Acute Oncology Service Research Articles

Implementing a pathway for patients diagnosed with cancer in the emergency department.

Patients diagnosed with cancer or suspected cancer during an emergency department (ED) presentation are often signposted back to their GP for urgent referral to cancer services. However, this can result in delays in patients receiving specialist support, confirmation of diagnosis and, vitally, starting treatment. A quality improvement initiative that aimed to address these issues through the introduction of an ED suspected cancer diagnosis pathway was implemented by the acute oncology service in two EDs in Oxford University Hospitals NHS Foundation Trust in April 2023. Data collected during the first year of implementation of the pathway show there has been a significant increase in the numbers of patients meeting the NHS England 62-day referral to treatment standard and in the numbers of patients receiving support from an acute oncology named cancer clinical nurse specialist from the point of discharge from the ED. This article details the initiative, which is ongoing, and shares some of the results from the first year of data collection.

Development of an ambulatory assessment unit – acute oncology service MDT to provide safe follow up of new oncology patients presenting to an SDEC unit

Development of an ambulatory assessment unit – acute oncology service MDT to provide safe follow up of new oncology patients presenting to an SDEC unit

Integrated Oncology Nursing Service (IONS)

In recent years, the clinical context for cancer has changed and it is now characterized by extended survival rates and complex cancer trajectories and symptomatology.The changes in landscape of cancer care have included a shift towards the home setting or the outpatient setting with an increase in the amount of care being delivered at home or transferred to the patient/family themselves.
 According to the literature, societies are confronted with an increasing burden of health care as a result of an ageing population, the growing number of chronic diseases and coronavirus have forced governments and health care to seek new models in order to organize health care cost-effectively, without losing the current quality of care.Multi-professional and multi-agency interventions are now needed compared to when single specialities used to suffice.We need holistic care delivered in partnership to individuals, by flexible person-centred approaches.
 The Acute Oncology and Community Services have come together to collaborate to provide supportive care to vulnerable cancer patients in the community. The objective of this Integrated Oncology Nursing Service (IONS) role is to refer cancer patients to Community Intervention Team (CIT), post a specialised oncology telephone triage by the Acute Oncology Clinical Nurse Specialist (AO CNSp), to further assess/treat patients in the community. The CIT will provide services such as clinical vitals, phlebotomy, medication administration and psychological support to patients in their home. The AO CNSp. will then link in with the patient at home the next day and continue to consult with the oncology/haematology team to discuss the best way to manage the patient at home. We aim to bring together these separate organisations and place an emphasis on the shared values of timely, efficient and person-centered care. 
 The benefit of this innovation is hoped to
 •Reduce unscheduled presentations and result in admission avoidance for patients accessing the Tallaght Hospital Oncology Services.
 •Improve the quality of patients treatment
 •Bring specialist knowledge to patients
 •Provides support to patients in their own home
 •Provide outreach to unwell patients at home
 
 The network governance model including nursing and clinical governance is shared by the Director of Public Health Nursing, the Director of Nursing of Tallaght University Hospital and the Oncology and Haemtology Consultants in Tallaght University Hospital. 
 We will roll out education and training with competencies before commencing the pilot.
 There will be a dual approach to the evaluation of this initiative focusing on organisational impact and patient outcomes and experiences. A service evaluation has been completed already. A qualitative approach will be utilised to determine the patient’s experience and ethical considerations will be incorporated into the rolling out of the service.
 In conclusion, modern cancer care is mainly delivered on an outpatient basis, meaning that there are many people in the community at risk of side effects of treatment or manifestations of progressive disease that can present as emergencies. This is where the Integrated Oncology Nursing Service is most valuable, providing outreach to acutely unwell patients at home and bringing specialist knowledge to their management.

