With immunotherapy (IO) being the standard of care in melanoma, over time this has led to pressures within the medical day unit (MDU), especially as other cancer algorithms have evolved incorporating IO. Main pressures include reduced capacity, increasing patient numbers leading to greater pressure on doctors and requiring greater consultation time with patients to discuss survivorship issues. To help address these issues a pharmacist and nurse (P/N) led clinic was created as a new model of care in 2017.
Melanoma patients prescribed IO are placed into the clinic and reviewed 2-4 weekly as per IO regimen. Doctors review patients 12 weekly in outpatients for scan results. To assess the benefit of the clinic the number of referrals made back to the doctor before 12 weeks were recorded. Consultations needing >10 mins to discuss survivorships issues and P/N interventions were recorded.
36 patients (age 24-89 yrs) have been referred to the clinic; 33 needed IO treatment, 2 steroid weaning and 1 temozolomide patient, needing nursing support. All patients required clinical evaluation for consideration of next cycle. Doctor’s input was required for 4 patients; 2 for inpatient admission for IO toxicity (monitoring for adrenal insufficiency, diabetic ketoacidosis), 1 for a biopsy (new skin nodule), 1 (scan results). Interventions routinely made by P/N included referrals to surgeons (3), dermatologist (2), ophthalmologist (2), tissue viability nurse (2), lymphedema team (2), physiological support (2) and fitness instructor (2). All patients required survivorship support and consultations ranged from 15-45 min. Common themes which emerged included how to partake in physical activity, anxiety on stopping IO, financial burden and advice on complementary therapies. In the melanoma team patients stop IO at 2yrs. Discussion on stopping IO is explored within 3 months of stopping IO; this discussion has occurred in 18/33 patients, in which the P/N helped alleviate patient’s anxiety over this time.
The clinic has become embedded within the melanoma service and has helped improve MDU pressures by removing patients requiring greater holistic support. This clinic in turn has sought out survivorship issues important to melanoma patients.
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All authors have declared no conflicts of interest.