Support Care Cancer (2014) 22:867–868 DOI 10.1007/s00520-013-2108-9
LETTER TO THE EDITOR
Dedicated supportive care team at the oncology unit: a model of simultaneous care for cancer patients Enrico Vasile & Maurizio Lucchesi & Laura Ginocchi & Isa Maura Brunetti & Luca Galli & Sergio Ricci & Alfredo Falcone & Andrea Antonuzzo
Received: 2 December 2013 / Accepted: 25 December 2013 / Published online: 5 January 2014 # Springer-Verlag Berlin Heidelberg 2013
Dear Editor, On the March 2013 issue of Supportive Care in Cancer, our group has presented its experience of integrated supportive care for cancer patients [1]. We have established a dedicated team of cancer specialists working in a specific ambulatory room integrated into the oncology unit for the management of patients who suffer from symptoms or toxicities and need supportive treatments. The team works 6 days per week (Monday to Saturday) from 08:00–14:00 and receives all planned and unplanned patients who enter the department due to complications from treatment. The team responds to patient telephone enquiries, which come through a dedicated number established for emergency contact and provided to patients who are receiving active treatment in our center. On an 8-month period (mid-March to mid-October 2013), we collected data on care provided to our patients in an electronic database containing more than 700 in person visits and more than 2,000 phone calls, and addressed more than 8,000 days hospital admissions in the same period. The majority of visited patients had metastatic disease (73 %) and were receiving active anticancer treatment (72 %). The main reasons for requiring a visit were uncontrolled symptoms in 54 % of patients and toxicities in 36 % of cases; 10 % of patients acceded to the ambulatory only for logistic problems. The most frequent (considering those experienced by more than 10 visited patients) reported symptoms/toxicities were the following: pain (136 patients), fatigue (93), anorexia (69), E. Vasile (*) : M. Lucchesi : L. Ginocchi : I. M. Brunetti : L. Galli : S. Ricci : A. Falcone : A. Antonuzzo Polo Oncologico, Azienda Ospedaliero—Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy e-mail: [email protected]
fever (66), diarrhea (62), nausea/vomiting (48), liver toxicity (43), neutropenia (33), dyspnoea (31), mucositis (30), skin reactions (29), neurologic symptoms (19), cough (18), anemia (14), edema (14), and renal insufficiency (11). A blood test was performed at the supportive care unit in 160 patients; an instrumental exam (i.e., ultrasonography or xray) was required for 109 patients; 133 patients received a consult from a specialist doctor different from the oncologist (for example, dermatologist, surgeons, etc.). A total of 110 patients received specific intravenous therapy at the supportive care unit for the reported symptoms, while for the others, an outpatient treatment was prescribed. The vast majority of patients have been followed in outpatient setting; only 36 patients (5.5 %) required hospitalization, in 19 cases at the emergency room, in 12 at the oncology department, in 6 at a hospice unit, and in the other 9 cases in other medical or surgical units. Our experience shows that a high proportion of cancer patients (about 10 %) needs unscheduled hospital accesses for supportive care mainly for disease-related symptoms but also for toxicities. Of course, unplanned visits were required mainly by patients receiving active anticancer treatment, but almost one third of visited patients were not receiving treatment for their disease at the time of visit. The management of supportive care for cancer patients inside the oncology unit could favor the accessibility of patients and help a better management of both cancer and treatment-related complications [2]. Moreover, having an ambulatory for supportive care localized into the oncology unit might consent a more rapid admission of patients with oncological emergencies or severe toxicities that should be treated in an oncological setting. However, considering the complexity of possible complications that should be treated, a dedicated team for supportive care made up of cancer specialists could be
868
helpful. It could enhance patient’s adherence to anticancer therapies and optimize reductions/delays of anticancer treatment according to its goal that oncologists could better evaluate [3]. Finally, a specialized integrated supportive care team working within the oncology unit may also contribute to inpatient costs reduction for cancer; in fact, in our experience, only 5.5 % of patients required hospitalization. For this reason, we are now working for a stronger integration with our emergency department toward a more efficient management not only of patients with complications but also of patients with a new cancer diagnosis going to the emergency.
Support Care Cancer (2014) 22:867–868 Conflicts of interests interests.
