The Clatterbridge Cancer Centre NHS Foundation Trust (CCC), 65 Pembroke Place, Liverpool L7 8YA (“CCC” or the “CW Partner”)

Project Name: Clatterbridge Systemic Anti-Cancer Therapy (SACT) Education and Toxicity Management Nurse

Project Summary:

The Collaborative Working Project (CWP) aims to free up capacity within the breast cancer pathway with the addition of a dedicated new role (the “Systemic Anti-Cancer Therapy Clinical Nurse Specialist (SACT CNS)”) providing pre-treatment education and optimisation, and support for the management, pre-assessment, review, education, and follow-up of metastatic breast cancer (mBC) patients who are eligible for Systemic Anti-Cancer Therapy (“SACT”) therapies.  There is a national attention on the stability of breast oncology services and an urgent need to pilot new workforce options and ways of working to manage increasing demand. Demand is increasing at an unprecedented rate within breast oncology services at the Clatterbridge Cancer Centre NHS Foundation Trust (CCC).

Specifically, by using established Process Mapping methodologies1 to integrate the new workforce role into all aspects of the service, the CWP aims to:

• Improve patient outcomes and experience by having a dedicated single point of patient contact to educate patients in relation to the available SACT options in the UK and conduct the relevant monitoring required e.g., blood glucose, electrocardiogram (ECG) monitoring, respiratory monitoring, cardiac function. At present, SACT therapies which require these monitorings could potentially be delayed because of the service implications.
• Provide a single point of contact to the wider clinical team to educate and provide ongoing advice and guidance so that all National Institute for Health and Care Excellence (NICE) approved treatment options are available to the patient
• Decrease the clinic burden on the current workforce and increase their satisfaction, reducing the risk of workforce burnout
• Optimise the proportion of duties performed by each healthcare professional (HCP) that are most appropriate to their skillset
• Gather relevant service metrics to develop a business case for the ongoing employment of the new workforce role beyond the scope of this project
• Reduce unplanned medical reviews and admissions

^1.The Reimagining Care Pathways service offer delivered by Novartis and utilising the ‘Process mapping – a conventional model’ and ‘Stakeholder Analysis’ guides from the NHS England Online library of Quality,Service Improvement and Redesign tools https://www.england.nhs.uk/sustainableimprovement/qsir-programme/qsir-tools/ (Accessed 30-Jun-2023).

Planned Milestones:

² The Solutions Implementation Manager role for Novartis is a non-promotional role leading on the development of collaborative working projects in accordance with the ABPI Code of Practice

Expected Benefits:

Anticipated Benefits to Patients:

• Increased access to equitable, consistent, and standardised care
• Improved patient experience and a more robust informed consent process i.e., truly informed so that patients understand their options and next steps
• Increased access to education on mBC and treatments to improve adherence and consequently improve patients' outcomes, supported by a personalised care plan
• Reduce patient waits in the clinic given extra capacity created by new workforce role
• Reduce unplanned medical reviews and admissions

Anticipated Benefits to the Organisation:

• Increase the overall quality of care and improve equity of access to specialist care for patients with mBC requiring treatment initiation, evaluation, and monitoring
• Provision of subject matter expertise to educate other members of the clinical team on treatment options
• Provide a single point of contact for patients, thereby reducing the potential for unplanned calls being received by the wider clinical team
• Free up consultant capacity for clinical activities that are unique to their skillset
• Reduce use of emergency triage line and unplanned admissions
• CWP would highlight CCC as an exemplar in understanding and optimising the utilisation of healthcare resources in a clinical setting, specifically the diagnosis treatment and management of mBC

Anticipated Benefit to Novartis:

• Better understanding of overall HCP and patient needs
• Optimal use of medicines in line with local/national guidance (including Novartis medicines) in appropriate patients.
• Ethical, professional, and transparent relationship between Novartis and the Healthcare Organisation

Start Date & Duration: July-2023 for 24 months

UK2307136628 

Project Name: Clatterbridge Systemic Anti-Cancer Therapy (SACT) Education and Toxicity Management Nurse

Organisation(s): The Clatterbridge Cancer Centre NHS Foundation Trust (CCC), 65 Pembroke Place, Liverpool L7 8YA

Completion Date: 20^th May 2025

Outcome Summary:

The Pathway Mapping exercise conducted in the early part of the project identified opportunities to enhance patient outcomes and support Health Care Professionals (HCP), including a heavy reliance on the Acute Oncology Nurses. The introduction of the new role of the SACT Clinical Nurse Specialist was able to help reduce clinical burden on various HCP roles within The Clatterbridge by being a single point of contact for breast cancer patients experiencing treatment related toxicities. This important, additional workforce resource contributed to patient benefit and lessened the burden on other HCPs. 

Key Project Outcomes Data:

Throughout the duration of the project the SACT Clinical Nurse Specialist completed over 1900 patient interactions and held over 280 clinics, including both face to face and phone clinics.

Outcomes:

Dedicated clinics were established to provide targeted support to patients at multiple stages of their care pathway. The establishment of these clinics enabled more frequent patient contact, allowing for timely resolution of issues and reducing the volume of emails to consultants. This approach not only facilitated earlier support for patients but also led to fewer inappropriate hotline calls, reduced hospital admissions, decreased overbooking of consultant appointments, and minimized treatment deferrals. By determining the optimal point at which to provide targeted support, patients on specific treatments were analysed and the CW Partner concluded that they were able to remain on treatment longer while maintaining their quality of life.

As it became evident that intervention at a later stage was often too late, with patients already having utilised services that could potentially have been avoided, the focus shifted to earlier intervention. By comparing hotline calls from the month of February 2024 with February 2025, there was a noticeable decrease in hotline calls for metastatic breast patients under the care of The Clatterbridge only consultants, with a 45% decrease in red calls, 41% in amber calls, and a 25% decrease in green calls.

The project also allowed for targeted training on the Common Terminology Criteria for Adverse Events system being provided to staff, enabling them to effectively identify and escalate cases requiring review and support to the SACT Clinical Nurse Specialist. This proactive approach ensured that emerging side effects were addressed promptly, educating patients on managing side effects at home, and mitigating the risk of complications and treatment interruptions. Empowering patients with information meant that they knew the correct course of action should a certain toxicity appear rapidly.

Working with its own internal Business intelligence Department, the CW Partner was also able to analyse data from patient assessments when they attended their SACT appointment to receive chemotherapy. This data revealed if a patient had more than one grading in numerous side effects or just one, and ensured an even greater targeted approach. The SACT CNS proactively engaged with these patients to provide education on the SACT patients were taking. Patients were educated to contact SACT CNS at an earlier time point to be able to manage side effects early, increasing the possibility of remaining on treatment longer.

Conclusion: 

The successful implementation and outcomes from this project have allowed the CW Partner to make the SACT Clinical Nurse Specialist role permanent. The improved patient outcomes seen during the project have helped to formulate plans for service development at The Clatterbridge in the future. Firstly, by highlighting the benefit of dedicated therapy area nurse support within SACT clinics, the model of care within the current SACT clinic is under consideration, so that each nurse can specialise and become expert in a specific area. Additionally, the successful implementation of patient education videos is being considered as a future project to produce a wider selection of support videos.

FA-11481823 | August 2025