Provision of acute oncology services in the UK: data from the Society for Acute Medicine Benchmarking Audit 2022 (SAMBA22)

Acute oncology services (AOS) manage acute cancer-related presentations alongside acute medical teams. This study assessed AOS provision against national peer review measures and the burden of acute cancer-related admissions. The 2022 Society for Acute Medicine Benchmarking Audit surveyed UK hospitals, collecting hospital-level and patient-level data for all medical admissions over a 24-h period. Logistic regression models were constructed to identify differences in patient outcomes for cancer-related admissions. Most hospitals (n=120 or 91.6%) reported having an AOS. There was heterogeneity in AOS provision, with many failing to meet peer-review measures. Of the 7,116 patients, 542 (7.6%) were cancer-related admissions. Cancer-related admissions had greater clinical acuity (p<0.05), length of stay (p<0.001) and 14-day mortality (adjusted odds ratio (OR)=3.54, 95% confidence interval (CI): 2.41–5.22, p<0.001) compared with other medical admissions. Increasing availability of AOS with integration of ambulatory pathways are vital next steps to improving care for acute cancer-related admissions.

Routine, molecular point-of-care testing for SARS-CoV-2 and other respiratory viruses within an acute oncology service improves patient care

COVID-19 has caused significant challenges for infection prevention measures and patient flow in hospital admission pathways. We aimed to assess the impact of replacing laboratory PCR with molecular point-of-care testing (mPOCT) for respiratory viruses including SARS-CoV-2, within an Acute Oncology Service (AOS). This pre- and post-implementation study took place in the AOS of a large teaching hospital, in Southampton, UK. We collected data from two periods: November 25th, 2019 to November 24th, 2020, when respiratory virus testing utilised laboratory PCR, and December 1st, 2020 to May 31st, 2021 following the introduction of mPOCT. The primary outcome was the time to results. 2189 patients were tested in the pre-implementation period and 1540 in the post implementation period. Median (IQR) time to results was 5.8h (4.2-10.6) pre-implementation and 1.9h (1.5-3.0) post-implementation (difference -3.6h [95%CI to -3.8 to -3.5]; p<0.0001). Median time spent in assessment areas was 6.0h (4.1-7.9) pre-implementation and 5.5h (3.8-7.4) post-implementation (p<0.0001). 20 (0.9%) patients admitted via AOS assessment unit developed hospital-acquired respiratory virus infection pre-implementation versus 0 (0%) post-implementation (p=0.031). Routine mPOCT for respiratory viruses, including SARS-CoV-2, was associated with a reduced time to results, reduced time in assessment areas, and a reduction in the rates of hospital-acquired respiratory virus infection in an acute oncology assessment unit.

Rapid Adaptation of Acute Oncology Services in One of the UK’s Largest NHS Foundation Trusts; Responding to COVID-19 and Beyond

Background: Acute oncology (AO) is a well-established subspeciality of oncology, supporting patients with complications of their cancer or its treatment. The COVID-19 pandemic has prompted changes in the delivery of both inpatient and outpatient cancer services to reduce face-to-face contact and limit patient exposure to secondary care environments. This necessitated urgent reconfiguration of acute oncology services (AOS) across Sheffield Teaching Hospitals NHS Foundation Trust (STHFT), as recommended by national guidelines.

Patient and treatment characteristics of emergency presentations due to immune-mediated toxicities

BackgroundThe prevalence of immune-mediated toxicities from immune checkpoint inhibitors (ICIs) is well described. However, the characteristics and treatment patterns for patients with emergency presentations owing to immune-mediated toxicity are less well known. Materials and methodsThis study reviews all emergency presentations in patients treated with ICI at a single centre between May 2018 and March 2020. The aims were to describe and quantify patient and treatment characteristics, toxicity type and outcomes. Results1165 patients were treated with ICI, and there were 597 emergency presentations in 370 patients. Of these, 191/597 (32%) were owing to an immune-mediated toxicity, median age was 64 years, and 127/191 (67%) were men. The most common tumour types were melanoma (53%) and lung cancer (22%), and the most common ICI received was ipilimumab + nivolumab combination immunotherapy (42%), followed by pembrolizumab monotherapy (21%) and nivolumab monotherapy (20%). The median number of cycles received was three (range 1–54), and 75/191 (39%) had previous ≥ grade 2 immune-mediated toxicity. 29% patients required second-line immunosuppression. The median time in the hospital was four days. There was a rising number of emergency presentations reflecting overall increasing use of ICI. ConclusionsOver a quarter of patients treated with ICI had an emergency presentation, and immune-mediated toxicity accounted for 32% of these. A diagnosis of melanoma, treatment with combination immunotherapy and previous ≥ grade 2 immune-mediated toxicity were common in patients with immune-mediated toxicity. These data allow better identification of patients likely to require admission and forward planning for acute oncology services.

