One morning last month Damien O’Reilly woke feeling distinctly unwell.
Most people might take this in their stride, but for someone with cancer like O’Reilly, a sudden turn in health can induce panic. Is it due to a worsening of his condition? Or just a side effect of treatment?
Until a few years ago, cancer patients at home and receiving chemotherapy or other therapies had few options. Their default was to head for their local hospital emergency department (ED), there to face long delays and the risk of cross-infection from other patients waiting to be seen.
I rang Dawn, the nurse in Tallaght. She told me to come straight in and she had my bloods taken within an hour
— Damien O’Reilly
Thanks to the deployment of oncology nurses in 26 cancer treatment centres countrywide during the pandemic, O’Reilly had another option.
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“I rang Dawn, the nurse in Tallaght. She told me to come straight in and she had my bloods taken within an hour. I had an infection so I was put in a private room and I was on a ward bed by six that evening.”
The 56-year-old from Clondalkin, who was diagnosed with kidney cancer last year, describes the oncology nurse service as “unbelievable” and “unreal. When I was sick last year I went to the ED and spent 15 hours there. I wouldn’t be up to that now. The nurses tell me if I feel in any way off, to just ring them. Even if I have to go to hospital, they look after me really well.”
The service, introduced during an emergency when it was vitally important to keep EDs free for Covid patients and to keep vulnerable patients with other conditions away from a new virus, has proved to be a resounding success.
It has been a lifeline for so many patients
— Terry Hanan, clinical lead for cancer nursing at the National Cancer Control Programme
An audit carried out last December showed 84 per cent of cancer patients who contacted the service did not need to go to an ED. Of those who did need to go into hospital, many were seen in an oncology day ward or medical assessment unit rather than having to go to an ED.
“It has been a lifeline for so many patients,” says Terry Hanan, clinical lead for cancer nursing at the National Cancer Control Programme (NCCP). “They have a dedicated mobile phone number for their oncology nurse, and they can get help almost immediately.”
Chemotherapy is often regarded as less toxic than other cancer treatments, Hanan says, but there are still side effects to be managed. Some of them, such as a condition known as neutropenic sepsis, can be life-threatening if not acted upon immediately, and so patients need quick access to specialist advice.
“An initiative like this would have been welcome at any time, but it was particularly welcome during the pandemic,” says Prof Charles Gillham of St Luke’s Radiation Oncology Network in Dublin. “The ability for someone with cancer who is unwell to be able to speak directly to a medical professional who knows about cancer is hugely invaluable.”
The funding provided to set up the service enabled the recruitment of 26 nurses, working 8am to 4pm, Monday to Friday, in their centres. However, arrangements for after-hours cover vary.
“If you ring outside the normal hours of operation, it becomes more challenging,” Hanan explains. “The call may be diverted to an inpatient ward, but it could ring off the hook because there is no dedicated person for the service and the staff there are busy with other work.”
At St Luke’s, after-hours calls from cancer patients go to the oncology nurse working the night shift, but other hospitals, particularly the smaller ones, don’t have staff specialised in cancer working these hours.
Maybe that wouldn’t have been necessary if I had been able to talk to the right person earlier
— Damien O’Reilly
“I worry when something happens at the weekend,” says O’Reilly, who is receiving immunotherapy treatment. “Once I felt bad on a Sunday and I left things until the Monday, when the nurse was back. I ended up coming into hospital and having to stay there [for] a week. Maybe that wouldn’t have been necessary if I had been able to talk to the right person earlier.”
Plans are now being made to expand the service. Initially, the recruitment of another 26 nurses would allow for an 8am-6pm service.
Hanan says the NCCP has had preliminary discussions on this with the Department of Health and a business plan has been prepared. With the recruitment of additional call handlers, she envisages night-times calls being forwarded to the ambulance service for triage. A similar arrangement has proved successful in Manchester, she says.
