Nurse led follow-up for CML patients on oral cancer treatment

Abstract

Background: Chronic myeloid leukemia (CML) is a bone marrow disorder accounting for 15% of newly diagnosed leukemia in adult patients (Rychter A et al. 2017 & Trivedi D et al. 2014). The introduction of tyrosine kinase inhibitors (TKIs) has changed the CML treatment significantly. Patients' concerns have shifted from reduced life expectancy to management of long-term toxicities and improvement of quality of life (QoL) (Isfort S & Brümmendorf TH2018). In 2016 Moulin et al. showed that closely monitoring patients affects adherence. Poor adherence is associated with greater overall health care utilization and medical costs in CML (Jabbour EJ et al. 2012). An increase in the patient health is expected from improvements in adherence. Methods: After receiving information from the doctor, patients remember approximately half of the information provided (Hillen MA et al. 2015). The hematology department in UZ Ghent has an interdisciplinary approache to CML patients. In a nurse led consultation patients who start with TKIs receive additional written information. The purpose is to reduce the information gap and manage patients concerns. Over time the nurse led consultation transforms to monthly telephone follow-up. This includes the assessment of the patient's condition, adverse events (AEs) and the influences on their QoL. Individual nurse led consultation supports a solid health care provider- patient relationship, offers patient tailored care and is ideally placed to detect psychological and social problems. Referral to other health care providers must always be based on shared decision making. Results: The aim is to educate the patients and offer psychosocial support. By creating a strong health care provider-patient relationship the goal is to make sure the patient feels free to talk about any issues. This also empowers the patient, improves adherence and helps to detect and control AEs prematurely. Conclusions: An interdisciplinary approach and establishing a care pathway is a necessity to streamline the patient treatment process. A more structured questionnaire is needed to improve the telephone nurse led follow-up and the handover to the doctor. After implementing such a structured tool the effectiveness of the project must be reviewed by using questionnaires that assess the adherence and QoL.