Wednesday 3rd April 2013
Macmillan Clinical Nurse Specialist Teresa Kua describes a recently established acute oncology service.
Acute oncology services play a critical role in managing urgent care when a person with cancer needs it.
The Acute Oncology Service at Imperial College Healthcare NHS Trust covers Charing Cross, Hammersmith and St Mary’s Hospitals. The service is run by myself and Rachel Sharkey, both clinical nurse specialists. The leading clinician for this service is Dr Philip Savage.
Our daily work consists of triaging people with cancer in all three A&E departments, telephone call triaging, and attending medical ward rounds and multidisciplinary team meetings.
While the service runs across three hospitals, the inpatient service is based at Charing Cross. People are encouraged to come to the A&E department there when they have problem. As we are among the first people that patients at A&E encounter, they do comment that they are glad to see familiar faces and someone who knows their cancer history and problems.
Since the service launched in October last year, we have triaged more than 5,000 people with cancer and successfully reduced waiting times and costs by avoiding unnecessary admissions and emergency unit attendances. This has been achieved by arranging urgent outpatient appointments when appropriate and avoiding unnecessary investigations. Our aim is to improve the patient experience.
The issues that people present with at the emergency unit can often be resolved in an outpatient setting. However, many do not receive adequate information about where to get assistance and have difficulty contacting professionals. For example, a patient with a blocked naso-gastric tube rang the acute oncology service telephone line. I arranged an appointment at an outpatient clinic and assessed the tube myself, changing it as required. By doing so, the patient didn’t have to go to A&E or spend too much time waiting.
Cancer can occur at any age, but the risk increases as we get older. More than three out of five people who get cancer are over 65, and more than a third (36%) over 75. In our service, we often meet older people admitted to hospital after collapsing or falling at home. During treatment, we often find undiscovered medical problems, including cancer. Our service gives advice on necessary investigations, such as biopsies or blood investigations, and provides a link to the oncology service or other multidisciplinary team members. Sometimes, these patients are too frail for investigations or not fit for available anti-cancer treatments. In such cases, we give advice to avoid unnecessary investigations that put patients at risk.
We are auditing people admitted with chemotherapy-related neutropenic sepsis and metastatic spinal cord compression, with the aim of improving their treatment pathways by looking at the timeliness of their investigations and treatment.
It’s a privilege having Macmillan adopt our job roles, in terms of education, funding and training. We are excited to have access to the resources needed to support people with cancer and their families.
Teresa Kua, Macmillan Clinical Nurse Specialist, Acute Oncology Service, Imperial College Healthcare NHS Trust
1. Macmillan Cancer Support website. Age, lifestyle, diet and cancer risk. September 2012. (Accessed 22 January 2013).