VOL: 98, ISSUE: 35, PAGE NO: 34
John Pattison, BSc, RN, DipPC, OncCert, is haematology nurse specialist, South Tyneside District Hospital, South Tyneside Healthcare NHS Trust;Karen MacRae, RN, OncCert, CertEd, is clinical operations manager, Healthcare at HomePeople faced with a diagnosis of cancer and the prospect of treatment have to come to terms with the fact that they have a life-threatening illness and will experience a range of emotions. They will therefore require both physiological and psychological support throughout their cancer journey, from diagnosis through treatment to remission or death.
People faced with a diagnosis of cancer and the prospect of treatment have to come to terms with the fact that they have a life-threatening illness and will experience a range of emotions. They will therefore require both physiological and psychological support throughout their cancer journey, from diagnosis through treatment to remission or death.
Like all areas of health care provision, cancer care is going through an evolutionary modernisation and change process (Department of Health, 2000). The aim is to improve patient care and increase cancer patients' quality of life.
The Calman Hine report (Calman et al, 1995) states that collaboration between hospital and community services must be an integral part of cancer services in the future. One area in which this is vital is the administration of treatment at home or in patients' workplaces.
This treatment option increases individual choice and empowerment. Collaboration between hospitals and the community enables services to be planned across the care pathway, with resources targeted where they are best placed to meet the cancer needs of the local population - this does not necessarily mean the local hospital (DoH, 2000).
Not all treatments are suitable for home administration. However, many patients prefer receiving cytotoxic chemotherapy at home, and ambulatory infusions of fluorouracil for colorectal cancer are now relatively common.
The aims of home-based treatment
The fundamental aim of any proposed home-based treatment service must be to improve the patient's quality of life. In the case of home chemotherapy, this improvement can result from:
- Reduced time in hospital (with reduced associated costs to the NHS);
- Decreased anxiety with no need to get to hospital for a specific appointment time;
- No waiting, often for long periods, in busy outpatient clinics;
- Less contact with other patients, who may be more seriously ill and could precipitate anxiety about the future.
DeMoss (1980) suggested another benefit of home chemotherapy after a study of 70 patients. They received a range of chemotherapy agents for different malignancies and experienced minimal side-effects, including a notable absence of nausea and vomiting. DeMoss suggested that this was a result of reduced psychological morbidity associated with having chemotherapy at home.
It could be argued that home-based treatment could lead to patients becoming isolated socially. This requires further investigation as anecdotal evidence suggests that rather than causing each other anxiety, patients can provide mutual support. However, receiving home chemotherapy does not preclude patients from becoming involved in support groups, which are an important and often neglected part of the cancer journey.
Many lead cancer nurses are trying to improve links between hospital and primary care to increase patients' opportunities to be treated at home. Cross-boundary working is becoming a clinical reality that should enhance the quality of care (Richardson and Miller, 2001).
NHS collaboration with the independent sector
While restructuring its oncology services, South Tyneside Healthcare NHS Trust identified a constraint that resulted in patients waiting longer than necessary for treatment. The trust needed a short-term intervention to ensure that they received treatment within the accepted time-frame.
Healthcare at Home, a company from the independent sector which has experience in the administration of chemotherapy and related supportive therapies in the community, was initially contracted to give chemotherapy to 15 colorectal carcinoma patients on a weekly basis. This project met the requirements of the DoH, which is keen to use the resources of the independent sector (DoH, 2001).
The case study below describes a typical example of a patient receiving home chemotherapy.
This small-scale project involving 15 patients shows that collaboration between the independent sector and the NHS can be successful. In this case, they provided patients with an extra dimension of, and continuity in, care.
Admittedly, David Michael's cancer journey was without complications (see case study). However, it is vital that safety measures, supported by protocols and care pathways, are in place so that complications can be identified as early as possible and managed effectively with confidence.
South Tyneside Healthcare NHS Trust currently has a maximum seven-day wait for chemotherapy, although most patients are seen within 24 hours, irrespective of their disease status. This process is subject to a monthly audit.
There is much local and national interest in home-based treatments, which give patients greater choice and control. Cancer units/centres - particularly chemotherapy day units - should consider providing home treatment, both to offer patients greater flexibility and as a cost-effective approach.