Acute care toolkit 7: Acute oncology on the acute medical unit

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Advances in cancer management continue to improve patient outcomes, but this has been accompanied by a steady increase in emergency admissions with disease- or treatment-related complications. The acute medical unit (AMU) currently shoulders much of this burden. Providing efficient and excellent care to this complex patient group in a busy AMU presents a key challenge. A good working partnership between the AMU and acute oncology service (AOS) can result in a significant improvement in patient care together with opportunities for admission avoidance and early discharge.

Key recommendations

For the first 4 hours:

  • Determine the patient’s cancer history Ensure details of patients’ cancer diagnosis, disease stage, treatment intent, drugs and timings of most recent treatments are ascertained and taken into account in decision-making processes. Has the patient been treated within the last 6 weeks?

For the first 24 hours:

  • Suspected newly diagnosed cancer patients should be referred to the site-specific team immediately with the option of early discharge and fast-track outpatient slot.
  • Patients with a malignancy of unknown origin (MUO) should receive early oncology opinion as to fitness for treatment and thus minimise unnecessary investigations.
  • Detailed history, examination, routine bloods and a chest X-ray are regarded as a minimum standard of investigation in the acute setting. All other investigations should be symptom- and patient-fitness led.
  • Robust pathways involving an MUO multidisciplinary team should be in place and AMU staff aware of how to access this service. It is likely that in practice the first point of contact for this service will be via the AOS.

For admission avoidance

  • AMU staff should have a reciprocal relationship with their local chemotherapy triage, allowing flow of patient information in both directions.
  • Consider forging working relationships with community, primary care and specialist services in order to improve the quality and speed of patient discharge and to avoid admissions.
  • Policy should be in place for day-case procedures to occur, such as paracentesis or rapid-access diagnostics without inpatient admission. These may be performed in the AMU, affording staff learning opportunities, or in specialist rapid access clinics. A range of cancer care providers should be able to gain access to these.
  • Ensure AMU staff have access to fast-track oncology, treatment (such as deep vein thrombosis clinic) and diagnostic clinics. AMU staff should be equipped with the tools to identify patients who are suitable for these outpatient-driven services.
  • Consider having a process of regular service reassessment and realignment in collaboration with other care providers to continue to meet the ever-changing needs of this patient group.

The toolkit contains a quick guide to common acute oncology emergencies, the key stages of patient management in the first four and 24 hours, how to avoid admission of acute oncology patients, a guide to the signs and symptoms of side effects of common cancer drugs, and a guide to common medical problems caused by cancer diagnosis.

The toolkit includes:

  • a quick guide to common oncology emergencies
  • key stages of patient management in the first four and 24 hours
  • how to avoid the admission of acute oncology patients
  • a guide to the signs and symptoms of side effects of common cancer drugs
  • a guide to common medical problems caused by cancer diagnosis.
Author Dr Ernie Marshall, Macmillan Consultant in Medical Oncology, explains why oncology is relevant to the acute take.