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Introduction

Cancer forms a significant part of the overall demand on emergency medicine and primary care. Acute oncology services are pivotal in managing urgent care when a cancer patient becomes unwell. They have been tailored to manage patients presenting acutely with newly diagnosed cancer (particularly malignancy of unknown origin [MUO]), those experiencing uncontrolled toxicities as a result of systemic anticancer therapy, and those with symptoms related to their cancer. Specialist care of these patients supports timely management of treatment, prevents unnecessary admissions and investigations, and improves patient outcomes. Acute oncology teams are fundamental in providing specialist advice and support. Although acute oncology provision may differ between district general hospitals, standalone cancer centres and teaching hospital cancer centres, NHS England quality surveillance teams (www.qst.england.nhs.uk) benchmark all acute oncology services against clinical indicators measuring structure and process, clinical outcomes and patient experience.

Inpatient ward visits by acute oncology teams are well established and have demonstrated reductions in hospital length of stay. Acute oncology services can play a pivotal role in reducing the increased pressure placed on emergency departments and acute medical assessment units. They must, however, ensure a joined-up approach by developing new ways of working with acute and emergency medicine. They must also respond to the NHS Five year forward view by ensuring that patients receive ‘the right care, at the right time, in the right place’.1

Developing the nurse’s role

Many acute oncology nurses are working at an advanced level with non-medical prescribing skills and clinical examination and diagnostic qualifications at master’s level. Using these extended skills to work innovatively is essential. Reduced medical staff in the NHS provides an opportunity for advanced clinical practitioners to bridge the gap working within their scope of practice. In 2017, Health Education England, NHS Improvement and NHS England worked in partnership to develop a national framework for advanced clinical practice,2 which ensures that there is national consistency and understanding about its role. Health Education England defines the advanced clinical practice role as being: ‘Delivered by experienced, registered health and care practitioners. It is a level of practice characterised by a high degree of autonomy and complex decision making. This is underpinned by a master’s level award or equivalent that encompasses the four pillars of clinical practice, leadership and management, education and research, with demonstration of core capabilities and area specific clinical competence.’ This extended role offers acute oncology nurses an opportunity for further development and independent practice within the national framework.

Acute oncology nurses often have a dual role, providing advice and management to all patients presenting with acute oncology episodes and giving essential key worker support to patients, especially those with MUO or those from outside the local area. The acute oncology nurse therefore combines the role of nurse practitioner and clinical nurse specialist. This brings variety to the role as well as opportunities for professional development, but ...

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