ideasIdea
Nurse-led chemotherapy day units with a doctor on a screen
Trained nurses following strict written protocols can safely run chemotherapy clinics for common cancers, with an oncologist available by video for decisions and problems.
Task-shifting delivered HIV treatment to millions when there were no doctors to do it. Chemotherapy for common, protocol-driven indications (early breast cancer, Hodgkin lymphoma, paediatric ALL, cervical chemoradiation) can be delivered by specialist nurses and clinical officers under protocols, with tele-oncology supervision. Partners In Health's Butaro Cancer Centre in Rwanda has run a version of this for more than a decade. The proposal is to define the national protocol set, credential the roles, and measure outcomes at scale.
Hypothesis
Nurse-led units under tele-supervision will achieve treatment-completion rates and 30-day treatment-related mortality no worse than physician-led units in the same country for a defined set of curative regimens.
Rationale
The cognitive load of protocolised chemotherapy is in the protocol, not the prescriber. Nurses already manage infusion reactions and toxicity in high-income units; the barrier is legal scope, not competence.
What would test it
A non-inferiority cluster comparison across ten districts on completion rates, dose-delay rates, febrile neutropenia mortality, and patient-reported experience, with an independent safety committee.
Maturity
being tested at scale
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
3
Bottlenecks it attacks
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
- Not enough oncologists, nurses, pathologists, physicists · The number of people with cancer is rising faster than the workforce trained to treat them.