Chemo at home helps cancer patients cut disruptions to daily life

SINGAPORE — When she was first diagnosed with a bone marrow cancer called multiple myeloma in 2011, Mdm Minah Ibrahim would spend almost a day each week travelling to the National University Hospital (NUH) for chemotherapy. The hour-long session would leave her fatigued for the rest of the day.

The 83-year-old suffered a relapse early this year and the hospital suggested home chemotherapy, which her daughter readily accepted.

“I was immediately attracted to the idea that treatment could be done within our comfort zone…especially now that (my mother) is no longer as energetic as she was five years ago,” said Ms Syaida Abdul Rahman, Mdm Minah’s primary caregiver.

Now, for about 45 minutes each week, Mdm Minah sees a nurse at her home in Teck Whye Lane. The nurse administers an injection of bortezomib — a drug commonly used for treating myeloma patients with kidney problems — assesses her vital signs and answers any queries Mdm Minah and Ms Syaida have.

Mdm Minah now goes to the hospital only once a month for reviews.

Home chemotherapy has “saved us the effort of moving her onto the wheelchair each time to go to the hospital,” said Ms Syaida, 23, who took on a part-time job as a religious teacher so that she could care for her mother.

“And after the session, she can just rest on the sofa…We have also cut down on transport costs.”

NUH’s team of four nurses make their rounds across the island daily, attending to patients like Mdm Minah. They each carry a backpack of equipment including drugs, needles, syringes, vital sign-monitoring devices and disposable gowns.

Altogether, the nurses make up to 12 home visits a day.

HELPING PATIENTS LIVE NORMAL LIVES

Home-based chemotherapy is a popular practice in Australia, Europe and the United States, due to the long distances patients often have to travel to regional cancer centres.

The regime first made its way to NUH in August 2015 and was introduced by Dr Lee Yee Mei, its Assistant Director of Nursing, who wanted to help patients maintain independence and “go about their daily lives”.

Apart from chemotherapy by injection, some public hospitals — such as NUH and the Singapore General Hospital (SGH) — also offer certain forms of chemotherapy administered via portable intravenous pumps.

The bulk of patients benefitting from this form of treatment are young lymphoma sufferers. They feel “burdened by their lack of independence and ask if they can go to school”, said Dr Lee.

Traditionally, those undergoing treatment for lymphoma — a cancer involving cells of the immune system — have to be hospitalised for one week in every 21-day cycle.

Patients under the home-based regime have drugs administered via the portable pump and return to the hospital only for fresh doses of the drugs.

“Our goal is for patients to not have to think of themselves as ‘patients’ as much as possible,” said Dr Lee, one of this year’s recipients of the President’s Award for Nurses.

The National University Cancer Institute, Singapore (NCIS), located at NUH, has about 80 patients undergoing home- and community-based chemotherapy — about 10 to 20 per cent of those eligible for the regime.

SGH began piloting house calls for cancer patients, primarily by a team of four nurses, in February. They have made 200 home visits to nearly 40 patients.

Besides saving time, home chemotherapy reduces the risk of patients catching an infection in hospital and frees up hospital beds and outpatient treatment spaces for more complex cases, said both hospitals.

“When you go to the hospital, there are a lot of viruses floating around,” said Mdm See Kim Lian, a multiple myeloma patient on SGH’s home chemotherapy regime. “I get around with the help of a walking stick, so it is more convenient (for me) if they come to my house.”

The 63-year-old, who was diagnosed with the condition in 2010, used to spend up to four hours a week travelling to and from her home at Serangoon North, as well as waiting at the hospital’s hematology department.

There are patients who choose not to be on home chemotherapy, however. They typically want more privacy or prefer to receive treatment in the clinic “as a form of outing”, said SGH senior nurse clinician Jordan Hwang.

CANCER CARE OUTSIDE THE HOSPITAL

Rolling out the home-based regime has empowered the nursing profession, said Dr Lee.

Preparations at NUH took almost a year and nurses had to source for gadgets such as a portable fridge and bags of a suitable size for patients receiving chemotherapy via the infusion pump.

Nurses can make the call to admit patients to the hospital should their conditions worsen, said Dr Lee.

At patients’ homes, they may also dish out advice on nutrition or making toilet facilities more elderly-friendly. “There is job satisfaction even though we frequently make our rounds under the heat, and a greater opportunity to build relationships with patients and their caregivers,” said Assistant Nurse Clinician Chen Litang, 36.

Cancer care is moving more into the community. The NCIS has made it possible for patients to do blood tests at selected community centres and polyclinics.

The walk-in service at 10 selected polyclinics will begin on August 1 and is available for four blood tests - full blood count, liver function test, renal panel and PT/INR.

Patients should check with their doctors if they are eligible.

“Currently, patients travel to the hospital regularly and wait approximately two to three hours for the results before they proceed for their doctor appointment or treatment. (This) will help ease the long wait in our clinics,“ said the NCIS on its website.