There are very few events in life that are as devastating as the moment someone is told that he or she has cancer.
Prioritising the comfort of cancer patients is of paramount importance, as it significantly influences their well-being, treatment efficacy, and overall quality of living.
Last October, a new service was announced for cancer patients who receive a specific type of chemotherapy, whereby the treatment will be administered in the comfort of their homes. Seven patients are already receiving this treatment at home.
The Journal spoke to Charge Nurse Berniece Scicluna to better grasp what this service is and who it will impact. She is highly specialised in cancer care at the Sir Anthony Mamo Oncology Centre.
Cancer and chemotherapy
Cancer is a group of diseases characterised by the uncontrolled growth and spread of abnormal cells in the body. These cells can form a mass of tissue, known as a tumour, which can invade nearby tissues and, in some cases, spread to other parts of the body through the blood and lymph systems. Chemotherapy is a medical treatment that uses powerful drugs to kill or slow the growth of these rapidly dividing cells. It is commonly used in the treatment of cancer, as cancer cells typically divide and grow at a faster rate than normal cells. The primary goal of chemotherapy is to target and eliminate cancer cells throughout the body.
What’s different about chemotherapy at home?
In the realm of cancer care, the Ambulatory Chemotherapy Service (ACS) is a transformative approach, allowing patients to receive their chemotherapy in a non-clinical setting. It involves receiving anti-cancer medicine through a special device called an Elastomeric Infusion Device.
Also known as a balloon pump, this one-time-use tool is like a balloon that delivers the medicine directly into the patient’s veins over a period of time. The equipment doesn’t need electricity or batteries to work, because it uses the energy from the balloon to push the medicine into the body.
“This Ambulatory Chemotherapy Service is intended to maximise patient convenience, improve the overall experience, and enhance treatment outcomes. The service aligns with the national oncology strategy and demonstrates the commitment to following established guidelines and contributing to broader healthcare objectives at the national level,” says Nurse Scicluna.
It’s completely free of charge
The Ambulatory Chemotherapy Service is provided for free by the Health Authorities as an integral part of cancer treatment for eligible patients.
“Patients undergoing chemotherapy at home need not bear any additional costs, as the government ensures that this service is financially viable while maintaining the highest standards of care. The aim is to prioritise the well-being of patients without imposing any financial burden on them,” explained Nurse Scicluna.
How can we be sure that it is safe?
There are policies and guidelines that provide a framework to follow. The approach involves a multidisciplinary team working collaboratively to deliver the best possible care. There’s an established care pathway that defines and optimises the process to reduce variability and promote evidence-based practice.
Only patients who meet the eligibility criteria are referred for this service. Patients and their accompanying family members or carers receive comprehensive education and attend pre-chemotherapy educational sessions, both verbally and through written materials. This includes information about the process, background information on elastomeric infusion devices, and troubleshooting tips. Additionally, patients and their family members are educated on potential toxicities associated with the treatment.
Support structures are available around the clock to ensure continuous assistance. Patients are provided with a contact number for any necessary inquiries or emergencies, operating 24/7.
Each patient is equipped with a spillage kit and cytotoxic bin, ensuring they have the necessary equipment in case of any spills or the need for proper disposal. The Standard Operating Procedure for the Handling and Administration of Chemotherapy in Sir Anthony Mamo Oncology Centre is strictly adhered to.
What specific type of chemotherapy is this new service intended for?
The specific chemotherapy considered for this service is called 5-Fluorouracil (5-FU). This drug has a proven safety and reliability track record over many years, particularly when administered through continuous infusion.
Nurse Scicluna explains that 5-FU is typically given for colon, pancreatic, gastrointestinal, and rectal cancers. Its selection for this programme is based on its established safety profile and effectiveness in managing these specific cancer types.
Around 40-60 patients will benefit from this service annually.
“Our aim is to extend this valuable service further into the community, ensuring that more individuals can access the benefits of receiving chemotherapy in the comfort of their homes,” said Nurse Scicluna.
The eligibility and exclusion criteria explained
There are eligibility criteria for cancer patients to access ambulatory chemotherapy, and they serve to safeguard the patient’s well-being and ensure adherence to strict guidelines and procedures during the administration of chemotherapy at home.
Patients must be clinically stable. They need to have a performance status of 0-2, which indicates their physical abilities and their level of functioning in terms of their ability to care for themselves.
