A study to evaluate nurse-led on-treatment review for patients undergoing radiotherapy for head and neck cancer

Aims and objectives. To evaluate a nurse-led clinic for patients undergoing radiotherapy to the head and neck.

Background. The side effects of radiotherapy to the head and neck are superimposed on already significant physical and psychological morbidity. Medical review clinics tend to focus on treatment complications and there is evidence that specialist nurses can provide more holistic care for patients. However, doubts have been raised about the appropriateness of nurse-led review in this highly symptomatic and complex group.

Design. This evaluation compared medical on-treatment review (Phase 1) with a nurse-led clinic (Phase 2) for patients having radiotherapy to the head and neck, using an historical control group.

Methods. Twenty patients were reviewed by their consultant and 23 by a nurse specialist, using a clinic protocol. A mixed-method approach to data collection was taken. Patients completed weekly quality of life questionnaires and were asked about their experiences of support and care. General practitioners completed a questionnaire about the communication received from the clinic. Checklists assessed the content of clinic consultations.

Results. Patients valued the relationship developed with the nurse specialist, had longer, more frequent consultations and were more often referred to the multidisciplinary team. The nurse specialist managed 83% of consultations without referral to the consultant. Few significant differences in quality of life were found between the groups. There were indications that oral and nutritional problems were managed more effectively in the nurse-led clinic, although emotional functioning was higher in the medical group. GPs were positive about the timing and content of information received.

Conclusions. On-treatment review for patients with head and neck cancer can be effectively managed by a nurse specialist.

Relevance to Practice. Radiotherapy nurse specialists make an important contribution to the supportive care of patients with head and neck cancer. More investment is required to maximize their contribution.