K. Del poso-Lee1, C. J. Tsai2, B. J. Cummings2, L. A. Dawson2, B. A. Millar3, P. Wong1, R. K. Wong2, J. Javor1, S. Mheid2, D. J. Valmonte4, and E. Taylor5; 1Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 2Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 3Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada, 4Princess Margaret Cancer Centre, Toronto, ON, Canada, 5University of Toronto, Toronto, ON, Canada
Purpose/Objective(s): Rapid-access palliative radiotherapy programs provide timely access to radiotherapy for patients with metastatic cancer. Most patients treated with conventional palliative fraction radiotherapy do not receive post-treatment follow-up due to the nature of these clinics. Nurse Practitioners (NP) are autonomous health care providers who provide independent follow up care for treatment-related side effects, pain and symptom management, and other health or psychosocial issues. This study aims to evaluate the benefit of a NP-led follow-up clinic for patients with metastatic cancer seen at a dedicated palliative radiotherapy program. Materials/
Methods: All patients seen in a rapid access palliative radiotherapy clinic at a tertiary cancer center were followed up independently by a NP 2 weeks after radiotherapy completion, either by a telephone or in-person visit. Symptom review, radiation side effects, and emerging health issues were assessed during each visit. Appropriate interventions and specialist referrals were initiated as warranted. Those treated with stereotactic body radiotherapy (SBRT) were followed routinely thereafter, typically every 3-4 months. Results: From May 2023 to May 2024, there were 909 referrals seen, representing 687 unique patients. Of the 909 visits, 637 (70%) resulted in palliative radiotherapy delivery. The most commonly seen histology were lung (34%), breast (32%) and prostate (17%). Frequently treated anatomic sites were non-spine bone (32%), spine (31%), and soft tissue (12%). Around 27% of patients received radiotherapy to more than one anatomic site. Sixty-three (10%) of the treatment courses were SBRT. A NP follow-up clinic was implemented starting May 2023. From May 2023 to May 2024, there were 698 radiotherapy courses representing 637 unique patients. A total of 318 (50%) patients were successfully seen in follow-up by the NP over a one-year period. Seventy-two of them (23%) were found to have radiation and/or other health-related issues that warranted further interventions by the NP. Interventions included additional medical management by NP (25 patients, 35%), referrals to another clinical specialty for future care (23 patients, 33%), and consideration of another course of radiotherapy (24 patients, 33%). Among those who were not followed, 35% could not be reached, 25% were admitted to another hospital or in hospice care, and 10% passed away. Conclusion: A NP-led follow-up clinic can improve health outcomes for patients with metastatic cancer treated with palliative radiotherapy. The NP plays a valuable role in the early identification of radiation-related and other health issues requiring immediate intervention. Further research is necessary to determine whether increased follow-up frequency and the use of validated assessment instruments can lead to enhanced patient outcomes.
