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ASTRO 2015: Frequent Post-Treatment Follow-up by Advance Practice Nurses Improves Care for Patients With High-Risk Head and Neck Cancer

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Key Points

  • Of the 49 total patients included in the study, 90% had stage IV or recurrent cancer. All patients were treated with intensity-modulated radiation therapy or stereotactic body radiation therapy techniques. Radiotherapy alone was given to 22 patients, and the other 27 patients received radiotherapy with concurrent chemotherapy using either cisplastin or cetuximab.
  • Of the 49 patients studied, 18 experienced adverse events a total of 26 times. Of those 18 who visited the emergency room or were admitted to the hospital, six (33%) were receiving frequent follow-up through the advance practice nurse (APN)-led clinic.
  • Patients who were treated with radiotherapy alone who were in the APN clinic group had the most significant decrease in complications, with only 16.7% experiencing adverse effects vs 60% in the standard follow-up group.

For high-risk patients who receive chemoradiotherapy for head and neck cancer, frequent follow-up appointments conducted by advance practice nurses (APNs) in a clinical outpatient setting allowed for more intensive symptom management, resulting in fewer post-treatment emergency room visits and hospital admissions compared to historical outcomes, according to research presented by Harr et al on October 19 at the American Society for Radiation Oncology’s (ASTRO’s) 57th Annual Meeting in San Antonio, Texas.

Treatments such as radiation therapy and chemoradiation therapy for patients with head and neck cancer can cause side effects, including short- and long-term pain, difficulty swallowing, tooth decay, bone pain, nausea, fatigue, mouth sores, and/or sore throat, resulting in infection risks and complications that may require unplanned emergency room visits or hospital admissions in the immediate post-treatment months.

APNs have postgraduate education in nursing, often in a specific role and/or patient population, allowing them to diagnose and treat illnesses and to prescribe medication.

Study Details

This study compared the incidence of adverse events (ie, unplanned emergency room visits and hospital admissions) in 25 high-risk patients with head and neck cancer who received post-treatment care at an APN-led, acute rehabilitation–focused clinic to the incidence of adverse events of 24 patients with head and neck cancer who received standard follow-up treatment. The standard follow-up group patients were identified using an approved institutional review board database.

Patients were considered high-risk if they had limited social support, resided in a nursing home, required multiple hydrations during treatment, received a second course of stereotactic body radiation therapy, and/or had a feeding tube.

Of the 49 patients included in the study, 90% had stage IV or recurrent cancer. All patients were treated with intensity-modulated radiation therapy or stereotactic body radiation therapy techniques. Radiation therapy alone was given to 22 patients (45%), and the other 27 patients (55%) received radiation therapy with concurrent chemotherapy using either cisplastin or cetuximab (Erbitux).

Compared to patients in the standard follow-up group, patients in the APN clinic group were seen twice as often (1.2 vs 2 visits), with the standard follow-up group being seen at 4 to 6 weeks post-treatment, then at 3 months post-treatment, while the APN clinic group patients were seen at 2 to 4 weeks post-treatment and every 2 to 4 weeks thereafter until symptoms stabilized.

Study Findings

Of the 49 patients studied, 18 experienced adverse events a total of 26 times. Of those 18 who visited the emergency room or were admitted to the hospital, 6 (33%) were receiving frequent follow-up through the APN-led clinic.

Patients who were treated with radiation therapy alone who were in the APN clinic group had the most significant decrease in complications, with only 16.7% experiencing adverse effects vs 60% in the standard follow-up group. No difference was found in the patients treated with chemoradiation, due to the intensive post-radiation therapy follow-up also provided by medical oncology.      

“This study illustrates an important role for APNs in radiation oncology,” said Bridgett Harr, CNP, of the Department of Radiation Oncology at Cleveland Clinic. “[APNs] are in a unique position to provide more intensive follow-up care, allowing them to better manage the post-treatment symptoms of high-risk patients with head and neck cancer. Not only is there greater patient satisfaction when being managed in an outpatient setting, it is more cost-effective to avoid emergency room or hospital admissions. The APN’s ability to provide high-quality, cost-effective care will play an increasingly vital role in the future of radiation oncology and health care.”  

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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