Do working practices of cancer nurse specialists improve clinical outcomes? Retrospective cohort analysis from the English National Lung Cancer Audit

Journal article


Stewart, I., Leary, A., Khakwani, A., Borthwick, D., Tod, A., Hubbard, R., Beckett, P. and Tata, L.J. (2020). Do working practices of cancer nurse specialists improve clinical outcomes? Retrospective cohort analysis from the English National Lung Cancer Audit. International Journal of Nursing Studies. p. 103718. https://doi.org/10.1016/j.ijnurstu.2020.103718
AuthorsStewart, I., Leary, A., Khakwani, A., Borthwick, D., Tod, A., Hubbard, R., Beckett, P. and Tata, L.J.
Abstract

Background
Cancer nurse specialists are advanced practitioners who offer continuity of care and expert support for people diagnosed with specific cancers. Health Education England's Cancer Workforce Plan prioritises expansion of cancer nurse specialist numbers by 2021 as part of the Cancer Taskforce Strategy for England.

Objective
To assess whether working practices of advanced practice specialist nurses are associated with clinical outcomes for people with lung cancer.

Methods
Adults with non-small cell lung cancer followed from 30 days post-diagnosis in English secondary care were obtained from the English National Lung Cancer Audit, 2007 to 2011. A national survey of lung cancer nurse specialists provided information on self-reported working practices. Mortality and unplanned admissions from 30 days to 12 months post diagnosis were respectively analysed using Cox and Poisson regression. Outcomes were assessed according to patients’ receipt of initial assessments by a lung cancer nurse specialist and according to trust-level reported working practices. Regression models were adjusted for individual sociodemographic and clinical characteristics, error adjusted for intracorrelations within regional cancer networks, and presented separately according to patients’ treatment pathways (surgery, chemotherapy, radiotherapy, or no anti-cancer therapy).

Results
Data for 108,115 people with lung cancer were analysed and associations with mortality and unplanned admissions were infrequent. Among people receiving only radiotherapy, however, the hazard for death was 17% lower among those who received an assessment by a lung cancer nurse specialist, compared with no assessment (hazard ratio=0.83, 95% confidence interval 0.73-0.94; p=0.003). The hazard was also lower among those receiving surgery (hazard ratio=0.91, 0.84-0.99; p=0.028). Among those receiving radiotherapy, nurse specialists’ reported confidence within multidisciplinary team settings was associated with a lower risk of death (hazard ratio=0.88, 0.78-1.00; p=0.049) and a lower rate of unplanned cancer-related admissions (incidence rate ratio=0.83, 0.73-0.95; p=0.007). Lung cancer nurse specialist assessments before/at diagnosis, were associated with a 5% lower rate of unplanned admissions, compared to when assessments occurred after diagnosis.

Conclusion
The contribution of nurse specialist working practices was occasionally associated with better outcomes for people with lung cancer. These were not limited to a single treatment pathway, but do indicate discrete relationships within pathways. Our study provides initial measures of overall lung cancer nurse specialist working practices at trusts, however, more detailed studies with longitudinal measurement of lung cancer nurse specialist-patient interaction are needed to better ascertain impacts on long-term patient outcomes. The findings highlight opportunities for potential improvement in effectiveness of service and care management.

Key words

Year2020
JournalInternational Journal of Nursing Studies
Journal citationp. 103718
PublisherElsevier BV
ISSN0020-7489
Digital Object Identifier (DOI)https://doi.org/10.1016/j.ijnurstu.2020.103718
Publication dates
Print29 Jul 2020
Publication process dates
Accepted29 Jul 2020
Deposited03 Aug 2020
Page range103718-103718
File
License
File Access Level
Open
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