(P 155) THE IMPACT OF THE ROLE OF A SARCOMA ADVANCED NURSE PRACTITIONER (ANP) BIOPSY CLINIC IN IMPROVING PATIENT ACCESS TO SARCOMA SERVICES

Objective: Access to soft tissue sarcoma services for the circa 200 new patients per year in Ireland, has improved significantly since 2013 following formalising and centralising Multidisciplinary Team networks. Oncological Survival rates are comparable to near EU/ UK healthcare regions, but timely access to biopsy and diagnostics remains challenging owing to the geographically spread relatively small population. Recently, an NCCP-sponsored Sarcoma Advanced Nurse Practitioner (ANP) led diagnostic clinic (SDC) was set up, in parallel to usual referral pathway. This study was to determine whether the SDC provided more efficient access to biopsy and diagnostic outcomes for patients with suspected/confirmed sarcomas in Ireland.

Methods: Sample patient data referred to one of the two SDCs (SVUH) the sarcoma ANP SVUH from Jan 2022 to May 2023 were retrospectively reviewed. Patients who had high clinical/radiological suspicion of sarcoma were offered an ANP examination and handheld 14/16G core biopsy appointment. Upon clinical review to determine suitability for non-image guided cores, the biopsy was performed by the trained ANP supervised by Consultant Surgeon/fellow. Method undertaken was as per standard ESMO guidelines, with the biopsy tract situated within further excisional scar. Intervention outcomes, Patient healthcare records (HCR’s), administration systems for time stamps and telephone/email logs were examined.

Results: A total of 35 patients between January 2022 and March 2023 were referred directly to the SVUH SDC and a further 5 were MDT referrals for treatment abroad scheme (TAS) and thus excluded from outcome but not time to MDT analysis. Within 72 hours of referral, 40% (n=14) were contacted by the ANP virtually for clinical history and consideration of imaging. Patients who had high clinical/radiological suspicion of sarcoma were offered a SDC within 2 weeks (100%). Upon clinical review 22% (n=8) had a biopsy performed by the ANP. There were no adverse events apart from expected minor ecchymosis and discomfort noted in this group. The SDC pathways had an average time to MDT of 7 days (range 5-13 days). A sample of 20 patients referred to TUH between 2015 and 2018 were divided equally and analysed with primary end point being time from referral receipt at sarcoma centre to treatment decision in either group. Results demonstrated patients referred from local hospitals with antecedent investigations were associated with almost double waiting time for definitive diagnosis at MDT than those referred from GP etc (See figure 1)

The 5 patients for review at the TAS MDT 100% (n=5) had the relevant proforma sent by the sarcoma ANP within 24 hours after MDM recommendation and an average time to MDT of 14 days (range 7-21 days). Prior to this, referrals were Consultant to Consultant and UK MDM co-ordinators were responsible for obtaining Irish datasets, a process which could take up to 6 weeks.

Conclusion: Soft tissue sarcomata can be selected safely and efficiently for handheld core biopsy in an ANP led sarcoma clinic. This allows quicker access for cases to MDT than standard pathways of care.


Figure 1. Results of TUH patient analysis