The WA Country Health Service (WACHS) undertook an audit in 2016 which identified opportunities to increase support to patients prescribed oral cancer therapy, to improve self-care and safe self-administering of treatment. In order to address this, a nurse led clinic utilising telehealth was implemented. The service aimed to improve quality and safety, increase patient support and improve access and completion of treatment.
Patients under the care of Fiona Stanley Hospital (FSH) Medical Oncology Department, who were prescribed oral cancer therapy were eligible for referral into the service. The service was trialled between September 2017 and April 2018. Interventions delivered through the service included delivery of education sessions to patients and carers, assessment of baseline vital signs and diagnostics, medication history, toxicity assessments and management, ordering diagnostic investigation and prescribing of supportive treatments, among others.
During the intervention phase, 41 patients (average age 62 years) from five regions across country WA were referred to the service. 180 outpatient service events (43% using telehealth) were provided with an average of 4.3 interventions per patient. The most common diagnoses in the cohort were colorectal, breast and lung cancer, and 64% of patients had multiple comorbidities. Capecitabine was the most common oral chemotherapy protocol. 100 percent of patients who completed the post service evaluation strongly agreed the nurse practitioner helped them to manage their treatment at home.
Patients living in rural areas who are prescribed oral cancer therapy are bypassing essential safety systems. This project explored the number and nature of patients referred to a nurse practitioner for support while receiving oral cancer therapy. The trial identified opportunities to increase patient and carer education, improve monitoring and management of toxicities, and increase rates of treatment completion, through the use of telehealth to support country patients receiving oral cancer treatment.