Mode of Referral of Ovarian Cancer Patients: Does it Alter Treatment and Survival?

Some studies have shown that ovarian cancer patients admitted after referral to the emergency department had a worse prognosis than those referred through non-emergency pathways. We believe that our study is the first in the UK to explore this difference and aimed to compare the 1-year, 3-year, and 5-year overall survival rates of ovarian cancer patients referred non-urgently from the general practitioner (GP) vs. patients referred urgently to the emergency department (ED). This was a retrospective cohort study conducted at the University Hospitals of Leicester (UHL) from 1st January 2015 to 31st December 2019 involving 298 ovarian cancer patients: 197 referred non-urgently from the GP and 101 patients referred to the ED. There was no significant difference in the 1-year, 3-year, and 5-year overall survival in ovarian cancer patients referred from the GP compared to patients referred to the ED, 84.8%, 62.2%, and 48.4% versus 80.2%, 64.8%, and 43.5%, respectively (p=0.732). The mode of referral for ovarian cancer patients may not affect their prognosis. Prompt referral to the gynaecological oncology multidisciplinary team, a good acute oncology service, early imaging and image-guided diagnostic pathways, timely appointment, and timely initiation of treatment in our centre may have minimized the difference in outcome in the two groups.

98 ‘AOSim’: A Decision-Making Simulation Course for Acute Oncology Nurses

Simulation-based education (SBE) as a learning tool is becoming more prevalent, as is the recognition of the importance of non-technical skills. With this insight comes a desire to improve clinical practice using these techniques. ‘AOSim’ has arisen from an intrinsic desire to achieve this from within an Acute Oncology Service (AOS). Wishes to improve confidence, decision-making and teamwork have guided the design and implementation of a novel simulation course in this field.The purpose of the course has been guided by the candidates. The hope is to be able to provide a safe learning environment to explore decision-making, improve confidence in clinical practice and strengthen teamwork.The course design was informed by direct stakeholder analysis. Pre-course surveys aided in planning the course and scenario design. The course would run over half a day and comprise three scenarios, each followed by a debrief. The candidates invited were nurses working in the local AOS and the AOS coordinator. Each scenario was designed with a particular focus in mind; ‘Respectful Challenging’, ‘Clinical Prioritisation’ and ‘Treatment Escalation’. The clinical context of the scenarios was based on oncology to provide a familiar environment for the candidates. This would also enable the focus to be paid to the non-technical skills related to the aims of the course. The scenarios were to be run in a high-fidelity setting using a mixture of role players, mannikins and plants. Faculty roles had been assigned prior to the course date.A course overview was sent to the candidates including the planned date for running the course to allow the candidates to plan for handover of their clinical duties; this allowed protected time for the course to run. ‘AOSim’ was run in a simulation suite in the high-fidelity setting with an experienced faculty. The candidates were introduced to the simulated environment and the importance of psychological safety was explained. The three scenarios ran as planned to include subsequent informative debriefs. Immediate and post-course feedback were positive, particularly with increased confidence levels and team-working ability. This has led to aspirations to run the course again for a different candidate group in the future.

Providing an acute oncology service during the COVID-19 pandemic

The COVID-19 pandemic has led to adaptations being made to all aspects of the NHS, including general practice, acute medical specialties and oncology. This has presented unique challenges to acute oncology services (AOSs) in how to provide continuity of care while maintaining the safety of patients and staff. We describe the experience of the AOS team at Barts Health NHS Trust, working across three acute hospitals in east London. Changes to the service due to COVID-19 included increased remote reviews and referrals to the specialist oncology cancer acute assessment unit. The patient population reviewed in April 2020 (at the initial peak of the pandemic in the UK) was markedly different to one reviewed in April 2019, with 55% more patients presenting with a new diagnosis of cancer via an emergency route. Finally, we suggest changes to AOSs for future waves of the pandemic.

