Pharmacist and Nurse Led Melanoma Immunotherapy Clinic

Dharmisha Chauhan, James Larkin, Samra Turajlic, Peta Hughes

Introduction

With immunotherapy (IO) being the standard of care in melanoma, this over time has led to pressures within the medical day unit (MDU), especially as other cancer algorithms have evolved incorporating IO. 

Aim

To help address these issues a pharmacist and nurse (P/N) led clinic was created as a NEW MODEL OF CARE in 2017.

Method

Melanoma patients prescribed IO are placed into the clinic and reviewed 2-4 weekly as per IO regimen. To assess the benefit of the clinic, the number of referrals made back to the doctor before 12 weeks, consultations needing >10 mins to discuss survivorships issues and P/N led  interventions were recorded. 

Results

In May 2017 to 2018; 36 patients (age 24-89 yrs) were referred to the clinic. 33/36 patients required clinical evaluation for consideration of their next cycle. Doctor’s input was required for 4 patients; 2 for inpatient admission for IO toxicity (monitoring for adrenal insufficiency, diabetic ketoacidosis), 1 for a biopsy (new skin nodule), 1 for scan results. 

Routine referrals made are shown in Figure 2. 

  • All patients required survivorship support and consultations ranged from 15-45 min. 
  • Common themes which emerged, included how to partake in physical activity, anxiety on stopping IO, sun awareness, financial burden and advice on complementary therapies.
  • Discussion on stopping IO is explored within 3 months of stopping IO; this discussion has occurred in 18/33 patients, in which the P/N helped alleviate patient’s anxiety over this time.  

Discussion

The clinic has helped improve MDU pressures, especially by removing patients requiring greater holistic support. This clinic in turn has sought out survivorship issues important to melanoma patients. 

Reccomendations/Future

When creating non-medical prescribing clinics, due to the skill mix and the multidisciplinary approach to care, pharmacists and nurses should work together.

Patient experience survey was conducted to evaluate this model and the results can be found at poster ID4475 

Pharmacists and Nurses should combine forces for non-medical prescribing clinics