Implementation of a Nurse Practitioner Led CNS Follow-Up and Survivorship Clinic in a NCI-Designated Cancer Center

Abstract

The role of the advanced practice provider (APP) in radiation oncology (RO) is not well defined but it has been shown that the APP can provide safe and efficient patient care. Most APPs are certified for primary care without specific concentration in oncology or RO during formal training. There are very limited fellowships available to train APPs before providing care in a specialty setting such as RO and even fewer resources for disease-site specific training. The purpose of this work is to describe our workflow and integration of a Nurse Practitioner (NP) into the RO clinic with a specific emphasis on independent management of a central nervous system (CNS) follow-up and survivorship clinic.MDs and NPs provide services for our NCI Designated Comprehensive Cancer Center which includes 10 hospitals/clinics with services/technology including external beam radiation therapy, brachytherapy, Gamma Knife radiosurgery (GK) and proton beam therapy. The hospital which is designated for GK includes 7 radiation oncologists (3 subspecializing in CNS diseases), 2 neurosurgeons who perform GK, and 2 NPs. Within this hospital, a NP assumed leadership of our CNS follow up clinic. We herein reviewed the clinical workflow for implementing this service and evaluated metrics associated with this clinic.In 2019, a NP assumed leadership for our CNS follow up clinic. Upon development of this workflow, our CNS radiation oncologists and neurosurgeons developed standardized imaging and follow up schedules for the various CNS diseases treated. The MDs provided education to the NP on management of CNS radiation side effects and imaging review. For 3-6 months prior to implementation of our clinic, the NP saw follow ups in conjunction with the radiation oncologist and neurosurgeon. This provided confidence to the NP and MDs to ensure the images were reviewed properly and the patients were satisfied with their quality of care. Given the complexity of imaging review, the NP introduced a weekly CNS imaging review meeting during which the imaging of all follow ups are reviewed. The NP also became the organizer of a bimonthly CNS tumor conference. In 2020 the NP provided independent management of the clinic and saw 360 CNS specific follow ups (out of 1,040 of their total follow ups) accounting for 35% of their practice. This correlated with an approximate increase of 10% in the number of consultations RO providers saw during this time period. In 2020, the NP's overall patient satisfaction score was 94.9% compared to an average of 90% for all RO providers.A CNS follow up clinic led by a NP was successfully implemented at our NCI Designated Cancer Center. This service was associated with excellent patient care and satisfaction and provided additional time and effort for our RO providers and neurosurgeons to see new consults and perform procedures. With specialty training from the radiation oncologist and neurosurgeon, an APP can be a critical asset to the RO team specifically in the CNS setting.