A new prognostic model for predicting 30-day mortality in acute oncology patients

ABSTRACT Introduction Acute oncology services (AOS) provide rapid review and expedited pathways for referral to specialist care for cancer patients. Blood tests may support AOS in providing estimates of prognosis. We aimed to develop and validate a prognostic model of 30-day mortality based on routine blood markers to inform an AOS decision to actively treat or palliate patients. Methods and Materials Using clinical data from 752 AOS referrals, multivariable logistic regression analysis was conducted to develop a 30-day mortality prognostic model. Internal validation and then internal–external cross-validation were used to examine overfitting and generalizability of the model’s predictive performance. Results Urea, alkaline phosphatase, albumin and neutrophils were the strongest predictors of outcome. The model separated patients into distinct prognostic groups from the cross-validation (C Statistic: 0.70; 95% CI: 0.64–0.76). Admission year was included as a predictor in the model to improve the model calibration. Conclusion The developed prediction model was able to classify patients into distinct prognostic risk groups, which is clinically useful for delivering an evidence-based AOS. Collation of data from other AOS centers would allow for the development of a more generalizable prognostic model.

Reversing the Friday peak in metastatic cord compression referrals: Not as simple as previously thought?

e14050 Background: Historically, metastatic spinal cord compression (MSCC) referrals trend towards a Friday peak in incidence (Koiter E, Radioth Onc 2013). However, data from a single, tertiary centre in the UK showed a reversal in the Friday peak (Adeleke S, Annals of Oncology 2020). This was attributed to early case referrals and quicker treatment decisions. In this new study, we explored whether a similar pattern was apparent in multiple district general hospital (DGH) settings and attempt to identify underlying causes. DGHs manage a larger proportion of cancer patients in the UK. Methods: 1,069 patients between 1 Jan 2015 and 31 Dec 2020 were identified across 4 hospitals in Kent, UK with a population of 1.6 million people. 220, 181, 182, 159, 134 and 193 MSCC patients were identified annually (2015-2020). Commonest cancers were prostate (24.1%), lung (19.3%) and breast (12.3%). Thoracic and lumbar regions constituted 80% of MSCC sites. Kruskal Wallis was used to compare differences in referrals across weekdays. Data was then dichotomised to Fridays only vs. other days of the week combined, as previously reported (De Bono B, Acta Neurochir 2019). Chi squared was used to compare frequency of referrals between the two groups. Chi squared goodness of fit test was conducted to detect if Friday reflected the day with highest referrals across the week. Results: Across the region, 2015 saw the highest number of Friday referrals relative to other days, p= 0.002. Friday referrals continued to drop, year on year, until 2018 with a corresponding increase in mid-week referrals. After 2018, there was a return in trend to a further Friday peak across the region, though p= 0.836. On an individual hospital basis, the persistent Friday peak in the region was driven by two hospitals. Having a 7-day acute oncology service (AOS), 7-day radiology reporting and single referral point of contact in the department, were factors identified that kept the referrals across the week uniform. On another note, a substantial shift towards a single 8Gy fraction vs. 20Gy in 5 fractions was observed across the region. This change coincided with SCORAD III data (Hoskin P, ASCO 2017) and demonstrates adherence to evidence-based practice in the region. Conclusions: This large multi-centre retrospective study shows a differential referral pattern in the region, with hospitals with 7-day AOS/Radiology reporting and single point of referral (e.g, similar to MSCC coordinator role) having a quicker treatment turnaround and uniform referrals across the week. The MSCC coordinator has been shown to streamline service, ensure timely decision-making and improved survival outcomes (Richards L, Spine J 2017). The role is recommended by NICE UK. DGHs should consider appointing an MSCC coordinator when designing/auditing their service. The shift towards single 8Gy fraction can provide a ‘one-stop’ service where patients are scanned, planned and treated on the same day.

