Little is known concerning the relationship of nursing activities in ambulatory oncology clinics in Canada to the utilization of available health resources such as hospital beds, emergency departments, and home care by cancer patients. In ambulatory cancer care, the scope of nursing activities can range from those which complement the work of the oncologist, to activities which may substitute for selected oncologist activities. Based on these economic concepts, two models of ambulatory nursing practice were studied: Nurse Complement Model (NCM) and Nurse Substitute Model (NSM).

The purpose of the study was to compare the two models, NCM and NSM, and their effect on health resource utilization (HRU) by persons with breast cancer receiving first-time chemotherapy treatment for cure or control of disease. For this study, four categories of treatment related HRU were measured: Extra clinic visits, homecare visits, emergency department visits, and hospital days.

A retrospective comparative design was selected and data collected in two ambulatory cancer care agencies in Canada. A chart audit was conducted for a sample of 190 female patients with breast cancer, 95 from each setting, who completed their chemotherapy during April, 1990 to February, 1993.

The subjects' charts were examined for data on the scope and complexity of two models of ambulatory oncology nursing practice and recorded on the Ambulatory Oncology Nursing Practice Checklist created from a taxonomy developed by Verran (1981). Demographic data and numbers of visits/days incurred during the complete course of chemotherapy were obtained from the subjects' charts and recorded on the Patient Chart Questionnaire developed for the study.

Nonparametric tests were used to analyse the data for group equivalencies and case mix. One tailed t tests were used to assess the differences, between the two sites, on the dependent variable, health resource utilization (HRU). Study results showed no significant differences between these groups on HRU though there were notable differences between the groups on level of physical activity of the subjects.