Poster Presentation 2025 Joint Meeting of the COSA ASM and IPOS Congress

Background/rationale

Medical treatments for Neuroendocrine Cancers (NETs) are diverse and highly personalised, their toxicities being complex and potentially serious, requiring careful assessment and management. At the Peter MacCallum Cancer Centre NET Service, prior to 2024, management of treatment-associated symptoms was patient-initiated, often resulting in late reporting of moderate-severe concerns. A need was identified by the NET team for a more proactive approach, utilising an Advanced Practice (AP) nurse-led model of care, for patients commencing new therapies.

Methods:

An audit was performed, identifying the five most common medical treatment regimens used in NET patients

For each regimen:

1. Therapeutic guidelines were reviewed to determine specific toxicities to be addressed
2. Recommendations were reviewed regarding Common Terminology Criteria for Adverse Events (CTCAE) grading, management, toxicity-related dose modifications
3. Key patient education resources were compiled
4. Structured, treatment-specific electronic documentation templates were built, incorporating CTCAE grading, investigations, management, referrals, follow-up, and patient education

A nurse led model of care was developed and ratified by the clinical team and nursing leadership, documenting all aspects of clinical protocols and workflows, including escalation of care (if outside of scope of AP nurse).

Impact on practice:

Although formal evaluation is yet to take place, it is envisaged this clinic will enable improvements to patient care that is proactive, evidence based, consistent, and accountable.  Alongside this, the project has fostered the building of clinical expertise, not only in the provision of clinical care, but also in grading, documentation, and reporting of toxicities and management strategies.

Discussion:

This project has provided a comprehensive clinical resource that can be used as a foundation to be expanded and built upon over time, not only in the NET service, but in developing approaches to increasing the scope of AP nursing roles organisationally.