Delivering Community Emergency Medicine during the COVID-19 pandemic: the Physician Response Unit

The COVID-19 pandemic has presented significant challenges to services providing emergency care, in both the community and hospital setting. The Physician Response Unit (PRU) is a Community Emergency Medicine model,...

Integration of a patient-centred MUO/CUP service within a new acute oncology service: challenges and rewards

Holistic approach to the clinical management pathway for malignancy of undefined primary origin (MUO)/carcinoma of unknown primary (CUP) patients remains an unmet clinical need. To address this, an MUO/CUP service was implemented during conception of a new acute oncology service (AOS). Over a comparable 17 months' duration, patient outcomes pre-MUO/CUP service implementation was retrospectively analysed and compared prospectively with post-service implementation database. Performance measures of MUO/CUP service were compared against national recommendations. In the retrospective cohort (n=32), median age was 71.5 years and median length of hospital stay (LOS) was 11.25 days. In the prospective cohort (n=42), median age was 75.5 years, median LOS was 7.75 days (p=0.037). Post-service implementation, 100% patients were discussed in MUO/CUP multidisciplinary team meeting; 96% of inpatient referrals were reviewed by oncology within 24-48 hours. In the prospective group, median overall survival (OS) was 73 days vs 35 days in the retrospective group (p=0.045; hazard ratio (HR) 1.61). Out of 20 patients suitable for anti-cancer treatment in the prospective group, 85% were treated within 31 days from the decision-to-treat; 90% were treated within 62 days of referral. Within the prospective group, median OS was 214 days in the treated sub-group, compared with 44 days in patients receiving best supportive care only (p<0.0001; HR 3.19). Timely specialised input from AOS with a dedicated MUO/CUP team can achieve enhanced patient-centred and healthcare-centred outcomes, both in terms of survival and hospital stay. However, heterogeneity in both retrospective and prospective study groups, as well as discrepancies in coding, makes direct comparison between both groups challenging.

Checklists for Complications During Systemic Cancer Treatment Shared by Patients, Friends, and Health Care Professionals: Prospective Interventional Cohort Study.

BackgroundAdvances in cancer management have been associated with an increased incidence of emergency presentations with disease- or treatment-related complications.ObjectiveThis study aimed to measure the ability of patients and members of their social network to complete checklists for complications of systemic treatment for cancer and examine the impact on patient-centered and health-economic outcomes.MethodsA prospective interventional cohort study was performed to assess the impact of a smartphone app used by patients undergoing systemic cancer therapy and members of their network to monitor for common complications. The app was used by patients, a nominated “safety buddy,” and acute oncology services. The control group was made up of patients from the same institution. Measures were based on process (completion of checklists over 60 days), patient experience outcomes (Hospital Anxiety and Depression Scale and the General version of the Functional Assessment of Cancer Therapy at baseline, 1 month, and 2 months) and health-economic outcomes (usage of appointments in primary care and elective and unscheduled hospital admissions).ResultsAt the conclusion of the study, 50 patients had completed 2882 checklists, and their 50 “safety buddies” had completed 318 checklists. Near daily usage was maintained over the 60-day study period. When compared to a cohort of 50 patients with matching disease profiles from the same institution, patients in the intervention group had comparable changes in Hospital Anxiety and Depression Scale and General version of the Functional Assessment of Cancer Therapy. Patients in the Intervention Group required a third (32 vs 97 nights) of the hospital days with overnight stay compared to patients in the Control Group, though the difference was not significant. The question, “I feel safer with the checklist,” received a mean score of 4.27 (SD 0.87) on a Likert scale (1-5) for patients and 4.55 (SD 0.65) for family and friends.ConclusionsPatients undergoing treatment for cancer and their close contacts can complete checklists for common complications of systemic treatments and take an active role in systems supporting their own safety. A larger sample size will be needed to assess the impact on clinical outcomes and health economics.

1378P Is 30-day mortality after systemic anticancer therapy in lung cancer in the era of varied treatments still relevant?

