Offering care closer to home for people with cancer
We believe everyone should be able to access the care they need in the location that best suits them.
Aishling McLoughlin, Lead Clinical Project Manager for the Systemic Anti-Cancer Therapy Closer to Home project, blogs about how staff across our partnership organisations are working as one team to provide care closer to home.
The Care Closer to Home programme has been running for several years across King’s Health Partners haematology services with the aim of empowering patients to decide how and where they receive care. Projects within the programme include remotely monitoring patients with long term conditions to reduce the number of times they need to attend hospital for an appointment; and offering patients with cancer (where safe and appropriate to do so) the option of having some of their treatment at home.
Last year we successfully delivered a small-scale pilot for systemic anti-cancer therapy at home to test the positive impact it had on people’s lives, and we have just commenced the second phase of this project to expand this offer so more patients can benefit from having greater choice in how and where they receive treatment.
Reducing hospital visits
There are several drivers for why we need to explore alternative models of care, including the increasing number of people being diagnosed with cancer, the pressure this is putting on hospital chemotherapy services, and the potential for improved patient experience.
These include models of care whereby treatment is delivered in a person’s home, or closer to their home (such as a mobile chemotherapy unit in their local supermarket car park) so it reduces the frequency a patient needs to attend hospital.
Patients attending hospital for cancer treatment can experience long waits in the chemotherapy day unit both before and after their treatment is administered (sometimes hours), and some patients also feel anxious about being in a public space for long periods of time during a pandemic because they have lowered immunity.
More treatment choices
Many of our patients come from outside the local area so have a significant travel burden to deal with on top of an already difficult day of treatment. Some treatments can require a person to attend hospital upwards of ten times in a 28-day cycle which can greatly impact on their quality of life as they try to fit their normal activities (such as work, family and friends) around their treatment.
Sometimes patients can refuse treatment or choose a sub-optimal treatment to avoid the burden of multiple hospital visits, so we want to offer patients more treatment choices that fit around their life rather than the other way around.
When the chemotherapy team at King’s College Hospital NHS Foundation Trust (including the Princess Royal University Trust) commenced phase one of this project in Spring 2020, a small cohort of haematology patients with multiple myeloma (a type of blood cancer) self-administered their cancer treatment at home.
Patients monitored
The treatment, called bortezomib, is administered via an injection subcutaneously (just under a person’s skin), and it carries a low risk of complications when self-administering. Comprehensive training is provided to each patient before commencing treatment at home, and the safety of every patient is monitored through our nurse-led telephone clinics.
In the nurse-led clinic, the nurse contacts the patient on every day of self-administration to complete a toxicity assessment, check that administration occurred without any issues, and that the patient doesn’t have any concerns.
Patients have told us that having a choice has made a big difference – even reducing a couple of journeys a month can enable a patient to do more of their everyday activities and reduce the burden of travelling to hospital.
It would be great if my chemo could be delivered to me at home as I get very tired and have a lot of pain.
We have also learnt that some patients prefer to come into hospital because they want to keep home as a ‘treatment-free’ space. By reducing the number of patients coming into hospital it will also improve the experience of those patients attending the chemotherapy day unit, with released capacity, reduced waiting times and less crowded clinical areas.
The second phase of our project commenced on 15th November 2021; during the next six months we will continue to expand the numbers of treatments being offered through this model of care for self-administering sub-cutaneous systemic anti-cancer therapy at home.
We are expanding this model in other cancers (such as breast and prostate cancer) and in other hospitals, with Guy’s & St Thomas’ NHS Foundation Trust and Lewisham & Greenwich NHS Trust joining the project so they too can offer this model to their patients.
We know it is very important to ensure we have people with lived experience of cancer treatment on our Project Group, so there are patient representatives who help us to better understand their treatment journey and what changes will make a positive difference in their lives.
Recruitment drive
As a collaborative project across south east London, we are also working with the South East London Cancer Alliance who offer their expertise and share our goal of wanting to enable people to have a more positive and empowered experience during treatment.
We have also recruited oncology pharmacists to be the project leads at each hospital site so they can work closely together to learn and adapt processes, so the model of care works effectively in each hospital setting.
Together as one team, we are co-creating and developing new models of care that empower patients to choose where and how they receive treatment. Through our expanding network we are sharing and learning from colleagues from other hospitals across the country who share our aim of improving the lives of people living with cancer and other long-term conditions.