A call for nurse practitioner-led cancer survivorship clinics: The need for development and adoption within Ontario, Canada

Lucy Chan, Georgia Dewart

Abstract


The growing prevalence of cancer survivors requiring comprehensive follow-up care after the completion of treatment is placing a significant strain on the Canadian healthcare system (Moura et al., 2022). Given the current landscape and the higher workload demands that are further exacerbated by shortages in healthcare staffing, the oncology specialist-led care, as the standard model for survivorship care is unsustainable and suboptimal in addressing a broad range of physical, psychosocial, supportive, informational, and rehabilitative needs of cancer survivors (Brennan et al., 2010; Canadian Partnership Against Cancer & Canadian Association of Provincial Cancer Agencies, 2010). Nurse-led models of survivorship care provided by oncology nurse practitioners (NPs) have been shown to be safe, effective, feasible, and appropriate for follow-up care (Chan et al., 2018). In the province of Ontario, survivorship care is provided mostly by physicians. Specialized NP-led survivorship clinics or programs are currently lacking based on a recent environmental scan. This paper outlines current barriers and opportunities in NP-led survivorship care. This is a call to action and for advocacy regarding the examination of oncology services and outlines the need for the development and implementation of NP-led survivorship clinics in Ontario, Canada. 

Keywords: cancer survivors, survivorship care, cancer follow-up care, nurse-led care, nurse practitioner-led clinics


Full Text:

PDF

References


Alberta Health Services. (n.d.). Supportive care and living well. https://www.albertahealthservices.ca/cancer/Page16325.aspx

Allan, C. (2018). The efficacy of nurse-led clinic. Annals of Oncology, 29(Suppl 8), viii683–viii688. https://doi.org/10.1093/annonc/mdy276.001

Association of Family Health Teams of Ontario. (2022, October 22). Congratulations to the Bright Lights 2022 Award Winners! https://www.afhto.ca/news-events/news/congratulations-bright-lights-2022-award-winners

BC Cancer. (2022). Primary care nurse practitioners. http://www.bccancer.bc.ca/our-services/services/primary-care

Brandenbarg, D., Berendsen, A., & de Bock, G. (2017). Patients’ expectations and preferences regarding cancer follow-up care. Maturitas, 105, 58–63. https://doi.org/10.1016/j.maturitas.2017.07.001

Brennan, M. E., Butow, P., Spillane, A. J., & Boyle, F. M. (2010). Survivorship care after breast cancer: Follow-up practices of Australian health professionals and attitudes to a survivorship care plan. Asia-Pacific Journal of Clinical Oncology, 6(2), 116–125. https://doi.org/10.1111/j.1743-7563.2010.01286.x

Brenner, D. R., Poirier, A., Woods, R. R., Ellison, L. F., Billette, J. M., Demers, A. A., Zhang, S. X., Yao, C., Finley, C., Fitzgerald, N., Saint-Jacques, N., Shack, L., Turner, D., & Holmes, E. (2022). Projected estimates of cancer in Canada in 2022. Canadian Medical Association Journal, 194(17), E601–E607. https://doi.org/10.1503/cmaj.212097

Canadian Nurses Association. (2022a). Advanced Practice Nursing. https://www.cna-aiic.ca/en/nursing/advanced-nursing-practice

Canadian Nurses Association. (2022b). Clinical nurse specialists. https://www.cna-aiic.ca/en/nursing/advanced-nursing-practice/clinical-nurse-specialists

Canadian Nurses Association. (2022c). Nurse Practitioners. https://www.cna-aiic.ca/en/nursing/advanced-nursing-practice/nurse-practitioners

Canadian Partnership Against Cancer. (2018, January). Living with cancer: A Report on the patient experience. https://s22457.pcdn.co/wp-content/uploads/2018/09/full-report-living-with-cancer-patient-experience-report-en.pdf

Canadian Partnership Against Cancer & Canadian Association of Provincial Cancer Agencies. (2010). The Cancer Workforce Scoping Study: A Report from the front lines of Canada’s Cancer Control Workforce. In Canadian Partnership Against Cancer. Canadian Partnership Against Cancer. https://s22457.pcdn.co/wp-content/uploads/2019/10/Cancer-workforce-study-technical-report-EN.pdf