Death within 30 days of systemic anticancer therapy (SACT) is a national benchmark of quality of care in England. This metric has mobilised changes in the delivery of Acute Oncology Services in the country. However, varying treatments with chemotherapy, immunotherapy and Tyrosine kinase inhibitors (TKIs) might influence clinical decision making and thereby mortality rates. This is the first study to analyse 30-day mortality after lung cancer SACT according to all treatment types. From Jan 2016-Dec 2018, a search for cycles of SACT for lung cancer returned 5294 entries. Data cleaning identified 367 (2016), 373 (2017) and 418 (2018) unique patient-SACT treatment type combinations annually. These treatments were received by 344 (2016), 356 (2017) and 389 (2018) unique patients respectively. All deaths within 30 days of SACT are reviewed in a multidisciplinary (MDT) mortality meeting. Descriptive statistics were used. 38 patients died within 30 days of SACT over 3 years. 7/38 (18%) patients died due to treatment related causes, and in 2 of these case death was attributed to neutropenic sepsis. 17/38 (45%) patients died due to progressive disease and 14/38 (45%) of patients died due to medical co-morbidities. The annual 30-day SACT mortality rates for 2016 to 2018 increased from 2.6% (9/344), 3.4% (12/356) to 4.4% (17/389). The 30-day mortality for chemotherapy was 2.6% unchanged from 2016 to 2018. 30-day mortality for immunotherapy showed variability from 9% (2016) to 3.4% (2017) to 4.3% (2018). However, TKI associated 30-day mortality increased from 0% (2016), to 6.8% (2017) to 12% (2018). All deaths on TKI were due to disease progression or co morbidities. Learning points were identified in 5/38 cases (13%) after MDT review. The changing landscape of SACT in lung cancer impacts 30-day SACT mortality rates, reflecting difficulties in predicting immunotherapy toxicity and decisions around TKI cessation. 30-day SACT mortality must consider trends and treatment types to be meaningful benchmarks that lead to appropriate service changes.

P-206 Prognosis of patients presenting as carcinoma of unknown primary and effectiveness of acute oncology service: A single institution experience

Carcinoma of unknown primary represents a heterogeneous group of patients who would often present in the acute setting with advanced cancer and in a poor state of general health, and as such, carries a poor prognosis. In 2010, the National Institute of Health and Clinical Excellence produced a guidance document mandating all acute trusts to formulate an acute oncology service and a CUP MDT to systematically assess and manage these patients for optimal outcomes. Consecutive patients discussed in the MUO/CUP MDT as part of the UGI cancer MDT at HUTH NHS Trust between September 2018 and October 2019 were identified from the Somerset cancer database for these analyses. The demographic and clinical details were identified from the electronic patient records. Local ethics approvals were obtained prior to data collection and analysis. Data were collected in an Excel database and statistical analyses were performed within Excel and SPSS software. A total of 110 patients were identified during this period, including 60 women and 50 men. Age ranged from 25-94 years. Overall, 47 referrals were from acute medical wards, 12 patients were directly referred to the MDT by GP, and 21 referrals came from other site-specific MDTs. Of 47 patients, 45 were referred to the AOS within 7 days of admission, and all 45 patients were reviewed within 3 days of referral. In all, 43 patients had a WHO PS of 0-1. A total of 20 patients had solitary organ involvement, 13 had 2 organs involved (oligo/pauci metastases), and the rest had multiple organ involvement. Imaging identified a primary site in 12 patients; imaging, histology, and immunohistochemistry suggested benign disease in 16 patients; 35 patients had a primary site suggested on immunohistochemistry; and 47 patients had a diagnosis of CUP. Overall, 33 patients had adeno/poorly differentiated carcinoma with immunohistochemistry suggestive of OG/HPB origin and 12 had hematological malignancies. Of patients with solitary organ/site involvement, 12 had radical therapy, 38 had palliative chemo or radiotherapy or both, and 60 patients had supportive care alone. Of the 47 CUP patients, 32 had supportive care, 14 had palliative oncological interventions, and 1 had radical therapy. The median OS of treated CUP patients was 10.7 months (95% CI, 6.4-15.1), and for untreated patients, 1.24 months (95% CI, 0.8-1.7). Patients who had a primary site identified and treated accordingly had a mean OS of 15.43 months (95% CI, 12.6-18.3). Our data show that it is vitally important to assess patients with MUO/CUP at an early stage, and to identify patients who will not benefit from any therapy and should be offered appropriate supportive and end-of-life care. It is also important to identify patients with good PS and offer appropriate oncological interventions, as the prognosis for such CUP patients is comparable with patients with metastatic disease from known primary sites. Hence, a dedicated CUP/AO service is a cost-effective and efficient way of managing these patients.

