The effects of immunotherapy and novel therapies on medical oncology work load in a Canadian province.

Abstract

6532 Background: Both novel targeted therapies and immunotherapies have dramatically changed the landscape in a number of disease sites with previously limited treatment options. This has resulted in an impact on clinical workload for oncologists with subspecialty practices in the areas of non-small cell lung, (NSCLC), melanoma (M), and genitourinary (GU) cancer. Our aim was to investigate the shift in workload amongst these practices as compared to other disease sites within a single academic cancer center in Nova Scotia (NS), Canada. Methods: The NS Cancer Center is the academic cancer center for the province of NS providing consultative and ongoing care for approximately 72% of provincial patients. We manually quantified appointment visits (new consultation, treatment and follow up visits) as well as telephone toxicity and chart checks booked from February 1 to April 30 across a 3-year interval (2016, 2017, and 2018) and then extrapolated this data to derive full year estimates. Disease sites most impacted by therapies that have changed treatment landscape (NSCLC, M and GU) were compared with the Breast and Gastrointestinal disease sites. Results: Clinical workload increased across all domains over the 3 year period but the majority of the increase is attributed to the 3 disease sites (Table). Conclusions: Medical oncology workloads are increasing over time and novel treatments (including immunotherapy) in disease sites with previously limited options likely account for a significant portion of that increase. New patient consultation metrics, taken in isolation, do not reflect current trends in medical oncology workload. Hiring practices, space allocation and use of physician extenders must take into account these shifting workload dynamics to mitigate physician burnout and potential impacts on quality and timeliness of care. [Table: see text]