Cancer Care Ontario. (2019, March). Follow-Up Model of Care for Cancer Survivors: Recommendations for the delivery of follow-up care for cancer survivors in Ontario. https://www.cancercareontario.ca/sites/ccocancercare/files/guidelines/full/FollowUpModelOfCareCancerSurvivors.pdf

CancerCare Manitoba. (n.d.). After treatment is over. https://www.cancercare.mb.ca/Treatments/after-treatment-is-over?utm_source=movingforwardaftercancer.ca

Casey, E. E. (2020, February 21). Supportive care for cancer treatment: QEII’s nurse-led clinic one of a kind in Canada. QEII Times. https://www.qe2times.ca/supportive-care-for-cancer-treatment-293

Chan, R. J., Marx, W., Bradford, N., Gordon, L., Bonner, A., Douglas, C., Schmalkuche, D., & Yates, P. (2018). Clinical and economic outcomes of nurse-led services in the ambulatory care setting: A systematic review. International Journal of Nursing Studies, 81, 61–80. https://doi.org/10.1016/j.ijnurstu.2018.02.002

Cox, K., & Wilson, E. (2003). Follow-up for people with cancer: nurse-led services and telephone interventions. Journal of Advanced Nursing, 43(1), 51–61. https://doi.org/10.1046/j.1365-2648.2003.02672.x

DiCenso, A., Bourgeault, I., Abelson, J., Martin-Misener, R., Kaasalainen, S., Carter, N., Harbman, P., Donald, F., Bryant-Lukosius, D., & Kilpatrick, K. (2010). Utilization of nurse practitioners to increase patient access to primary healthcare in Canada – Thinking outside the box. Nursing Leadership, 23(Special Issue), 239–259. https://doi.org/10.12927/cjnl.2010.22281

Eastern Health. (2018, October 5). Nursing. Cancer Care. https://cancercare.easternhealth.ca/cancer-care-services/nursing/

eHealth Ontario. (2022). ConnectingOntario ClinicalViewer. https://ehealthontario.on.ca/en/health-care-professionals/connectingontario

Evans, J., Matheson, G., Buchman, S., MacKinnon, M., Meertens, E., Ross, J., & Johal, H. (2014). Integrating cancer care beyond the hospital and across the cancer pathway: A patient-centred approach. Healthcare Quarterly, 17(SP), 28–32. https://doi.org/10.12927/hcq.2014.24006

Fitch, M., Ristovski-Slijepcevic, S., Scalzo, K., Bennie, F., Nicoll, I., & Doll, R. (2009). Cancer survivorship: Creating a national agenda. Canadian Oncology Nursing Journal, 55–59. https://doi.org/10.5737/1181912x1925559

Fitch, M., Zomer, S., Lockwood, G., Louzado, C., Shaw Moxam, R., Rahal, R., & Green, E. (2019). Experiences of adult cancer survivors in transitions. Supportive Care in Cancer, 27(8), 2977–2986. https://doi.org/10.1007/s00520-018-4605-3

Fondation Québécoise du Cancer. (2016, September). Appointment with the pivot nurse. Fondation Québécoise Du Cancer. https://fqc.qc.ca/en/information/quebec-health-system/appointment-with-the-pivot-nurse

Government of New Brunswick. (n.d.). Cancer patient navigation program. Cancer Patient Navigation Program. https://www2.gnb.ca/content/gnb/en/departments/health/NewBrunswickCancerNetwork/content/cancer-patient-navigation-program.html

Government of Ontario. (2015, May 21). Nurse practitioner-led clinics. Ministry of Health & Ministry of Long-Term Care. https://www.health.gov.on.ca/en/common/system/services/npc/

Government of Prince Edward Island. (2022, October 28). Cancer patient navigation program. https://www.princeedwardisland.ca/en/information/health-pei/cancer-patient-navigation-program

