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Chemotherapy in the community UKONS September 2008

Chemotherapy in the community UKONS September 2008. Melanie Hall Nurse Consultant Oncology / Lead Cancer Nurse City Hospitals Sunderland. Sunderland Experience. Home Chemotherapy Operational since September 2003 Annually around 140 patients access the service

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Chemotherapy in the community UKONS September 2008

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  1. Chemotherapy in the communityUKONS September 2008 Melanie Hall Nurse Consultant Oncology / Lead Cancer Nurse City Hospitals Sunderland

  2. Sunderland Experience • Home Chemotherapy Operational since September 2003 • Annually around 140 patients access the service • Well over 1000 visits to patients per year • Average 6 patients per day • 8 patient slots available per day • Percentage of home patients to CHDU – 15% • Percentage of eligible patients – 46% • No patients currently on the waiting list • Completed research with anthracycline Breast patients • Outreach chemotherapy in Primary care centre opening soon

  3. Background • Rationale for home chemotherapy • Quality issues • Capacity issues • Issues to overcome • Safety issues • Funding issues

  4. Presentation will cover • Rationale for home chemotherapy • Quality issues • Capacity issues • Issues to overcome • Safety issues • Funding issues

  5. Quality Issues • Patient focussed service • Privacy and Dignity • Experienced chemotherapy trained staff • Continuity of care • Back up of Hospital facilities • Safe and well managed

  6. Capacity Issues • Attendance at Chemotherapy Day Units has more than doubled over a five year period • Aging population • Early diagnosis • New treatments in addition to existing treatments • Treatments used at earlier stage • Treatments often 3rd and 4th line • Targeted biological therapies • Increase in the complexity of treatment regimens House of commons Heath committee evidence submitted bu Cancer Capacity Coalition (2006) http://www.publications.parliament.uk/pa/cm200506/cmselect/cmhealth/1077/1077wel18.htm

  7. Capacity Issues • Space • Privacy / Dignity • Busy departments = perception by patient that nurses are too busy to talk • Accurate patient assessment • Lengthy waiting lists • Lengthy waiting times

  8. Safety issues • Competent and responsive staff • Following nurse led protocols / Patient group directions • Eligability criteria • Exclude drugs that are associated with hypersensitivity reactions • Anaphylactic drugs / equipment at hand • Extravasation equipment at hand • Operational policies inc.Health and Safety policy • Transportation of waste

  9. Cost issues • A significant proportion of chemotherapy workload requires 1 : 1 Nursing attention • Feasibility study / time in motion study • Cost neutral (excluding minimal start up costs) • One Chemotherapy trained staff nurse can deliver up to 8 treatments per day – 40 per week

  10. Evaluation • Experience of Chemotherapy • Challenged there ability to cope • Significant impact upon daily life • Worse than the cancer itself • Social isolation - lethargy, confidence, appearance

  11. Evaluation • Home Experience • High levels of satisfaction • Comfort in own environment • Privacy • Practicalities - travel, cost, time constraints • Nurses undivided attention • Easier to understand information / ask questions • Reduced anxiety levels

  12. Evaluation • Hospital Experience • Security of Environment • Contact with other patients (pros + cons) • Back up of hospital • Comfort • Busy department • Practicalities v. draining

  13. Evaluation • Relationship with chemotherapy nurse • Most patients felt that this was of benefit • Hospital – 30% (range 25 – 100%) • Home – 70% (range 25 – 100%)

  14. ‘going to the hospital, I get agitated, I know they aren’t going to say anything or do anything to me, but my stomach still churns when you are in the waiting room.but when I am at home I don’t get that feeling because, I think, well you are in your own house so you haven’t got anything to be nervous about,’

  15. ‘it only takes 45 minutes in the home because she comes she has everything set up and she knows exactly what she’s doing. Today I’ve been at the hospital; my appointment was at 10.30am; I left before 9am I didn’t get back here till 12.45pm. ’ ‘so while I was waiting for the nurse to come I could just potter on and do some jobs in the house rather than just sitting in the hospital; it wasn’t wasted time’

  16. Next step • Maintenance of activity levels in the home service • Re-assess regimens acceptable for home treatment • New patients at home • Outreach chemotherapy • Large proportion of treatments that would not be cost effective at home, accommodate these within primary care settings.

  17. Any Questions or comments? Melanie.hall@chs.northy.nhs.uk

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