Systemic anti-cancer therapy delivery in the home: a service model
The Christie NHS Foundation Trust is a leader in adapting patient care in response to treatment advances and new patient-centred care/efficiency initiatives. Due to extended waiting times in cancer clinics, The Christie developed an at-home treatment service to help reduce the pressure on clinics and improve patient experience. This article provides a detailed examination of the requirements necessary to successfully develop a home service for the delivery of systemic anticancer treatment. The authors discuss the criteria used to identify suitable at-home treatments, as well as necessary resources and equipment. The success of the Christie at Home service was examined using a patient survey to assess the standard of this care. Details are given regarding the challenges of implementing a homecare service and potential future challenges. As an example, systemic treatment with eribulin as a ‘Christie at Home’ therapy demonstrates the practicalities of introduction of new therapies in a homecare service.
The Christie NHS Foundation Trust—the largest single-site cancer centre in Europe—is a tertiary specialist cancer centre based in Manchester, serving a population of approximately 3 million people, treating all types of solid tumours and haematologic cancers in adults (The Christie NHS Foundation Trust, 2020). The Christie is a leader in adapting patient care in response to treatment advances and policy changes, developing models for the evolving NHS, and responding to patient-centred care and efficiency initiatives (NHS England, 2016; Vanguard Innovation, 2020).
In 2015, nurses at Christie outpatient clinics began to report extended on-the-day waiting times for patients due to an increase in numbers needing treatment. As a result, The Christie began to explore ways to adapt its services to improve clinic capacity and patient experience; around this time, expanding out-of-hospital care was targeted as a priority for NHS England (2014), and homecare was predicted to have wide-ranging benefits, including reduced pressure on hospitals and improved adherence to therapies, quality of life, and patient engagement with treatment (Outram et al, 2015). As such, the team identified homecare as a service that could potentially reduce pressure on clinics, and would also provide a financial benefit via a value-added tax (VAT) saving because homecare medicines are exempt from VAT (Hackett, 2011). The resulting VAT saving would then help cover the cost of resources needed to run the homecare service (Hackett, 2011). Trastuzumab, a targeted therapy for breast cancer, was already being delivered at home, and this offered a platform for the expansion of treatment site options by The Christie.
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