CHICAGO—Implementation of a roving pharmacist/nurse model for supportive care at the North Carolina Cancer Hospital resulted in a significant improvement in patient symptoms, researchers reported at a poster session at the 2010 annual meeting of the American Society of Clinical Oncology. The multidisciplinary Oncology Supportive Care Consult Service was started at the hospital in 2008. Members of the team include a medical oncologist, a clinical pharmacist practitioner, and a clinical nurse specialist. A novel feature of the service is that the pharmacist and nurse travel to the individual outpatient adult oncology clinics (hematology/ oncology, gynecologic oncology, surgical oncology, radiation oncology), resulting in more timely consults and less travel and in convenience for patients, explained Stephen Bernard, MD. Service is available 5 days a week. A designated On cology Supportive Care Clinic was added when a need was identified to ac commodate complex cases and patients needing ongoing follow-up.
In the first 18 months, the service saw 89 new patients and there were 292 encounters, including both new and return visits. Referrals were received from radiation oncology, medical oncology, gynecologic oncology, and surgical oncology and were for patients with a variety of malignancies. Pain management was the primary reason for consults (75%); others were constipation (11%), nausea/vomiting (8%), anxiety/mood (4%), and spiritual (2%). New consults and established visits with the service increased by 50% in the second 6 months compared with the first 6 months.
The most common recommendations by the Oncology Supportive Care Consult Service were dosage increases and addition of new medications. Improvements in symptom scores were evident by the second visit and were maintained beyond that visit. In a sample of 49 patients, pain scores decreased from 4 to 2.7 (5 being the maximum), nausea from 4 to 1.4, and constipation from 2 to 1.6.
The researchers noted that the service allowed the primary oncologist to focus on disease management while the supportive care consult team focused on managing symptoms of the disease and treatment. A study using a formal tool to evaluate patient satisfaction with the service is under way.