With Europe’s Beating Cancer Plan (EBCP), the European Commission follows a new approach to cancer prevention, treatment and care. The action ‘OBS-Learning From Progress In Addressing Cancer In Europe’ (OBS-PACE) contributes to this by improving the understanding of the national cancer control situation and policy actions in EU Member States.
OBS-PACE is collecting case studies of innovative actions in cancer research, care, and policy across the cancer care pathway. The case studies mirror the implementation of the EBCP at the national and regional level and can inform new actions to better tackle cancer across Europe. Each case study describes the objective of the new action, its implementation, including enablers and barriers, and its outcomes at the health system level.
03 April 2025 | Case Study
Patients undergoing systemic anticancer therapy (SACT) frequently experience acute side effects that require prompt medical attention. However, overcrowded emergency departments (EDs) often lead to long wait times, increasing the risk of complications. Additionally, haematology-oncology day units (HODU) have limited capacity to accommodate unplanned urgent care, creating a gap in service delivery. Recognizing this critical gap, the National Cancer Control Program (NCCP) established an alternative care pathway to ensure timely and appropriate management, optimizing patient safety and treatment continuity.
The Acute Haematology Oncology Nursing Service (AHOS) was developed as part of Ireland’s National Action Plan, published by the Department of Health in March 2020 in response to COVID-19. Established across Ireland’s 26 SACT centres, the AHOS introduced several key components to enhance patient care. A dedicated telephone triage service was implemented, allowing cancer patients experiencing acute treatment-related issues to access clinical nurse specialists (CNS) for immediate advice, support and referrals. To ensure effective triage and follow-up, a specialized workforce was recruited, composed of trained CNS professionals assigned to each SACT centre.
The initiative also involved HODUs, ensuring that patients requiring further care could be assessed in designated spaces on the day unit rather than EDs, thereby reducing congestion in the ED and minimizing exposure risks. Collaboration with the UK facilitated the adoption of the UK Oncology Nursing Society (UKONS) validated triage assessment tool. Training was provided by UK colleagues to AHOS nurse specialists in each of the 26 SACT services nationally. Patients who are on active treatment are triaged on the SOS (Sort Out My Symptoms) Hotline using the validated UKONS triage assessment tool. This assessment uses a red amber green system to assess and manage a patient’s symptom. Additionally, digital enhancements, including the introduction of video-enabled consultations, expanded the service’s reach and accessibility. Early data indicate significant patient engagement, with increasing utilization rates and reduced reliance on emergency services.
2025 marks the fifth anniversary of the National Acute Haematology Oncology Nursing Service in Ireland. A recent key highlight is the announcement of plans to recruit 18 additional clinical nurse specialists and advanced nurse practitioners, supported by €0.7 million in newly secured funding. This will help reduce unnecessary ED visits for cancer patients.
The HSE National Service Plan 2025 outlines a dedicated pathway for cancer patients undergoing active treatment, using the Acute Haematology Oncology Service to minimize ED visits and inpatient admissions. Additionally, the Programme for Government in January 2025 emphasized expanding the service to ensure cancer patients receive care without going through general EDs.
A special event will be held in September 2025 to reflect on progress and discuss future developments.
Enablers: The success of the service was facilitated by several key factors, including strong governmental support through national health strategies (Governance), the allocation of an Assistant Director of Nursing dedicated to driving national development of the service, support from nursing management in all 26 SACT services, a well-trained workforce of clinical nurse specialists and advanced nurse practitioners ensuring high-quality patient care (Resources), and secured initial funding for 26 clinical nurse specialist positions with additional allocations for expansion (Financing). Furthermore, the integration of digital triage tools and video consultations has significantly enhanced service accessibility (Resources).
Barriers: Challenges remain, such as limited 24/7 access due to restricted operational hours (Financing), single-nurse staffing at most centres, creating vulnerabilities in service delivery and variations in available resources across centres impacting service consistency (Resources).
While this initiative is proving to bridge the gap for better cancer care, future efforts should focus on developing AHOS units within designated areas of each regional health authority. Achieving this goal will provide tangible benefits for cancer patients across Ireland, ensuring timely and equitable access to specialized care.
Since its inception, the patient voice has been a driving force behind service development, shaping its evolution to better address real-world challenges. A key partnership initiative with the Department of Health Cancer Patient Advisory Group in 2024 led to the creation of standardized, evidence-based patient information for all service users. Ongoing efforts in diversity, equity and inclusivity aim to make the service more accessible to marginalized populations. As part of these efforts, standardized patient information has been translated into nine languages, with additional focus on developing easy-to-read materials for individuals with intellectual disabilities, as well as resources in Braille and sign language to promote inclusive communication. Moving forward, efforts will focus on extending telephone triage to a 24/7 model, increasing workforce capacity, and incorporating further digital health solutions to optimize service delivery and patient outcomes.
Lessons learned: Lessons from the initiative underscore the necessity of multisectoral collaboration to ensure effective implementation and scalability. The NCCP, as the national leader and driving force, unites and guides the 26 AHOS nursing services with a commitment to quality and standardized care, fostering collective growth and learning. The integration of standardized triage tools has been instrumental in enhancing care efficiency and patient safety. A patient-centred approach has significantly contributed to improving accessibility and satisfaction, reinforcing the importance of tailoring services to meet diverse patient needs. The AHOS nursing strategy is strongly driven by data collected monthly from all sites, guiding resource planning, advocacy and responsiveness to service needs. Key areas of focus within the AHOS nursing strategy include quality, communications, education and collaboration. Together, these elements strengthen the case for further investment in the service. Additionally, sustained investment in staffing and infrastructure is crucial for long-term service sustainability and expansion.
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