References
Delivering chemotherapy at home: how much do we know?
Abstract
Ambulatory chemotherapy offers many advantages from supporting a closer to home treatment approach to lowering the cost of care. Ambulatory devices such as elastomeric pumps can deliver prolonged infusions of a variety of chemotherapy agents. Elastomeric pumps are preferred by the patients, as they get them connected at the hospital or cancer centres, then go back home where they can have visits from the district nursing team. This minimises disruption to carers and families. Despite all the advantages, experiments carried out by the authors and others in the literature showed that the performance of these pumps varied depending on the temperature and/or viscosity of the diluent. Interestingly, a two-phase study that was carried out to observe and evaluate patients receiving ambulatory chemotherapy concluded that in 50% of the observed cases the infusion pump did not finish on time. This disrupted the patients' treatment schedule and, in some cases, resulted in sub-therapeutic dosing.
Delivering care closer to home has become a priority within the NHS, as it reduces the burden on secondary and tertiary care while maximising convenience to the patient and supporting the ethos of person-centred care.
Home chemotherapy is one example of such care, which allows patients to receive their treatment in the comfort of their home and thereby avoid the stress and inconvenience of hospital visits (Corbett et al, 2015).
Traditionally, home chemotherapy has entailed the delivery of the treatment under supervision by a specialised nurse. With the advent of ambulatory devices, this term has evolved to include ambulatory chemotherapy. The devices used for this, also known as infusion pumps, allow patients to safely receive prolonged infusions unsupervised, with the community nurses visiting the patient at the end of the infusion disconnecting the device.
Specialised community nurses can deliver a range of chemotherapeutic agents of differing complexities at home. Some agents, such as intravenous cytarabine used for the treatment of paediatric leukaemia, are described by community nurses as simple, due to the small volume required to be administered. In contrast, others, such as subcutaneous azacitidine for myelodysplastic syndromes (MDSs), are more complicated due to the need to maintain a cold chain (Murthy et al, 2019).
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