Patients will receive chemotherapy through a Central Venous Access Device (CVAD). Their homes must be equipped with running water, electricity, and a telephone service.
Either the patient or the accompanying carer must be proficient in numerical literacy, and they must be willing to comply with home delivery administration.
Some patients will not be able to receive this therapy, for their own safety. These are patients who have had previous allergic reactions to the prescribed chemotherapy agent, patients who have had multiple, chronic, uncontrolled health conditions, and patients whose CVAD insertion is clinically not recommended.
How will the government ensure that patients who receive chemotherapy at home receive the same level of care as those in a clinical setting?
Nurse Scicluna explains that there are detailed, standard procedures that are outlined in a document called Ambulatory Chemotherapy Service: Procedure Along the Patient’s Pathway Standard Operating Procedures. This was compiled by a group of nurses in collaboration with practise nurses at Sir Anthony Mamo.
These SOPs establish a standard patient pathway and detail each step of the treatment to promote efficiency and safety. The procedures for each step are described in detail to promote an efficient and safe service. The ultimate objective of these SOPs is to ensure that all patients eligible for this service receive the same level of care as those in the clinical setting.
A 24-hour telephone service is also available where patients can discuss issues with the Chemotherapy Practice Nurse or a fully trained Oncology Nurse.
How will the success and impact of this new service be monitored?
A robust evaluation system is in place to thoroughly assess the success and impact of the new ambulatory service for cancer patients. This comprehensive system incorporates various key components, including systematic data collection, rigorous analysis of patient outcomes, and soliciting feedback from both healthcare providers and patients.
Stakeholders, particularly medical professionals, play a crucial role in this evaluation process, ensuring a well-rounded perspective on the service’s effectiveness. Their insights will be instrumental in gauging the service’s impact on patient care and overall healthcare delivery.
Considering that this initiative is in its initial stages, continuous monitoring is paramount. The ongoing assessment will identify areas for improvement, allowing for evidence-based decisions to enhance the quality of care provided to cancer patients. This commitment to constant refinement underscores the government’s dedication to ensuring the ambulatory service meets and exceeds the expectations for delivering optimal care to those in need.
What are the expected benefits and potential challenges?
A major benefit is that patients experience the comfort and convenience of receiving treatment in familiar surroundings, potentially reducing stress and anxiety associated with hospital visits. This approach allows patients to maintain their daily routines and support systems, which can positively impact their overall well-being.
Additionally, Nurse Scicluna observes that the ambulatory chemotherapy service contributes to improved resource allocation in Malta’s healthcare facilities.
Recognising that challenges may arise, she acknowledges that ongoing evaluation and regular monitoring are integral components of the strategy. This will allow for the identification and timely addressing of any issues that may emerge, ensuring the safety and effectiveness of chemotherapy at home.
Moreover, the government acknowledges the importance of equitable access to this service. Efforts will be made to provide necessary training and expand services, such as the introduction of Outreach Oncology services in the community, to ensure that all eligible patients have access to this vital aspect of cancer care.
“By proactively addressing potential challenges and focusing on equity, the government aims to optimise the benefits of administering chemotherapy at patients’ homes and enhance overall patient outcomes,” says Nurse Scicluna.
Words of gratitude
She says that this initiative wouldn’t have been possible without the dedication, commitment and perseverance of many individuals. She really wanted to express her appreciation to her colleagues, especially nurses Fiona Scalpello Hammet and Abgail Camenzuli.
“They have worked tirelessly with me to turn this service, which was just a dream many years ago, into a reality. I would also like to thank the entire oncology team, which played an important role in this achievement: the management, nurse navigators, directors, pharmacy staff, doctors, consultants, IT team, and the oncology systems lead,” she says with gratitude.
Finally, she was deeply grateful towards Oncology Ward 1 at Sir Anthony Mamo Oncology Centre, who will be the pioneers in this field. They will coordinate this service and lead the way to provide more patients with the opportunity to receive treatment at home.
“We are pleased with this collective commitment to offering our patients the freedom to receive treatment at home and striving to be a beacon of hope in the field of Oncology. We look forward to a brighter future and will continue improving our services for cancer patients. Our team is determined to continue working hard to ensure the best possible outcome for each patient we serve,” Nurse Scicluna remarked.