Oncology Rapid Access Clinics: APPs Improve Outcomes for Acutely Ill Patients

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Advancements in cancer research have led to more complex regimens and therapies. Although these treatments have resulted in longer survival for patients with cancer, they also bring various adverse effect profiles. Patients with cancer are one of the patient populations that present most often to the emergency department (ED) due to their high need for supportive care, and account for more than 4.5 million visits annually.¹ Study findings suggest that lung cancer, noncolorectal gastrointestinal cancer, and breast cancer account for the most frequent oncology diagnoses seen in the ED.¹ Although emergency services can be beneficial for life-threatening symptoms, most oncologic urgencies have better outcomes when treated by oncology providers. Advanced practice provider (APP)–led oncology rapid-access clinics can increase access to care by providing same-day symptomatic visits. These increase patient and family satisfaction, reduce health care costs, improve patient outcomes, and significantly decrease ED patient volumes.

APPs Provide Prompt Care

A diagnosis of cancer can be extremely overwhelming for a patient. Not only must they begin to navigate a highly intricate health care system, but as they undergo intense treatment, they incur unwanted adverse effects. Oncology patients receiving chemotherapy and immunotherapy may complain of pain, dyspnea, nausea, vomiting, and constipation,¹ which are often the most common issues for which patients present to the ED. Furthermore, prompt assessment and treatment of fever in an immunocompromised oncology patient can decrease the risk of life-threatening outcomes.¹ Patients with cancer can experience longer wait times and delayed access to care, increasing overall distress when they receive treatment for their complications in the ED setting.² APP-led oncology rapid access clinics can provide immediate attention to their urgent needs in a treatment area familiar to patients and caregivers. Early assessment and intervention limit hospitalizations and lead to fewer disruptions in cancer treatment. This prompt evaluation and continuity of care results in increased patient and family satisfaction and improved patient outcomes.²

APPs Decrease Health Care Costs

Often, oncology patients cannot schedule same-day appointments with their primary oncology team. General urgent care department providers frequently lack the training to assess and treat patients receiving complex treatments such as chemotherapy and immunotherapy.² ED visits, especially those resulting in hospital admission, can result in high health care expenses for oncology patients. EDs are often high-risk settings for patients with cancer who are immunocompromised. This increases the chances of infection and the likelihood of unnecessary admission, increasing the burden of health care costs for the patient.² Oncology rapid access clinics led by APPs can deliver cost-effective ambulatory care without gaps in cancer treatment in safe environments. Effective treatment within an outpatient oncology rapid access center reduces the need for inpatient admission, thereby decreasing further hospital costs for patients.

APPs Bridge the Gap

Oncology-trained APPs in the rapid access setting can help bridge the gap between emergent situations and the patient’s oncologic care with their primary team. Access to this high-quality care reduces the number of ED visits by patients undergoing cancer treatment and improves patient outcomes when patients are seen in these same-day settings.² Oncology-trained APPs use specific protocols to manage treatment-specific adverse effects and urgencies that general ED personnel may not. Due to limited staffing, space, and resources, ED providers may be less equipped to identify and treat complications related to cancer treatments.² Oncology-trained APPs are knowledgeable about chemotherapy and immunotherapy regimens, the adverse effects of these drugs, and which medications and alternative treatments patients should avoid while receiving treatment.²

Essential for Positive Outcomes

Each year, the number of patients living with cancer increases, and APP-led oncology rapid-access clinics can meet the growing needs of these patients. These APPs can improve patient outcomes and access to high-quality oncology care while decreasing ED visits and health care costs. They can quickly diagnose and treat urgent adverse effects unique to cancer treatment and readily communicate concerns to the primary oncology team, taking the burden off ED providers and staff. Oncology rapid-access clinics should be essential to patient care standards across the oncology continuum.

References

1. Iannelli M, Brimm-Akins A, Foxwell AM, et al. Advanced practice provider model for urgent oncology care. J Adv Pract Oncol. 2023;14(1):73-81. doi:10.6004/jadpro.2023.14.1.7
2. Lange KA. Hematology-oncology acute care clinic: an advanced practice provider–led model. Clin J Oncol Nurs. 2023;27(4):365-368. doi:10.1188/23.CJON.365-368