# Acute oncology telephone triage: the 24-hour helpline and the UKONS red, amber and green grading

Source: https://onco.cc/protocols/acute-oncology-telephone-triage/  
OnCo record `acute-oncology-telephone-triage` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

During cancer treatment you should have a phone number answered day and night. A trained nurse asks set questions about each symptom and grades it green, amber or red. Green means advice for home, one amber a review within 24 hours, and red (or two ambers) being seen in person as soon as possible. A temperature of 37.5 °C or more, or below 36 °C, always means urgent assessment.

## Summary

The UK model: everyone on systemic anticancer therapy (SACT) or radiotherapy has a 24-hour number for specialist advice, and calls are triaged with the UKONS Triage Assessment Tool, now version 3. Each symptom is graded from 0 to 4 against NCI-CTCAE-based descriptors and assigned a colour: all green is self-care advice; one amber is a review within 24 hours; two or more ambers escalate to red; red is a face-to-face assessment as soon as possible. Some symptoms are red at any grade: chest pain (stop SACT, advise 999, disconnect an infusion pump), and fever on SACT, where a temperature of 37.5 °C or above, below 36.0 °C, or feeling generally unwell means urgent assessment on the neutropenia pathway, with a caution that analgesia, steroids or dehydration can mask a temperature. Version 3 includes prompts for checkpoint inhibitor toxicity at any time, for ICANS and CRS after cell therapy, for MSCC with back pain and for SVCO with breathlessness.

The UKAOS four-nations review (June 2025) found 99% of UK providers support 24/7 access and 90% use the UKONS tool, but variation in who answers (41 providers used non-clinical staff first), in cut-off periods after treatment, and in records; it recommends a national framework, trained and competency-assessed triage staff, and standardised data. In Clatterbridge's year of calls, 45.2% of clinical calls were red, and 72.3% of out-of-hours reds went to the emergency department against 38.3% in hours. Scotland's Cancer Treatment Helpline routes out-of-hours calls through NHS24 call handlers using UKONS questions. Canada's COSTaRS practice guides (updated 2020 and 2026) are the main national alternative.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: UKONS triage tool; 24-hour SACT helpline; chemotherapy helpline; oncology triage line; acute oncology advice line; Cancer Treatment Helpline
- Tags: protocol; acute-oncology; oncological-emergency; telephone-triage

## Connected records

- protocols: [ICANS after CAR T-cell therapy: ICE score, ASTCT grading, steroids and seizure management](https://onco.cc/protocols/icans-grading-and-management/), [Metastatic spinal cord compression: recognition, MSCC coordinator, MRI, dexamethasone, radiotherapy and surgery](https://onco.cc/protocols/metastatic-spinal-cord-compression-emergency/), [Raised intracranial pressure in cancer: recognition, urgent scan, dexamethasone and referral](https://onco.cc/protocols/raised-intracranial-pressure/), [Suspected febrile neutropenia (neutropenic sepsis): the first hour](https://onco.cc/protocols/febrile-neutropenia-first-hour/)
- ideas: [Acute oncology assessment units so sick cancer patients bypass the emergency department](https://onco.cc/ideas/idea-acc-acute-oncology-assessment-units/), [Weekly electronic symptom reporting as a standard of care during systemic therapy](https://onco.cc/ideas/idea-acc-electronic-pro-monitoring-standard/)
- technologies: [Electronic patient-reported outcome (ePRO) symptom monitoring](https://onco.cc/technologies/epro-symptom-monitoring/)
- institutions: [Leicester Cancer Research Centre / University Hospitals of Leicester](https://onco.cc/institutions/leicester-cancer-research-centre/), [The Clatterbridge Cancer Centre NHS Foundation Trust](https://onco.cc/institutions/clatterbridge/)
- terms: [CTCAE toxicity grading (grade 3-4 adverse events)](https://onco.cc/terms/ctcae-grading/), [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Superior vena cava obstruction](https://onco.cc/terms/superior-vena-cava-obstruction/)
- key papers: [Basch: asking patients to report symptoms online during chemotherapy improved survival](https://onco.cc/key-papers/paper-basch-epro-survival-jama-2017/)

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