EDITORIAL: The critical role of nurse practitioners in the care of cancer patients.

Abstract

A Happy New Year to all of our EJCC readers! I hope you have all had a restful festive period and that you are staying safe in these difficult times. At the time of writing, the COVID-19 epidemic remains out of control in the UK and across many other parts of the world. The impact of this global pandemic on cancer preventive, diagnostic and treatment services has been well documented and the importance of maintaining these vital cancer services, while effectively responding to the pandemic, is now recognised. Amidst the current challenges, there is optimism that COVID-19 vaccines provide a way out of these difficult times. Here's hoping that things will look much brighter as the year progresses. The pressure on cancer services caused by COVID-19 has highlighted the importance of supporting all sectors of the cancer workforce. In the UK there are concerns about the supply of cancer nurses, and real shortages in some parts of the country (Leary et al., 2017). There's a growing body of evidence that nurse-led services can provide a high quality of care that is both safe and efficient – workforce research emphasises the associated benefits of continuity of care and facilitated access to support cancer patients' multiple and complex needs (de Leeuw & Larsson, 2013). Nurse-led clinics have also shown a potential to achieve improved clinical outcomes in areas such as detection of recurrences and management of metastatic disease – while avoiding the overburdening of oncology services (McFarlane et al., 2012; Randall et al., 2017). The potential for nurse-led telephone services has also been examined – such an approach can provide high-volume contact and achieve high levels of patient satisfaction (Casey et al., 2017; Leahy et al., 2013). Indeed there is a growing trend towards innovation in nurse-led follow-up, with a number of different approaches emerging. These approaches are often supported by strong evidence, demonstrating equivalence with, or superiority over conventional approaches (Uitdehaag et al., 2014). Long term follow-up studies have demonstrated that improved, or equivalent outcomes can be sustained over many years (Moloney et al., 2019). In this issue of the journal, (Molassiotis et al., 2020) report on a scoping review of the impact of nurse-led clinics in the care of cancer patients. They highlight the importance of workforce flexibility in the care of cancer patients with a growing number of cancer survivors as the population ages. Clearly oncologists are not able to meet this growing clinical demand and other healthcare professionals may be just as well placed or even better placed to meet this need. The authors argue that nurse-led clinics have the potential to streamline service delivery and ideally improve patient outcomes. However, they also emphasise the need for good role delineation and definition of outcomes which can provide clear evidence on effectiveness. While there is good evidence that clinical nurse specialists and nurse practitioners can impact positively on patients' quality of life and provide essential supportive care, service development should build on this research in a careful way. The review includes nurse-led telephone clinics which further highlights the potential of this approach – although some patients still prefer to have the reassurance of a clinical examination. Many studies within the review reported on increased satisfaction, improved symptom management, improved emotional functioning and less medical appointments with nurse-led clinics – all adding to the generally positive body of evidence. The review also concludes that these clinics are generally cost effective, while suggesting more evidence is needed. The authors advocate further evaluative studies, and stronger evidence of improved healthcare outcomes – further, they emphasise the importance of integrating the roles of various providers of cancer services rather than working in competition – a frequent conclusion in the cancer services literature (Soukup et al., 2018). I hope you find the paper, and the many others in this issue, of interest and, as always, we welcome your feedback. Once again, my very best wishes to all of our readers for the year ahead.