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Nurses ‘pivotal’ to better care and quality of life for cancer patients

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Investing in a nursing post to specifically boost continuity of care for oncology patients can bring tremendous benefits in terms of satisfaction and quality of life, according to researchers.

They looked at the impact of the introduction during 2001-05 of a dedicated role called the “pivot nurse in oncology” in the province of Quebec in Canada.

“The score difference we saw between the two cohorts was huge across the board”

Elie Kassouf

Their study, presented this week at the European Lung Cancer Congress in Geneva, has produced new evidence of the different ways in which this service improves patients’ lives during treatment.

To study the efficacy of the new service, researchers recruited 65 patients with advanced lung cancer at Notre Dame University Hospital three months after the start of their treatment.

The patients were divided into two cohorts, with 82% assigned to a continuous care arm provided via a pivot nurse, while the remainder received usual care and acted as a control group.

Patients in both cohorts answered patient satisfaction and quality-of-life questionnaires, as well as questions to assess their understanding of their health status. The first group also filled out a specific survey on the role of their pivot nurse.

Analysis of the questionnaires demonstrated superior outcomes in regards to information exchange, empathy, and quality of life for the continuous care cohort, said the researchers.

“This work shows a clear tendency of continuity of care improving when there is an established role”

Anja Kröner

Results from the FACT-L scale – a survey for evaluating lung cancer patients’ quality of life in Canada – also favoured the pivot nurse cohort in all categories, including physical, emotional and functional wellbeing.

The researchers said the differences between the questionnaire results were “highly significant and translated into better satisfaction” when comparing the total scores were compared for each group.

The study authors said: “The pivot nurse in oncology appears to have a substantial role in the care of patients with advanced lung cancer.

“Continuity of care seems to improve patients’ quality of life and satisfaction by reducing the symptom strain experienced in the ambulatory patients,” they said.

Study author Dr Elie Kassouf stated: “The score difference we saw between the two cohorts was huge across the board.”

He added: “Introduced to oncology clinics in 2001, the position of the pivot nurse was enshrined by the Ministry of Health and Social Services of Quebec in 2005. However, very little data has been collected about its impact on patients’ lives.

“Our study’s main goal was therefore to determine whether the continuity of nursing care has tangible benefits to patients treated for lung cancer, as compared to the usual standard of care without a coordinating nurse,” he said.

Dr Kassouf noted that increased cure rates and survival for the condition had come at the cost of higher toxicity in treatment and greater complexity in the care process – impacting on quality of life.

Regarding use of the nursing role, he highlighted that each pivot nurse cared for 50 to 60 patients, who all have his or her direct phone number.

Elie Kassouf

Nurses ‘pivotal’ to better care and quality of life for cancer patients

Source: ELCC 2018

Elie Kassouf

“The pivot nurse has the patients’ files and can take care of scheduling follow-up appointments with their physician as soon as they receive new test results,” he said.

“If a patient calls to report worrying symptoms, the nurse will also speak directly to their doctor, who may then see that person on short notice without the latter having to go through the regular emergency system,” he added.

The researchers noted that, due to its small sample size and single hospital setting, it was difficult to generalise the study findings. But Dr Kassouf said: “Our results certainly show that it is an avenue worth exploring.”

Anja Kröner, a PhD-prepared nurse in oncology at the Comprehensive Cancer Centre in Zurich, Switzerland, also backed the findings of the Canadian study.

“Despite the small number of patients involved, which means we must be cautious with the results, this work shows a clear tendency of continuity of care improving when there is an established role similar to that of the pivot nurse on a patient’s medical team,” she said.

Further in support of the role, Dr Kröner highlighted that the growing complexity of cancer treatment – from surgery to oral therapy and radiation – created “many breaks in the care process”.

“Parallel to this, we see patients with financial or social burdens who are at particular risk for low adherence to treatment,” she said. “In oral therapy, for example, they have pills to take on their own at home that cause severe side-effects.

“The routine care process is not very good at detecting individuals who stop taking their medication without telling their doctor about it. That is where pivot nurses can make a real difference,” she said.

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