Background:
A nurse navigator (NN) role was implemented in Townsville Cancer Centre to meet the needs of elderly patients with cancer. The service includes a pre-assessment clinic for patients ≥75years old referred to medical oncology, to identify deficiencies and optimise health domains. Nurse navigation consults were provided for ongoing monitoring and multi-disciplinary co-ordination during treatment. The safety outcomes and patterns of oncology management since the implementation of this service were examined.
Materials and Methods:
A retrospective audit was performed of patients ≥75 years who were referred to receive systemic therapy between January 2019 and November 2022. Patients receiving intra-vesicular or hormonal treatment were excluded. Data collection included rates of de-escalation of treatment plans from standard of care, and safety outcomes including unplanned hospitalizations and discontinuation rates of systemic therapy due to toxicity. Comparison was made between a historical group (January 2019 to March 2020) to post NN implementation (April 2020 to November 2022).
Results:
44 patients in the NN cohort and 47 patients in the historical cohort received systemic therapy. The rates of de-escalated therapy were similar between both cohorts (31.8 vs 34%, p=0.82). 25 (56.8%) patients in the NN cohort received nurse navigation during systemic therapy with the remainder either declining the service (18.2%), were followed up by other services e.g cancer care coordinators (9.1%) or deemed appropriate to not require follow up through the pre-assessment clinic (11.4%). Safety outcomes were improved since the implementation of the NN service, with a significant reduction in the number of unplanned hospitalizations (mean 0.75 vs 1.38, p=0.005), length of hospital stay [mean 3.64 vs 7.55 days p=0.03] and treatment discontinuations due to systemic therapy related toxicity (15.9% vs 21.3%, p=0.04).
Conclusions:
Our 2-year experience with the geriatric oncology NN service suggests that navigation through systemic therapy improves safety outcomes despite no significant changes in de-escalated systemic therapy rates.