General Discussions

Toxicity Clinics

By Lisa Schulmeister, RN, MN, APRN-BC, OCN, FAAN
It’s a simple concept—follow patients at high risk for treatment-induced toxicity, implement early interventions, and see what happens. Researchers from the University of Michigan in Ann Arbor evaluated two groups of patients with head and neck cancer receiving concurrent chemotherapy and radiation therapy. The first group of 50 patients received standard treatment (historical control) while the second group of 51 patients were followed by a group of nurse practitioners (NPs).

Patients who attended the NP clinic met weekly with an NP and the supportive care team beginning at the second week of treatment and ending 1-2 weeks after treatment was completed. The visits included a physical assessment, psychosocial assessment, and CBC and electrolytes monitoring, along with patient education about self-care measures.

Patients receiving standard care were more likely to be hospitalized during treatment (28% versus 12% in the NP group) and were more likely to require reductions in chemotherapy dosing (48% versus 6%). Only 46% of the patients in the standard practice group received the full schedule of chemotherapy, compared with 90% of patients in the NP group. These data are impressive, and support the role of early intervention and NPs in providing oncology care to patients at high risk for treatment-induced toxicity.

Mason H, DeRubeis MB, Foster JC, et al Outcomes evaluation of a weekly nurse practitioner-managed symptom management clinic for patients with head and neck cancer treated with chemoradiotherapy. Oncology Nursing Forum 2013; published online in advance of print. DOI: 10.1188/13.ONF.40-06AP.
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