Nurse-led innovations in phase 1 clinical trials

Speaking at the inaugural Cancer Nursing Practice conference in Manchester, Lorraine Turner discusses the audit which resulted in more cancer patients being identified for clinical trials

Speaking at the inaugural Cancer Nursing Practice conference in Manchester, Lorraine Turner discusses the audit which resulted in more cancer patients being identified for clinical trials

More cancer patients are being matched to the right clinical trials, says Lorraine Turner
Picture: Neil O'Connor

Nurses at Manchester’s Christie Hospital have instituted a ‘cultural change’ in their hospital that has led to a significant increase in the number of cancer patients being identified for early phase 1 clinical trials.

More cancer patients are identified early in their disease trajectory and more eligible patients are matched to the right clinical trials after the changes were introduced, advanced nurse practitioner at the Christie, Lorraine Turner told delegates.

‘When I first started at the Christie in 2012 there were a number of issues,’ she explained, including limited and inappropriate referrals, the same clinicians referring patients to trials, a lack of both understanding of eligible criteria for trials and of palliative care support.

Ms Turner conducted an audit of patients referred to phase 1 trials at the Christie Hospital. She found that from January to December 2012, 99 patients were referred, 91% were white British, with a median age of 60 years and that 56% had already undergone more than three chemotherapy regimens. Nearly two thirds of referrals were from within the Christie and one quarter travelled more than 50 miles to attend their phase 1 clinic.

In addition, the patients waited on average 66 days from their last treatment to referral to a phase 1 trial. Of these 35% were ineligible due to poor performance status or medical history and one tenth withdrew their interest.

‘I just felt we needed to promote more [about] what we did at the Christie,’ she said. The Christie is the largest treatment centre in Europe treating 40,000 patients each year and wants to be one of the top three phase 1 research centres by 2020, Ms Turner told the audience.

‘It made me think about the problems and I decided to develop an easy referral form,’ she said. Alongside this, Ms Turner also raised awareness of the issues with her colleagues.

The result has seen potential phase 1 trial patients identified much earlier in their disease trajectory, and eligible patients are matched to the right trial at the right time, said Ms Turner. As well as having a nurse-led clinical oncology metastatic breast MDT, the project has led to increased engagement among clinical oncologists.

Some 61 patients were identified for early clinical phase trials between October 2015 and December 2016, compared to none in 2012. Between January and April this year, a further 23 patients have been identified, Ms Turner said. ‘It’s been a slowly changing culture, which is what we wanted to see.’

Ms Turner also highlighted some of the issues associated with early phase trials, which include:

  • no available slots for eligible patients
  • delays caused by pre-screening to identify mutations
  • insufficient tumour samples for analysis leading to the need for further biopsies
  • unrealistic patient expectations
  • the role of nurses as ‘gatekeepers’ for accessing early phase trials.

‘We want to make early phase trials an additional treatment option and not a last option; we want to have an optimal practice approach,’ Ms Turner told the audience.

What attendees of the CNP conference had to say
 Adrian Lloyd, senior chemotherapy nurse at GenesisCare, Oxford

‘What I found most interesting was the information we were given in terms of the research, developing the research and how it’s key in developing awareness among the wider community. The lesson I will take home is collaborative work with GPs and informing the wider teams linked to patients with cancer such as the community teams, and district nurses.’  

Marjorie Amoah, bank nurse at Barts Health NHS Trust, London

‘I wanted to help improve how I deal with the inpatients who see me before starting their treatment and find out new ways of answering their questions.

‘Also I am looking ahead to revalidation next year and conferences like these are excellent ways of achieving the required continuing professional development (CPD). I knew how to run health and well-being sessions for patients on a one-to-one basis, but it was great to find out how to do them in a group setting too.

‘I’m also going back to my job confident in assessing the holistic needs of patients, rather than focusing only on those directly relevant to their treatment.’

Read more on the CNP conference

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