Halpern, M. T., McCabe, M. S., & Burg, M. A. (2016). The cancer survivorship journey: Models of care, disparities, barriers, and future directions. American Society of Clinical Oncology Educational Book, 36, 231–239. https://doi.org/10.1200/edbk_156039

Howell, D., Hack, T. F., Oliver, T. K., Chulak, T., Mayo, S., Aubin, M., Chasen, M., Earle, C. C., Friedman, A. J., Green, E., Jones, G. W., Jones, J. M., Parkinson, M., Payeur, N., Sabiston, C. M., Sinclair, S., & Tompson, M. (2011, April). Pan-Canadian guidance on organization and structure of survivorship services and psychosocial-supportive care best practices for adult cancer survivors. Canadian Association of Psychosocial Oncology. https://www.capo.ca/resources/Documents/Guidelines/2.%20Pan%20Canadian%20Guidance%20on%20Organization%20and%20Structure%20of%20Survivorship%20Services%20and%20Psychosocial-Supportive%20Care%20Best%20Practices%20for%20Adult%20Cancer%20Survivors.pdf

Jefford, M., Howell, D., Li, Q., Lisy, K., Maher, J., Alfano, C. M., Rynderman, M., & Emery, J. (2022). Improved models of care for cancer survivors. The Lancet, 399(10334), 1551–1560. https://doi.org/10.1016/s0140-6736(22)00306-3

Kerr, H., Donovan, M., & McSorley, O. (2021). Evaluation of the role of the clinical Nurse Specialist in cancer care: an integrative literature review. European Journal of Cancer Care, 30(3), 1–13. https://doi.org/10.1111/ecc.13415

Lai, X. B., Ching, S. S. Y., & Wong, F. K. Y. (2017). Nurse-led cancer care: A scope review of the past years (2003-2016). International Journal of Nursing Sciences, 4(2), 184–195. https://doi.org/10.1016/j.ijnss.2017.02.001

Laurant, M., van der Biezen, M., Wijers, N., Watananirun, K., Kontopantelis, E., & van Vught, A. J. (2018). Nurses as substitutes for doctors in primary care. Cochrane Database of Systematic Reviews, 2019(2), 1–110. https://doi.org/10.1002/14651858.cd001271.pub3

Loftus, L. A., & Weston, V. (2008). The development of nurse-led clinics in cancer care: Nurse-led clinics in cancer care. Journal of Clinical Nursing, 10(2), 215–220. https://doi.org/10.1111/j.1365-2702.2001.00488.x

Mattison, C. A., & Wilson, M. G. (2018, October). Rapid synthesis: Enhancing health system integration of nurse practitioners in Ontario 60-day response. McMaster Health Forum. https://www.mcmasterforum.org/docs/default-source/product-documents/rapid-responses/enhancing-health-system-integration-of-nurse-practitioners-in-ontario.pdf?sfvrsn=4

Mittmann, N., Beglaryan, H., Liu, N., Seung, S. J., Rahman, F., Gilbert, J., Ross, J., de Rossi, S., Earle, C., Grunfeld, E., & Sussman, J. (2018). Evaluating the impact of survivorship models on health system resources and costs. Journal of Clinical Oncology, 36(7_suppl), 1. https://doi.org/10.1200/jco.2018.36.7_suppl.1

Molassiotis, A., Liu, X., & Kwok, S. W. (2020). Impact of advanced nursing practice through nurseâ€led clinics in the care of cancer patients: A scoping review. European Journal of Cancer Care, 30(1), 1–17. https://doi.org/10.1111/ecc.13358

Moura, S., Nguyen, P., Benea, A., & Townsley, C. (2022). The development and implementation of the After Cancer Treatment Transition (ACTT) Program for survivors of cancer. Canadian Oncology Nursing Journal, 32(1), 3–11. https://doi.org/10.5737/23688076321311

North York Family Health Team. (n.d.). Programs & services. https://www.nyfht.com/services

North York General Hospital. (2012, May 8). New colorectal cancer survivorship program the first of its kind in Ontario. CISION News. https://www.newswire.ca/news-releases/new-colorectal-cancer-survivorship-program-the-first-of-its-kind-in-ontario-510201421.html

