Toxicity assessment clinic as an efficacious tool to provide fast care to oncology patients on systemic therapy by minimizing emergency department visits and streamlining admissions directly from the cancer clinics.

Abstract

12124 Background: The Toxicity Assessment Clinic (TAC) at the Hudson Regional Cancer Centre was established to improve access to care for cancer patients experiencing treatment-related toxicities, ensuring timely access to oncology-specific symptom management. The TAC is nurse led and utilizes an evidence-based oncology assessment tool to determine the appropriate care pathway, ensuring symptom assessment and treatment in a timely and safe manner. Methods: We reviewed the volume and characteristics of patients seen in the TAC for one year (2024), including visit modality, primary causes for TAC consultation, and appropriateness of TAC referrals by identifying related vs. unrelated complaints and determining the proportion of patients without a family physician who utilized TAC services for unrelated concerns. Results: There were 15,387 total chemotherapy clinic visits. Among them, there were 692 visits to TAC (4.5%). In total, 94.8% of patients had a family physician. Majority (93.9%) called TAC directly, 4.6% were sent by chemo suite nurses and 1.4% were referred from outside the cancer center. In addition, there were 997 registered nurse phone calls to follow up on health issues occurring within the clinic hours. Median age was 69 years [range 19-93]; 61% of patients were over 65. 61.9% of TAC patients had a solid tumor diagnosis, 24.5% had a hematological malignancy, and 6.8% had gynecological cancers. Gastrointestinal malignancies (26.9%), breast (17.5%) and lung (12.3%) were most prevalent. 47.9% had stage IV cancer, 27.2% had stage III. 93.5% of patients were on active systemic therapy, with 80.8% on first line. In-person TAC visits composed 89.1% of consults, and 10.9% had assessments over the phone. Skin lesions (7.8%), diarrhea (6.9%), disease progression (6.5%), urinary tract infection (5.8%) and respiratory infections (5.6%) were the most common issues. In 92.3% of cases, the presenting complaint was considered directly related to the cancer or therapy. Consult assessment durations were the following: 30 minutes or less (23.2%), 30-60 minutes (71.8%), and ≥60 minutes (4.9%). Of note, 76% of phone calls required ≤30 minutes compared to 39% patients who attended TAC in person. 52.6% of admitted patients from TAC required ≥ 60 min of assessment time. In 85.7% of cases, medical problems were resolved during the TAC visit; 1.4% were sent to ED and 12.9% were directly admitted to hospital. Conclusions: The TAC model is feasible and provides rapid assessment of patients on systemic therapy, particularly in the front-line setting. It is a cost-effective alternative to ED visits and streamlines admissions directly from cancer clinics. TAC improves patient flow for vulnerable populations such as elderly and immunocompromised patients.