Background/rationale:
Optimal Care Pathways (OCP) recommend optimal wait times for the initiation of chemotherapy for new patients in Victoria. With increasing pressures on public health systems, these targets are not always met. This study aimed to assess the time points that caused the greatest delays in oncological care, and the impact of a clinical nurse navigator on time to treatment.
Methods:
This retrospective audit used data from clinic attendance, multidisciplinary team meetings and chemotherapy records. Patients who attended lung and gastrointestinal medical oncology clinics at a single Victorian centre between two time periods pre- and post- recruitment of a clinical nurse navigator were included: January 1 2024 to March 31 2024, and June 1 2024 to August 31 2024. Descriptive statistics were used to compare time to key events in each patients care.
Impact on practice:
199 patients were included (78 lung and 121 gastrointestinal). Following the recruitment of clinical nurse navigators to lung and gastrointestinal cancer clinics, the mean number of days between a patient’s ready for care date and the initiation of chemotherapy was reduced by 22 days (45 days vs 23 days) and 15 days (47 days vs 32 days) respectively. The total number of new clinic patients seen in three months was increased by 30% (34 vs 44) in the lung stream and 42% (50 vs 71) in the gastrointestinal stream. The greatest point of delay varied based on stream; referral to multidisciplinary team meeting for lung, referral to clinic for gastrointestinal. These were minimally affected by the addition of a clinical nurse navigator.
Discussion:
Clinical nurse navigators play a key role in improving timely access to chemotherapy for new cancer patients. Pressure points that cause delays to treatment are non-universal and require targeted assessment.