All authors have declared no conflicts of
References 1. Antonuzzo A, Lucchesi M, Brunetti IM et al (2013) Supportive care and not only palliative care in the route of cancer patients. Support Care Cancer 21(3):657–658 2. Bandieri E, Sichetti D, Romero M et al (2012) Impact of early access to a palliative/supportive care intervention on pain management in patients with cancer. Ann Oncol 23(8):2016–2020 3. Ripamonti CI, Pessi MA, Boldrini S (2012) Supportive care in cancer unit at the National Cancer Institute of Milan: a new integrated model of medicine in oncology. Curr Opin Oncol 24(4):391–396
LETTER TO THE EDITOR
Dedicated supportive care team at the oncology unit: a model of simultaneous care for cancer patients Enrico Vasile & Maurizio Lucchesi & Laura Ginocchi & Isa Maura Brunetti & Luca Galli & Sergio Ricci & Alfredo Falcone & Andrea Antonuzzo
Received: 2 December 2013 / Accepted: 25 December 2013 / Published online: 5 January 2014 # Springer-Verlag Berlin Heidelberg 2013
Dear Editor, On the March 2013 issue of Supportive Care in Cancer, our group has presented its experience of integrated supportive care for cancer patients [1]. We have established a dedicated team of cancer specialists working in a specific ambulatory room integrated into the oncology unit for the management of patients who suffer from symptoms or toxicities and need supportive treatments. The team works 6 days per week (Monday to Saturday) from 08:00–14:00 and receives all planned and unplanned patients who enter the department due to complications from treatment. The team responds to patient telephone enquiries, which come through a dedicated number established for emergency contact and provided to patients who are receiving active treatment in our center. On an 8-month period (mid-March to mid-October 2013), we collected data on care provided to our patients in an electronic database containing more than 700 in person visits and more than 2,000 phone calls, and addressed more than 8,000 days hospital admissions in the same period. The majority of visited patients had metastatic disease (73 %) and were receiving active anticancer treatment (72 %). The main reasons for requiring a visit were uncontrolled symptoms in 54 % of patients and toxicities in 36 % of cases; 10 % of patients acceded to the ambulatory only for logistic problems. The most frequent (considering those experienced by more than 10 visited patients) reported symptoms/toxicities were the following: pain (136 patients), fatigue (93), anorexia (69), E. Vasile (*) : M. Lucchesi : L. Ginocchi : I. M. Brunetti : L. Galli : S. Ricci : A. Falcone : A. Antonuzzo Polo Oncologico, Azienda Ospedaliero—Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy e-mail: [email protected]
fever (66), diarrhea (62), nausea/vomiting (48), liver toxicity (43), neutropenia (33), dyspnoea (31), mucositis (30), skin reactions (29), neurologic symptoms (19), cough (18), anemia (14), edema (14), and renal insufficiency (11). A blood test was performed at the supportive care unit in 160 patients; an instrumental exam (i.e., ultrasonography or xray) was required for 109 patients; 133 patients received a consult from a specialist doctor different from the oncologist (for example, dermatologist, surgeons, etc.). A total of 110 patients received specific intravenous therapy at the supportive care unit for the reported symptoms, while for the others, an outpatient treatment was prescribed. The vast majority of patients have been followed in outpatient setting; only 36 patients (5.5 %) required hospitalization, in 19 cases at the emergency room, in 12 at the oncology department, in 6 at a hospice unit, and in the other 9 cases in other medical or surgical units. Our experience shows that a high proportion of cancer patients (about 10 %) needs unscheduled hospital accesses for supportive care mainly for disease-related symptoms but also for toxicities. Of course, unplanned visits were required mainly by patients receiving active anticancer treatment, but almost one third of visited patients were not receiving treatment for their disease at the time of visit. The management of supportive care for cancer patients inside the oncology unit could favor the accessibility of patients and help a better management of both cancer and treatment-related complications [2]. Moreover, having an ambulatory for supportive care localized into the oncology unit might consent a more rapid admission of patients with oncological emergencies or severe toxicities that should be treated in an oncological setting. However, considering the complexity of possible complications that should be treated, a dedicated team for supportive care made up of cancer specialists could be
868
helpful. It could enhance patient’s adherence to anticancer therapies and optimize reductions/delays of anticancer treatment according to its goal that oncologists could better evaluate [3]. Finally, a specialized integrated supportive care team working within the oncology unit may also contribute to inpatient costs reduction for cancer; in fact, in our experience, only 5.5 % of patients required hospitalization. For this reason, we are now working for a stronger integration with our emergency department toward a more efficient management not only of patients with complications but also of patients with a new cancer diagnosis going to the emergency.
Support Care Cancer (2014) 22:867–868 Conflicts of interests interests.
All authors have declared no conflicts of
References 1. Antonuzzo A, Lucchesi M, Brunetti IM et al (2013) Supportive care and not only palliative care in the route of cancer patients. Support Care Cancer 21(3):657–658 2. Bandieri E, Sichetti D, Romero M et al (2012) Impact of early access to a palliative/supportive care intervention on pain management in patients with cancer. Ann Oncol 23(8):2016–2020 3. Ripamonti CI, Pessi MA, Boldrini S (2012) Supportive care in cancer unit at the National Cancer Institute of Milan: a new integrated model of medicine in oncology. Curr Opin Oncol 24(4):391–396
