45 Nurse Led CNS Review Clinic for Patients Receiving Concurrent Chemotherapy and Radiation Therapy for Glioma: A Pilot Project

Abstract BACKGROUND Patients with Gliomas are often treated with concurrent radiation and chemotherapy. Patients and families are typically seen in a weekly review clinic, where toxicities are managed (radiation and chemotherapy), counselling can be explored and symptoms can be evaluated and improved. Historically, these clinics were led by the radiation oncology team. Specialized oncology nurses follow the patients through their entire course at the cancer centre, from diagnosis through palliative care. We proposed and initiated a nurse led, physician supported, review clinic for patients with gliomas managed with concurrent chemotherapy and radiation therapy. We hypothesized that this clinic would improve patient outcomes by improving continuity of care, focusing on quality of life, frequent toxicity management and creating a simple pathway for assessment by both radiation and neuro-oncolgy. We also anticipated an improvement in nursing job satisfaction by increasing nursing autonomy and independence. METHODS After a one-year preliminary phase we investigated the clinic by reviewing all charts in the clinic for the month of January 2025. We evaluated rates of toxicity management, counselling as well as rates of radiation or neuro oncology opinion. A survey of CNS nurses who work in the clinic was done to evaluate clinic satisfaction and adjust for improvement RESULTS 2 CNS trained nurses were assigned weekly to the review clinic. Eight patients were seen on average (range 7-10) Detailed Counselling occurred in 10/34 patient visits Toxicity was managed independently in 10/34 patient visits Surgical incisions were cleaned and evaluated in 2/34 patient visits Immediate physician consults for treatment toxcity occurred in 4/34 patient visits Immediate physician consults for pathology review or counselling occurred in 5/34 patient visits DISCUSSION The nurse led review clinic has been highly successful. Patients have benefitted by having continuity and exceptional patient centred care. Nurses found satisfaction in autonomy and independence. Physicians in neuro-oncology had increased capacity to see other patients by removing this group of patients from their weekly review clinic. Despite these advantages, this clinic requires dedication from the administration to ensure that specialized CNS nurses are trained and comfortable in the management of gliomas and the common toxicity of radiation and chemotherapy.