ASTRO: follow-up by advanced practice nurses after head and neck cancer treatment improves care

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ASTRO: follow-up by advanced practice nurses after head and neck cancer treatment improves care

by Lauren Dubinsky, Senior Reporter | October 19, 2015
Emergency Medicine Population Health Risk Management
When high-risk head and neck patients who were treated with chemoradiation therapy underwent frequent follow-up visits with advanced practice nurses (APN), they received more intensive symptom management, which led to fewer post-treatment emergency room visits and hospital admissions. The research was presented today at the American Society for Radiation Oncology’s (ASTRO’s) 57th annual meeting.

“Advanced practice nurses can be utilized to provide consistent, proactive symptom management in this and other patient groups,” Bridgett Harr, lead author of the study and certified nurse practitioner at Cleveland Clinic, said in a conference call.

Radiation therapy and chemoradiation therapy treatments can cause side effects including short- and long-term pain or difficulty swallowing, tooth decay, bone pain, nausea, fatigue, mouth sores, sore throat, resulting in infection risks and complications that may lead to unplanned emergency room visits or hospital admissions.

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The researchers compared the occurrence of adverse events among 25 high-risk head and neck cancer patients who received post-treatment care at an APN-led, acute-rehabilitation-focused clinic with adverse events among 24 head and neck patients who received standard follow-up care.

The researchers considered patients to be at “high risk” if they had limited social support, lived in a nursing home, needed multiple hydrations during treatment, received a second course of stereotactic body radiation therapy (SBRT) and/or had a feeding tube.

All of the patients were treated with intensity-modulated radiation therapy (IMRT) or SBRT techniques. Radiation therapy alone was administered to 22 patients and the other 27 patients received radiation therapy with concurrent chemotherapy.

They found that patients in the APN clinic group were seen twice as often as the patients who received standard care. The patients in the standard follow-up group were seen at four to six weeks after treatment and then at three month after treatment. The patients in the APN clinic group were seen at two to four weeks after treatment and then every two to four weeks until their symptoms stabilized.

Out of all of the patients, 18 experienced adverse events a total of 26 times. Out of the 18 who visited the emergency room or were admitted to the hospital, six were undergoing frequent follow-up care through the APN-led clinic.

In addition, only 16.7 percent of patients in the APN clinic group who were only treated with radiation therapy experienced adverse events versus 60 percent in the standard follow-up group.

Harr believes that APN’s ability to provide high-quality, cost-effective care will play an increasingly important role in the future of radiation oncology and health care. “As individual providers, advanced practice nurses are in a unique position to fill these follow-up gaps, by providing intensive symptom management in the 90 days immediately post treatment,” she said.

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