptoms, (2) provide patients with automated, tailored coaching using evidence-based symptom management strategies, and (3) deliver automated alerting to providers about the patient’s symptom status. 1,9-20,33 Unique to the SCH system is the integration of a patient assessment and coaching system with a Web-based decision support system to guide symptom management by a NP. The NP is distinctively positioned to provide assessment, education, support, and pharmacologic and non-pharmacologic interventions to better manage symptoms at home.…”

“…Patient care management by the NP has been shown to improve the health outcomes of patients receiving chemotherapy. 25,33 …”

The Process of Oncology Nurse Practitioner Patient Navigation: A Grounded Theory Approach, Carving the Role

“…Triaging phone calls and reducing ER admissions are well cited in the literature as clinical outcome of the advanced practice nurse [19]; as are symptom management [20], survivorship clinics [21], and genetic counseling [22]. Table 2 depicts other ONP navigators functions performed by the nurses in the study.…”