Outpatient Treatment Center

Masafumi Ikeda, Koichi Goto, Takayuki Yoshino, Hirofumi Mukai, Susumu Okano, Sachiko Seo, Atsushi Konno, Naomi Ito, Hisanaga Nomura, Nahoko Yoshino, Masayuki Fukatsu, Chiyo Ito

Introduction

The Outpatient Treatment Center is responsible for anticancer treatment, such as chemotherapy and hormonal therapy for patients with all kinds of cancer. Our basic policy is to provide high-quality anticancer treatment and to support the life style of patients and their families. Our goals are 1) To provide the appropriate and satisfying management of chemotherapy, and 2) To share the mind of outpatients with our staff. We can provide high-quality and comfortable treatments with the collaboration of medical oncologists, nurses, pharmacists, medical social workers, and clinical research coordinators (CRCs).

Our team and what we do

Our team consists of one director, five medical oncologists, one nurse manager, two deputy nurses, 15 nurses, one chief pharmacists, three pharmacists, two assistants of nurses, and three reception staff, with an average of 58 beds in the outpatient treatment center. In 2016, a total number of 35,599 patients received anticancer treatment, and the number of patients is gradually increasing year by year (Figure 1). The detailed numbers of each department are 12,053 in gastro-intestinal oncology, 8,503 in breast and medical oncology, 6,713 in hepatobiliary and pancreatic oncology, 4,627 in thoracic oncology, 2,481 in hematology, 1,067 in head and neck oncology, and 155 in others (Figure 2).

Because the number of patients receiving anticancer treatments in this center is growing up, the waiting time has extended, especially in the morning time. To resolve the problem of long waiting time, we will set the limit of the number of patients reserved in the morning, and patients receiving anticancer treatments are dispersed in the afternoon time. In addition, the number of patients in the early morning is increased and the total daily number of patients who receive anticancer treatments will be increased.

The monthly steering committee is held on the third Monday, 16:30-17:30, every month with the participation of medical oncologists, nurses, pharmacists, clinical research coordinators, and hospital clerks. We discuss about the monthly activities and problems of this center raised from each sections, such as nursing, pharmacy, and clinical trial, and plan the remedy for these problems.

Before new regimens and clinical trials are initiated in this center, the staff meeting with medical oncologists, nurses, and pharmacists are held to safely and appropriately manage these treatments.

We have a telephone consultation service (Hot line) for outpatients who have received anticancer treatments in this center. Pharmacists and nurses, who are well-sophisticated with the outpatient treatment, reply with the countermeasures for adverse events and answer any queries from patients or their families by telephone. If the consultaions are serious, they transfer those to medical oncologists. This service was started in 2008 and approximately 200 calls are coming every month. This service contributes to prevent serious adverse events and relieve patients'anxiety.

Research activities

The following researches were presented in annual meetings of the Japanese Society of Medical Oncology and the Japanese Society of Cancer Nursing:

*The enlargement of activity of nurses in clinical trial ward and approach on training of nurses

*Approach to collaborate with nurses in the inpatient ward and those in the outpatient clinic through patients receiving FOLFIRINOX regimen

*Evaluation of efficacy for the orientation before the initiation of outpatient treatment

Education

We train up nurses and pharmacists with special knowledge who can intensify the skill of self-care for patients and properly resolve some problems arising in the patients and their families during anticancer treatment.

Future prospects

Although the daily number of patients receiving anticancer treatments in this center is increasing, it is difficult to accept the further patients from the capacity of this center. Therefore, the additional 14 beds will be enlarged in September 2017. In the future, the efficient management of beds is warranted to improve the long waiting time and take a lot of the patients receiving anticancer treatments in this center. Furthermore, a lot of new regimens and clinical trials are also aggressively accepted.