CN90 - Managing the increasing capacity pressures in a nurse-led rural, satellite oncology unit in the era of immunotherapy

Background

University Hospital Kerry (UHK) Oncology Unit is a satellite unit of Cork University Hospital (CUH), an ESMO designated Centre of Integrated Oncology and Palliative Care. It is led by oncology clinical nurse specialists, tumour-site specific nurse specialists, nurse prescribers and advanced nurse practitioners and serves a population of 180,000 people, providing infusional and oral systemic anti-cancer therapy (SACT) ambulatory units, supportive care, acute oncology service (AOS), survivorship follow-up and consultant-led outpatient clinics. Medical support is provided by two on-site registrars and 3 visiting medical oncologists.

Methods

This was a retrospective review of electronic admissions records correlated with pharmacy records and treatment plans for patients with non-small cell lung cancer (NSCLC), melanoma and breast cancer, the most common tumour types treated with immune checkpoint inhibitors (ICI).

Results

In 2019, 262 new patients were referred to UHK and 55% were treated with SACT. 10% of these patients were treated with ICI. The percentage of patients treated with ICI increased to 16% in 2020, 17% in 2021 & 25% in 2022. In 2019, 93% of patients treated with ICI had lung cancer, either small cell or NSCLC. This reduced to 88% in 2020, 86% in 2021 and to 76% in 2022, accounted for by the relative rise in ICI for melanoma: 0% (2019), 13% (2020), 13% (2021) and 22% (2022). Since the AOS was introduced in 2019 the number of calls have remained stable, however, the percentage related to ICI has increased. Admissions of patients have reduced but the proportion with a ICI related toxicity is increasing.

Conclusions

The delivery of SACT to patients living in rural areas presents unique challenges. The growth in ICI use including its unique toxicity profile is specifically challenging to a nurse-led satellite, a necessitated a review of the service. ICI related toxicities are more complex and do not fit neatly into a single algorithm. Recognition of immune-mediated toxicity and knowledge of treatments is lacking among the rural general medical and emergency department community. A dedicated acute oncology CNS, robust educational sessions, ICI work-up algorithms and structured patient review pathways are pivotal to patient care.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.