Nurse-Led Telephone Triage Decreases Hospitalizations and Cancer Costs

Home healthcare has become increasingly popular in recent months, and with it, nurses and other healthcare providers must ensure that they are properly and effectively managing adverse events (AEs) from anti-cancer treatments.

Recent research presented at the 2020 ASCO Virtual Scientific Program analyzed the impact of nurse-led telephone triage in reducing hospitalizations in patients being treated for cancer.

“Integration of triage pathway protocols in addition to early palliative care may help in avoiding unnecessary hospitalization of cancer patients. Thinking about our patients receiving medical treatment in our oncology department, this might be translated into an early assessment, an early detection, and an early management of both treatment-related toxicity and cancer-related symptoms,” said Lorenzo Calvetti, MD, Department of Oncology, San Bortolo General Hospital in Vicenza, Italy.

The study involved 1,075 patients receiving systemic anticancer therapies between September 2018 to September 2019. The most common cancers were breast, colorectal, and lung cancer. Participants were instructed to refer to nurse-led telephone triage if they were experiencing any AEs. The nurse, who was working under supervision of a medical oncologist, would then assess the AE per the CTCAE scale, and take the needed subsequent actions.

There was a total of 429 consultations with a nurse, with 581 AEs reported — 117 patients reported more than one AE. The most common grade 3 or higher AEs were:

• Fever (38 events; 33.6%), including 7 cases of febrile neutropenia
• Cancer pain (15 events; 13.3%)
• Fatigue (9 events; 8%)

“Our nurses were trained to do autonomous interventions in case of mass grade 1, grade 2 events,” Calvetti said. “While in the case of grade 3 and grade 4 events, immediate referral to the MD on duty was required. All the events were registered in our clinic records, and an analysis was performed after the observation period of 1 year.”

One hundred-nine patients were hospitalized, compared to 138 in the control group observed the year prior. This was a normalized hospitalization rate of 10.1% versus 14.7% in the observation period versus the controlled period, respectively. The normalized number of hospitalizations reduced was 44.

“According to our main hospital stay cost, the reduction of normalized hospitalizations resulted in an estimated cost savings of around 380,000 euros in one year,” Calvetti said.

In US dollars, 380,000 euro is equivalent to about $424,500.

“These results have been achieved only thanks to a close collaboration of our medical and nurse team,” Calvetti said.

Reference

Calvetti L, Tealdo M, Cimenton R, et. al. Home-based management of cancer patients (CPs) experiencing toxicities while on anticancer treatment: The impact of a nurse-led telephone triage (NTT). Presented at: 2020 ASCO Virtual Scientific Program. May 29-31, 2020.