Taking care of our own: A narrative review of cancer care services-led models of care providing emergent care to patients with cancer.

To synthesise available evidence on cancer care services-led models of care in the acute care setting that aim to reduce emergency presentations and/or hospital admissions for patients with cancer. A narrative review of studies describing models of care for patients with cancer and emergent healthcare needs was undertaken. Four databases were searched using keywords to identify primary research or quality improvement articles published between January 2005-June 2017. After a systematic search, 22 studies were included in the review. The methodological quality of the included studies was poor when assessed using the Mixed Methods Appraisal Tool. Most studies were retrospective and set in a single centre. The overarching outcomes associated with the most commonly described models of care (telephone advice services and/or unplanned care and assessment units) were improved coordination of care/continuity of care, prompt access to specialist care, reduced utilisation of emergency departments, fewer hospital admissions and reduced cost. At the time of this review, evaluation of Nurse Practitioner-led services and acute oncology services had been limited. Findings indicate several models of care reduce emergency presentations and/or hospitalisations for those living with cancer and improve patient outcomes. What remains unclear is which underlying mechanisms reduce emergency presentations and/or hospitalisations for patients with cancer and whether successful models of care are uniquely suited to specific contexts of care or applicable across different healthcare settings. More research is needed to assist healthcare services to develop and evaluate models of care to address the emergent needs of people with cancer.

Toxicities and acute oncology service demand of patients receiving immunotherapy for NSCLC: single centre experience

Toxicities and acute oncology service demand of patients receiving immunotherapy for NSCLC: single centre experience

CN50 - Overview of an acute oncology service in a UK cancer centre

Background: In the UK there has been increasing emphasis on the ability to review oncology patients who are admitted as an emergency. Two reports, NCEPOD report into systemic Anti-Cancer Therapy: For better, for worse? (2008) and the NPSA Report 'Patient safety risks of incorrect dosing of oral anti-cancer medicines' (2008) identified shortcomings in the manner in which patients presenting to emergency departments following systemic anti-cancer treatmentrs (SACT) were cared for. This had led to increased mortality, morbidity and extended lengths of stay. In addition to the above patients presenting as an emergency with Metastatic Spinal cord compression were found to have delays in urgent treatment and patients who had a cancer diagnosis following an emergency admission had poortrer outcomes than those identified in a more controlled fashion. At the Royal Berkshire NHS Foundation trust we responded to NHS England guidance by establishing an oncologist-led acute oncology service with nursing support. We have been succesful in reducing length of stay for oncology patients, forming sucesaful partnerships with acute physicians, succeasfully auditing and treating neutropaenic sepsis and bringing in a 7 day Acute Oncology service. This poster p[resentation will provide an overview of this service as part of the Oncology Nursing Track. Methods: The presentation will cover a narrative overview of our experience of establishing, auditing and developing an Acute Oncology Service at a busy District General Hospital with a Cancer Centre. We will present audit information to support this narrative review. Results: We will present data covering Acute Oncology activity, effectiveness, presentation and referral by tumour group, referral type and source. This will be presented in graphical format in order to support the narrative review. Conclusions: The overall conclusions will outline our generally positive exprience of establishing and developing Acute Oncology services. We hope that this will be relevant to others wishing to do the same across Europe. Legal entity responsible for the study: Mark Foulkes (Macmillan Lead Cancer Nurse and Nurse Consultant in Acute Oncology). Funding: Has not received any funding Disclosure: The author has declared no conflicts of interest.