Models of Care Toolkit

Community-based chemotherapy

clipart of male patient receiving chemotherapyCommunity oncology clinics provide high quality care to patients in their local community. Receiving regular care close to home can lessen the burden of the disease while improving resource utilization and reducing health-care costs both for patients and the system.

Community-based chemotherapy models rely on a team of physicians, nurses, pharmacists, social workers and other staff who have specialized training in cancer services. In the model, the patient’s treatment is monitored by their family physician and cancer specialist to assess changes in their status and adjust care plans if needed.

The model has been shown to improve patient compliance and management of side-effects. Involving a patient’s regular, community care team can also support the delivery of care that is in line with their culture and values, resulting in better outcomes, patient satisfaction and quality of life.

Virtual chemotherapy supervision for rural patients

clipart of female doctor on a computer screenWhile oral-based chemotherapy is amenable to virtual care, remote IV chemotherapy administration can be more challenging. Selected IV chemotherapy regimens can be administered in rural hospitals by generalist doctors and nurses under the virtual supervision of a medical oncologist and nurses trained in chemotherapy. The reported benefits of this model include patient convenience, enhanced inter-professional communication across disciplines, expanded scope of practice for CPOs, continuity of care and maintenance of patient safety and compliance with guidelines while delivering chemotherapy. Ensuring adequate training for rural providers, coordinating between urban and rural sites and between health care providers and documenting clinical encounters are critical to optimize this model.

Through British Columbia’s Community Oncology Network, nurses, family physicians and pharmacists are trained to administer and manage cytotoxic and hazardous products and to conduct clinical diagnostic assessments and monitor patient care. They also have the ability to respond to therapy complications and provide around the clock support for symptom management and toxicity.

This model offers an opportunity to deliver low-risk treatments close to home for common cancers. This enhances access to care in rural and remote communities and can shift the provision of routine cancer care to community-based clinics. The approach ensures that cancer centres have appropriately trained and competent staff who are able to manage the delivery and monitoring of cytotoxic drugs, access to clinical diagnostic services and the capability to respond to complications 24-hours a day.

This community oncology program is organized as a network model. Learn more about network models.

Learn more about British Columbia’s Community Oncology Network.11

Learn more about a similar community clinical oncology network in Ontario.12

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  2. Beaver K, Williamson S, Sutton CJ, Gardner A, Martin-Hirsch P. Endometrial cancer patients’ preferences for follow-up after treatment: A cross-sectional survey. Eur J Oncol Nurs. 2020;45(101722):101722..
  3. Beaver K, Williamson S, Sutton C, et al. Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial. BJOG. 2017;124(1):150-160.
  4. Cohen PA, Webb PM, King M, et al. Getting the MOST out of follow-up: a randomized controlled trial comparing 3 monthly nurse led follow-up via telehealth, including monitoring CA125 and patient reported outcomes using the MOST (Measure of Ovarian Symptoms and Treatment concerns) with routine clinic based or telehealth follow-up, after completion of first line chemotherapy in patients with epithelial ovarian cancer. Int J Gynecol Cancer. Published online 2021:ijgc-2021-002999.
  5. Schenker Y, Althouse AD, Rosenzweig M, et al. Effect of an oncology nurse-led primary palliative care intervention on patients with advanced cancer: The CONNECT cluster randomized clinical trial: The CONNECT cluster randomized clinical trial. JAMA Intern Med. 2021;181(11):1451-1460.
  6. Komatsu H, Yagasaki K, Yamaguchi T, et al. Effects of a nurse-led medication self-management programme in women with oral treatments for metastatic breast cancer: A mixed-method randomised controlled trial. Eur J Oncol Nurs. 2020;47(101780):101780.
  7. Nelson S, Turnbull J, Bainbridge L, et al. Optimizing Scopes of Practice: New Models for a New Health Care System.; 2014. Accessed November 22, 2021. https://www.cahs-acss.ca/wp-content/uploads/2014/08/Optimizing-Scopes-of-Practice_REPORT-English.pdf
  8. BC Cancer. Primary Care Nurse Practitioners. Accessed December 2, 2021. http://www.bccancer.bc.ca/our-services/services/primary-care
  9. Bayshore Health Care. CareChart. Accessed December 2, 2021. https://www.bayshore.ca/services/government/care/?gclid=CjwKCAjw7fuJBhBdEiwA2lLMYeRHHHTW01oLkWjEuxEeotQ1xyCr14JRceToJfkl_rnOhyYHhVqg4RoCIFEQAvD_BwE
  10. Ontario Health (Cancer Care Ontario). Complex Malignant Hematology Models of Care: Recommendations for Changes in the Roles and Composition of the Multidisciplinary Team and the Setting of Care to Improve Access for Patients in Ontario – March 2017. Accessed December 2, 2021. https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/43051%5d
  11. BC Cancer. Community Oncology Network. Accessed December 2, 2021. http://www.bccancer.bc.ca/health-professionals/networks/community-oncology-network
  12. Health Sciences North. Cancer Care. Accessed December 2, 2021. https://hsnsudbury.ca/en/Services-and-Specialties/Cancer-Care
  13. BC Cancer. General Practitioner in Oncology Education Program. Accessed December 2, 2021. http://www.bccancer.bc.ca/health-professionals/networks/family-practice-oncology-network/general-practitioner-in-oncology-education-program
  14. BC Cancer. Family Practice Oncology Network. Accessed December 2, 2021. http://www.bccancer.bc.ca/health-professionals/networks/family-practice-oncology-network
  15. Ontario Health (Cancer Care Ontario). Advanced Practice Nursing Toolkit. Accessed December 2, 2021. https://www.cancercareontario.ca/en/guidelines-advice/treatment-modality/nursing-care/advanced-practice-nursing-toolkit
  16. Ontario Health (Cancer Care Network). Oncology Nursing Program. Accessed December 2, 2021. https://www.cancercareontario.ca/en/cancer-care-ontario/programs/clinical-services/oncology-nursing-program
  17. University of Manitoba. Cancer Care Enhanced Skills Residency. Accessed December 2, 2021. https://umanitoba.ca/medicine/department-family-medicine/cancer-care-enhanced-skills-residency
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