A community-based ANP-led integrated oncology care model for adults receiving oral anticancer medication-protocol for a pilot study

Oncology has been undergoing a profound transition in the last ten years or more with the increased usage in oral anti-cancer medication (OAM). Approximately 25% of all anti-cancer medication is now designed for oral use and this is likely to increase prospectively. Oral anti-cancer medications have the potential to alleviate capacity issues in cancer treating units as patients receive their treatment at home. There remains however a requirement for safe and efficient assessment and monitoring but this does not necessarily require them to repeatedly attend a hospital day unit. Therefore the opportunity exists to transition this cohort to a community-based setting to be assessed by a specialist such as an Advanced Nurse Practitioner (ANP) in nurse-led clinics. Having an OAM assessment closer to their home would be more convenient to the patient. Furthermore, this could help alleviate hospital capacity issues which were brought into sharp focus with the onset of the COVID-19 pandemic and the use of nurse-led clinics are promoted in the aims of the current healthcare system reform process in Ireland. Within the context of the Irish healthcare system reform and the COVID-19 pandemic this protocol will outline a collaboration between an Oncology Department in Letterkenny University Hospital in Ireland and the National University of Ireland, Galway aimed to develop and pilot a community-based Advanced Nurse Practitioner-led integrated oncology care model for adults receiving OAM. Phase 1 of this two-phase study commenced in September 2020 and comprised a scoping review, a benchmarking exercise and a qualitative analysis of relevant stakeholders. This protocol paper presents a pilot to be undertaken in phase 2 as OAM care is transitioned to an ANP-led community-based model, which is a radical shift for oncology care in Ireland. The pilot outlined will provide data that will identify potential refinements to the model and address specific uncertainties about a definitive trial. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by The Irish Cancer Society Grant number CNRA19RIC in collaboration with the Health Research Board (HRB) the National Cancer Control Programme (NCCP) and the Office of the Nursing and Midwifery Services Director (ONMSD). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee of Letterkenny University Hospital Research Ethics Committee gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors