Site last updated:
December 2011
Cancer Services Forum currently has 2172 registered members
Chemotherapy delivery: challenges for the future
Share
Capacity issues
Moving cancer treatments into the community setting, when clinically appropriate, can reduce demands on specialist centres2 as well as improving patient and family experiences. Delivery of chemotherapy in the community is not a new concept; the NHS Cancer Plan6 and the NHS Manual of Cancer Service Standards7 both recognised that initiatives were needed to address the emerging issues of providing oncology treatments in more efficient and effective ways.
There is a distinct lack of research into the delivery of chemotherapy outside of traditional settings. However, investigators have identified that some fundamental issues need to be addressed when considering the delivery of cytotoxic treatments in the community.8-10 For example, appropriate infrastructures must be put in place,8 effective communication is essential between primary and secondary care, and there is a need to prioritise the education of all those involved in the delivery of oncology treatments.10
The issues highlighted above mirror those discussed in the Cancer Reform Strategy of 2007.11 There is now a need to deliver these reforms and monitor their effectiveness.
There are many examples of chemotherapy being delivered outside of specialist cancer units, for example, treatment in haematology units, and the outreach services that most cancer centres offer to district general hospitals within their geographical locations. Several oral treatment formulations are now available for patients with cancer, for example, certain chemotherapy agents, bisphosphonates and monoclonal antibodies, enabling administration in local settings, including patients’ homes. Some patients in the west of England now even have access to a mobile chemotherapy unit (Panel 1).12 There can be reluctance to deliver certain intravenous chemotherapy agents, for example, docetaxel (Taxotere™), outside of the specialist setting. However, no such restrictions exist in the private sector, where well run, structured services are being delivered in patients’ homes by specialist chemotherapy nurses. This policy suggests that consultant oncologists who treat private patients are confident of the safe delivery of Taxotere and other treatments in the home. Clearly some questions need to be asked:
- Why is Taxotere considered safe to use in the community in the private sector but not in the NHS?
- Is there an educational issue for NHS outreach chemotherapy nurses in the community setting?
Nevertheless, there is a need for caution when seeking solutions to capacity issues and trying to comply with government initiatives. It is important to make sure the safety and efficacy of treatments are not compromised by use of novel treatment settings. For example, some authors suggest that oral and intravenous chemotherapy require similar levels of care, and that community-based treatment may require greater attention to patient education and involvement.13
More localised care could also have implications for cancer centres themselves. For example, there is a risk that the deployment of chemotherapy staff in the community could create skill-mix problems in the specialist base. The overall impact of community initiatives will be monitored with interest.
- The UK’s first mobile chemotherapy unit is funded entirely by charitable contributions and run by the oncology team at Gloucestershire Hospitals NHS Foundation Trust
- The purpose is to reduce the amount of travelling for patients
- Treatments are delivered by specialist chemotherapy nurses, and all patients receive some of their treatments in hospital
- The unit began treating patients in Cirencester and Ross-on-Wye in June 2007,
and there are hopes that it will eventually travel further afield, throughout Gloucestershire, Herefordshire and Worcestershire
Panel 1: Chemotherapy on the move12
Page 3 of 6
Discussion.