Oncology nursing partnerships shape the future of after-hours toxicity management support

Emergency department (ED) visits and hospitalizations are common among patients receiving cancer treatments. Recognizing the need for appropriate toxicity management for cancer patients in Ontario, a Toxicity Management Advisory Committee (TMAC) was established by Ontario Health - Cancer Care Ontario (OH-CCO) in December 2016. The TMAC's recommendations included ensuring patients have access to remote toxicity and symptom management advice (i.e., tele-triage) from a knowledgeable provider. Following the initial success of an after-hours pilot, OH-CCO entered into a partnership with Bayshore HealthCare Limited to launch the provincial after-hours toxicity management telephone support line - CareChart Digital Health - for patients on cancer treatment. The goals of the partnership were to decrease ED utilization through enhanced toxicity management, and to enhance coordination and communication to improve person-centred care. Since 2018, a team of specialized oncology nurses have supported patients across 72 hospitals after hours (e.g., evenings, weekends, and holidays) utilizing evidence-based tele-triage tools including the pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides. Nurses managed most of the calls with self-management strategies and 24% of the callers were referred to the ED. There was an estimated annualized 5,211 ED visits saved, resulting in provincial cost-savings of $3.8 million. Patient experience surveys revealed more than 90% of patients who completed the survey agreed or strongly agreed that they had a good experience with this service and expressed high satisfaction with the quality of the service on all parameters asked.