EONS Magazine Winter/Spring 2019 edition

EONS11 ESMO 2018 Masterclass - How to observe and manage an acutely ill patient

Celia Diez de los Rios de la Serna explains how important nurses are in both recognising symptoms and teaching patients and carers to identify them.

Celia Diez de los Rios de la Serna

Celia Diez de los Rios de la Serna

Cancer patients frequently suffer complications from their diagnosis or the treatments used to treat it. In addition to this, a significant number of them are not aware of the severity of their problems without consulting a healthcare professional.

Acute oncology focuses on the management of patients with complications of their cancer and treatment, as well as the management of patients with an acute new cancer diagnosis.

Acute oncology services started in the United Kingdom in 2008. This was a national initiative following a report that identified concerns regarding the quality and safety of patient care. The National Chemotherapy Action Group in England recommended creating acute oncology services in any hospital with an emergency department. The key to the services was creating a systematic approach following guidelines facilitating early interventions and, most important, that patients with acute oncology presentations had access to cancer specialists as soon as possible. 

Specialist nurses

Guidelines were created (UKONS triage system) to identify the severity of the symptoms and aid healthcare professionals’ assessment. One of the most important drivers for acute oncology assessment were specialist nurses, most of them trained as advanced nurse practitioners. These nurses have training in emergency oncology as well as university training to develop and expand their scope of practice and become independent, some of them being able to prescribe medication. The services vary between hospitals but almost all of them have a telephone assessment service and some have an assessment unit too.

Every healthcare professional involved in the treatment of cancer patients has a responsibility to understand the possible complications of the treatments given and needs to feel confident explaining these to the patients receiving the treatment. The EONS Cancer Nursing Education Framework addresses these needs: the overall purpose is to provide guidance to cancer nurses regarding the knowledge, skills and competencies required.

In the management of oncology emergencies, healthcare professionals should focus on four points: prevention, early recognition, timely treatment and education of patients and carers.

Signs and symptoms can be very vague and unspecific however, so at EONS11 some of these were explained, with examples of situations that can present both in wards or when the patients are home: 

Prevention: Tumour Lysis syndrome

Prevention: Tumour Lysis syndrome

Early recognition: Hypercalcaemia

Early recognition: Hypercalcaemia

Timely treatment: Neutropenic sepsis

Timely treatment: Neutropenic sepsis

The main aim of the session was to appreciate how important nurses are in both recognising the symptoms and teaching patients and carers to identify them; and how small interventions, such a telephone assessment service, can change enormously the management of patients, making it easier for them to ask advice and receive the treatment they may need in a timely manner.

Key points

Key points



 

Celia Diez de los Rios de la Serna is Lead Macmillan Advanced Nurse Practitioner, Breast Services, University Hospital Southampton NHS Foundation Trust.