Ontario Nurses’ Association. (2017, October). Nurse Practitioners: Improving access to quality care for Ontarians. https://www.ona.org/wp-content/uploads/ona_npsimprovingaccesstoqualitycareforontarians_201710.pdf

Peacock, E. (2019, August 2). Nurse ‘navigators’ hired to improve NWT cancer care. Cabin Radio. https://cabinradio.ca/18843/news/health/nurse-navigators-hired-to-improve-nwt-cancer-care/

Registered Nurses’ Association of Ontario. (2018). Increase access to care by fully utilizing NPs. https://rnao.ca/sites/rnao-ca/files/Increase_access_to_care_by_fully_utilizing_NPs_QPOR_2018_public.pdf

Romkey-Sinasac, C., Saunders, S., & Galica, J. (2021). Canadian resources, programs, and models of care to support cancer survivors’ transition beyond treatment: A scoping review. Current Oncology, 28(3), 2134–2145. https://doi.org/10.3390/curroncol28030198

Statistics Canada. (2022, June 14). New cancer estimates for 2022. https://www.statcan.gc.ca/o1/en/plus/1181-new-cancer-estimates-2022

Sussman, J., Souter, L. H., Grunfeld, E., Howell, D., Gage, C., Keller-Olaman, S., & Brouwers, M. (2017). Models of care for cancer survivorship. In Cancer Care Ontario: Guidelines & Advice (Evidence-Based Series 26-1 Version 2). Cancer Care Ontario. https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/246

The Ottawa Hospital. (2022, March 4). Wellness Beyond Cancer Program. https://www.ottawahospital.on.ca/en/clinical-services/deptpgrmcs/programs/cancer-program/what-we-offer-our-programs-and-services/wellness-beyond-cancer-program/

Thunder Bay Regional Health Sciences Centre. (n.d.). Survivorship. https://tbrhsc.net/programs-services/regional-cancer-care/information-for-healthcare-providers/survivorship/

Truant, T. L., Lambert, L. K., & Thorne, S. (2021). Barriers to equity in cancer survivorship care: Perspectives of cancer survivors and system stakeholders. Global Qualitative Nursing Research, 8, 233339362110067. https://doi.org/10.1177/23333936211006703

University Health Network. (2022, November 24). Cancer rehab and survivorship program. Princess Margaret Cancer Centre. https://www.uhn.ca/PrincessMargaret/Clinics/Cancer_Rehab_Survivorship

Vélez, M., Bain, T., Rintjema, J., & Wilson, M. G. (2021, May). Rapid synthesis: Expanding scopes of practice in cancer care to provide high-quality person-centred care and to enhance access to care 30-day response. McMaster Health Forum. https://www.mcmasterforum.org/docs/default-source/product-documents/rapid-responses/expanding-scopes-of-practice-in-cancer-care-to-provide-high-quality-person-centred-care-and-to-enhance-access-to-care.pdf?sfvrsn=32d27ea9_5

William Osler Health System. (n.d.). Survivorship. https://www.williamoslerhs.ca/en/areas-of-care/survivorship.aspx

Williamson, S., Beaver, K., Gardner, A., & Martin-Hirsch, P. (2018). Telephone follow-up after treatment for endometrial cancer: A qualitative study of patients’ and clinical nurse specialists’ experiences in the ENDCAT trial. European Journal of Oncology Nursing, 34, 61–67. https://doi.org/10.1016/j.ejon.2018.02.005

Williamson, S., Hack, T. F., Bangee, M., Benedetto, V., & Beaver, K. (2020). The patient needs assessment in cancer care: identifying barriers and facilitators to implementation in the UK and Canada. Supportive Care in Cancer, 29(2), 805–812. https://doi.org/10.1007/s00520-020-05542-6

Women’s College Hospital. (n.d.). After Cancer Treatment Transition Clinic (ACTT). https://www.womenscollegehospital.ca/care-programs/after-cancer-treatment-transition-clinic-actt/


Refbacks

  • There are currently no refbacks.