Pharmacist/Nurse Led Clinic Eases Care for Melanoma

A pharmacist and nurse led non-medical prescribing clinic that was focused on side effect management and survivorship support for patients with melanoma helped to improve common every-day pressure seen in a medical day unit (MDU) and improved overall patient experience, according to findings from two posters presented at the ESMO Congress 2019.^1,2

"When creating non-medical prescribing clinics, due to the skill mix and the multidisciplinary approach to care, pharmacists and nurses should work together," according to the authors of the study. "The clinic has helped improve MDU pressures, especially by removing patients requiring greater holistic support. The clinic in turn has sought out survivorship issues important to melanoma patients."

The treatment of cancer has evolved rapidly in the past 10 years, with the introduction of immunotherapy. One of the primary areas where immunotherapy had an impact was for the treatment of melanoma, where the first immune checkpoint inhibitor ipilimumab (Yervoy) was approved nearly a decade ago. Accommodation of these new therapies, and the vastly improved outcomes that come with them, has let to added pressures in the MDU related to patient education and discussions, according authors of the poster.

Overall, the study enrolled 36 patients (age range, 24-89 years). Of these, 33 participated in further involvement in the clinic. The primary reason for inclusion in the clinic was to discuss immunotherapy, followed by steroid weaning and chemotherapy. Of those included, 4 required a physician's input: 2 for inpatient admission due to immunotherapy toxicity, 1 for a biopsy of a new skin nodule, and 1 for new scan results.

Within the pharmacist and nurse led clinic, patients received initial survivorship support consultation that ranged from 15 to 45 minutes. The common education needs that emerged during these discussions were focused on the physical activity, anxiety on stopping immunotherapy, sun awareness, financial burden, and advice on complementary therapies.

Next steps from the clinic included referrals to other experts, including fitness instructors, psychological support, lymphedema education, tissue viability nurse, ophthalmologist, dermatologist, and surgeon. Additionally, within 3 months of stopping treatment, the clinic also initiated a discussion with patients on stopping care geared toward alleviating anxiety. This discussion occurred in 18 of the 33 patients.

Patient experience surveys consisting of 10 questions using the Likert scale were given to 10 participants. Five participants returned the survey, with 2 not responding and 3 passing away. Of those who did response, all felt comfortable being included in the clinic. Patients noted that they felt heard and that they had the opportunity to ask questions.

"I very much felt that I was a participant in the direction of my care," the poster at ESMO quoted one of the patients as saying. "Sharing responsibility and a sense of purpose helped me to foster a positive attitude in dealing with my disease."

Overall, all patients included in the clinic felt involved in the decision related to their care and felt empowered in the management of their disease. All patients said they would recommend this service to their friends or family, should the need arise.

"We are aware of the small patient numbers and another patient satisfaction survey is planned," the authors wrote. "However, this new model of care showcases that patients can be referred to a pharmacist/nurse led non-medical prescribing clinic."

The study was conducted at the Royal Marsden NHS Foundation Trust in London. Based on the findings, the authors noted that a new outpatient clinic has been creating, using the model developed for the study. Given the benefits, the authors recommended that similar units be considered in other hospitals.

References:

• Chauhan D, Larkin J, Turajlic S, Hughes P. Pharmacist and nurse led melanoma immunotherapy clinic. Presented at: ESMO Congress 2019, Barcelona, Spain, September 27 to October 1, 2019. CN58.
• Chauhan D, Larkin J, Turajlic S, Hughes P. Pharmacist and Nurse Led Melanoma Immunotherapy Clinic: Patient Experience Survey. Presented at: ESMO Congress 2019, Barcelona, Spain, September 27 to October 1, 2019. CN70.