Specialist nurses can play a key role in supporting patients having radiotherapy

Cancer patients who attended a specialist nurse clinic rather than a consultant-led clinic for regular radiotherapy reviews benefited from longer, more frequent consultations and good symptom management, according to a paper in the June issue of the Journal of Clinical Nursing.

And because the clinical nurse specialist was able to carry out 83 per cent of the consultations without referring issues to the consultant, patients also avoided the need to see their doctor on a routine basis.

Researchers from the University of Dundee and the City's Ninewells Hospital also found that the patients – who were undergoing treatment for head and neck cancer – were more likely to be referred to members of the multi-disciplinary team. This resulted in better management of common radiotherapy side effects, like oral and nutritional problems.

When researchers compared the 23 patients attending the nurse specialist-led clinics with the 20 who had attended consultant-led clinics in the previous six months, they found that the patients reported few significant differences in quality of life. Their comments also showed that they particularly valued the relationship they had built up with the clinical nurse specialist.

Feedback from the family doctors who took part in the study was also good. They were positive about the timing and content of the information they received from the clinical nurse specialist about their patients' ongoing treatment.

"Our study showed that clinical nurse specialists can play a key role in the management of head and neck cancer patients having radiotherapy and this may take the pressure off busy consultants, with no reduction in the quality of care provided" says lead author Dr Mary Wells, a Lecturer and Clinical Research Fellow in Cancer Nursing from the University.

"As a result of our research, the majority of radiotherapy review clinics at Ninewells Hospital are now conducted by a clinical nurse specialist. But greater investment is needed to develop specialist nursing roles if initiatives like this are to be replicated elsewhere in the UK."

Key findings of the study included:

• Nurses were able to spend 16 minutes on each consultation - four times as long as the consultants - and patients had shorter waits to see them (two minutes versus nine).

• Overall quality of life scores were similar in both groups, but patients in the consultant-led clinic group reported slightly higher emotional functioning.

• Baseline pain scores were higher in the nurse-led group but rose less sharply than in the medical group.

• Patients in the nurse-led group had better scores for social eating, social contact, dry mouth, sticky saliva, teeth problems and weight loss.

• Patients in the medical group were more likely to have lost weight and less likely to have gained weight, despite receiving more nutritional supplements.

"Our study demonstrates that clinical nurse specialists in radiotherapy can effectively lead on-treatment reviews for patients using a protocol-based approach and that patients and family doctors appreciate the support, information and communication provided by nurse-led clinics" says Dr Wells.

"The findings suggest that when nurses work as part of a supportive multi-disciplinary team they can manage the majority of these routine consultations without direct input from the consultant, even in this highly symptomatic and complex group."

The study has led to direct changes in the way neck and head cancer patients are managed at Ninewells Hospital and the majority of the radiotherapy review clinics are now conducted by a clinical nurse specialist with specific training and expertise in radiotherapy care.

"The clinical nurse specialist is now able to prescribe a wider range of medication and is responsible for coordinating complex treatment regimes and supporting patients with complex symptoms" says Dr Wells.

"We also believe there is considerable potential to develop the assessment and care of patients with head and neck cancer before and after treatment as well as during radiotherapy.

"Clinical nurse specialists are ideally placed to provide information and advice on issues like health education, smoking cessation and alcohol consumption, to help reduce the impact of the patient's symptoms and improve their quality of life.

"They could also provide support, community liaison and symptom management immediately after treatment when patients are no longer in day-to-day contact with the hospital but the side effects continue to affect their daily life."

However the researchers point out that the potential to develop nurse-led radiotherapy clinics across the UK is hampered by a lack of investment in radiotherapy nursing.

"Nurses working in radiotherapy are relatively few and far between, postholders often work in isolation and their contribution has not been sufficiently acknowledged" says Dr Wells.

"We hope that our study, and the service developments it has inspired, will stimulate a debate about the valuable role that nurses can play in supporting cancer patients undergoing radiotherapy.

"We also hope that it will highlight the need for greater investment in this valuable speciality."

• A study to evaluate nurse-led on-treatment review for patients undergoing radiotherapy for head and neck cancer. Wells et al. Journal of Clinical Nursing. 17, 1428-1439. (June 2008)

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