Occult cancer assessment in a nurse-led DVT clinic

ABSTRACT

Background: 1 in 20 cases of unprovoked VTE are associated with and maybe the first manifestation of an occult malignancy. Current UK guidelines for patients with unprovoked VTE no longer recommend routine screening for cancer and instead advise targeted investigations based on history taking, base line investigations and basic radiology. Physical examination in the context of our outpatient DVT clinic has historically been performed by physicians, supported by clinical nurse specialists. The COVID-19 pandemic has necessitated changed ways of working in the DVT service due to clinical pressures and redeployment of medical staff. With less in-person medical cover, a need to develop a nurse-led pathway for cancer assessment without routine physical examination was identified. Aim(s) To develop a cancer assessment tool for history taking in the nurse-led DVT clinic Methods: National guidance "Suspected cancer Recognition and referral" (NICE NG12) www.nice.org.uk/guida nce/ng12 reviewed to identify signs and symptoms warranting investigation and referral for suspected cancer. Grouped according to body systems (e.g. respiratory, gastrointestinal) to facilitate ease of use in a structured assessment questionnaire used by clinical nurse specialists in the DVT clinic. The tool was then incorporated into modified clerking paperwork as part of the patient's systems review. A pathway was established to ensure appropriate referral or investigation if cancer suspected, including weekly discussion of all cases in a DVT clinic MDT meeting, arranging medical review for physical examination if indicated and regular review of the outcome of investigations. Result(s) A pragmatic, nurse-led cancer assessment tool has been successfully implemented as part of routine patient assessment for unprovoked DVT in an outpatient clinic. Ongoing audit and review is planned to ensure a high standard of patient care Conclusion(s) The COVID-19 pandemic has precipitated changes in clinical working practice that we as nurses have embraced to fimplement a new occult cancer assessment pathway for patients with unprovoked VTE.