Background: The outpatient delivery of cancer treatment often results in patients experiencing malignancy-related symptoms or treatment related side-effects necessitating prompt clinical review1. The development of Symptom and Urgent Review Clinics (SURC) have been demonstrated to facilitate access to timely, oncologic specific care, circumventing delays to treatment, decongesting emergency department (ED) demand and improving patient experience2.
Methodology: With all stakeholders consulted, one SURC was established at a quaternary hospital centre in Perth metropolitan area. Staffed by one clinical nurse consultant and one medical registrar, it was supported by consultant medical oncologists and hospital pathology and radiology services. We evaluated clinic volume, interventions and volume of ED-diversions from September 2023 to March 2024.
Results: Over a 6-month period, 1163 services events were recorded for 422 patients, equating to 178 events of care per month. 25% (n=284) of events were face to face after an initial telephone triage call. 66% (n=188) of face-to-face patients would have been advised to attend ED if SURC appointment was not available, equating to 29 ED diversions per month. Contact was patient driven in 56%; and of those from healthcare workers, only 3.4% were from ED clinicians. Factors predisposing SURC contact included age over 50-years (80%, n=353), female (51.8%), and those on systemic therapy for breast (27.1%), upper gastrointestinal (18%) and lung cancers (13.9%). The most common symptoms managed included gastrointestinal symptoms (38%), pain (24%), infection (15%) with the most common interventions being blood (n=265) and microbiology (n=108) testing. Of the 1163 events recorded, 582 resulted in discharge after telephone advice, 424 received follow-up appointments (telephone or face-to-face), provision of prescriptions in 241 events and 65 were admitted via clinic to hospital.
Conclusion: We have demonstrated SURC at this site is an effective management avenue for ambulatory cancer patients, enabling timely access to care and reducing ED presentations.