Improving the quality of oral chemotherapy services using home care

Abstract

SO J. (2010) European Journal of Cancer Care19, 35–39 Improving the quality of homecare oral chemotherapy services There has been a plethora of oral chemotherapeutic agents introduced over recent years. For hospital pharmacies this has meant unprecedented activity. At the same time there is pressure to meet waiting time targets and to improve patient experience. The Cancer Centre had already used homecare services for trastuzumab (Herceptin) so it seemed reasonable to apply this to selected oral agents. A formal tender resulted in a contract award for homecare. The service has been running successfully for 3 years with imatinib in chronic myeloid leukaemia and in gastro‐intestinal stromal tumour patients. Patients are informed about the homecare supply service in clinic by the nurse or pharmacist, with most patients opting for the service rather than a wait in pharmacy for their prescription. The drug is then delivered by post to the patient's home. We plan to extend the service in the coming months to include a second oral agent, erlotinib for the treatment of non small cell lung cancer. As well as avoiding a patient wait in pharmacy, provision through a homecare company offers a more cost effective way for the Trust to deliver an oral chemotherapy service. By reducing the number of patients arriving in pharmacy for prescriptions, it facilitates the achievement of outpatient waiting time targets and improves the overall patient experience.

Introducing the United Kingdom Oncology Nursing Society's (UKONS) Position Statement on Oral Chemotherapy'

“…In the following papers, Oakley et al (2010b) outline the patient experience of oral chemotherapy and the development of an oral chemotherapy patient diary to assist them in managing their own treatments, and Vidall (2010) outlines the development of community oral chemotherapy nursing support roles. In the final paper, So (2010) outlines the cost effectiveness of delivering oral therapies in the home from the perspective of the hospital pharmacy service in line with the requirements of the UK Chemotherapy Services in the Community (DOH 2010) report, which urges the commissioners of healthcare services to consider how chemotherapy services may be better provided to patients in their own homes.…”

Providing community oral chemotherapy services

“…The increased number of prescriptions for oral chemotherapy agents has placed a strain on the hospital pharmacies required to dispense these drugs at the same time that they are having to meet strict quality improvement criteria in relation to dispensing waiting times (So 2010), so an alternative means of managing the delivery and administration of oral cytotoxic drugs in the patient's own home therefore has to be found. These need to be as safe and effective as the dispensing and administration arrangements for intravenous chemotherapy currently in place in hospital inpatient or outpatient settings (National Patient Safety Agency 2008), and the degree of information and counselling needed by patients in relation to the self‐management of their oral chemotherapy also needs to be considered.…”