Julie Adams, a bohemian free spirit who likes to challenge the status quo in healthcare, and Lorna Cook, a dynamic powerhouse of networking and marketing energy, founded chemo@home in 2013. We are passionate about growing chemo@home across Australia; aiming to provide true patient centred care to cancer and chronic illness patients and their families. This blog is partly health information and partly a reflection of our personal experiences and opinions. Happy reading. www.chemoathome.com.au
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Is chemo in the home a “pink batts disaster” in the making?
There are few of us who escaped the news coverage of what
happened when the Australian government wanted to boost the economy back in 2009, by
funding the installation of “pink batts” into homes.
Tragically, four young men died, from what
was found to be a lack of oversight by the government resulting in massive
system failures. Simply put, the
government provided the money, but did not ensure that there was the appropriate
legislation, regulation or training available to make it safe. And where there is money to be made, there will
always be some who will want to profit from it.
Some of these people will have no regard for the safety of the product
they are supplying, some will be ignorant of what is needed to make it
safe. The result is the same.
When people ask me, “is giving chemo in the home safe?”, I
find it difficult to answer. To be
honest the answer is both yes and no.
I have worked managing a “home chemo” service for just under
20 years. I’ve developed a robust set of
systems and process to treat cancer and chronic disease patients, who are
receiving some of the most complex and risky chemotherapy and immunotherapy
treatments, safely, in the home. Arguably,
I am the most experienced health care professional, and chemo@home is the
largest, most skilled and experienced health care service in Australia
delivering this type of service.
Over the last 12 months, numbers of other businesses have
put their hands up to say, “we can do chemo in the home too”. After the Medibank Private ads, featuring
chemo@home and our patient Liam, the number of business who came out of the woodwork
saying they can do this reached fever pitch.
So, if chemo@home can do it safely, can’t everyone?
Let me explain why.
Most people, I think, would be shocked to know that to
provide a home health service you do not need to be licensed or accredited.
Licensing of health services is done at a state government level, and in each
state, the health departments license hospitals, but not “home hospitals”. This means there is no state government
oversight of the home healthcare industry anywhere in Australia. Accreditation, which is a process that
ensures national healthcare standards are in place, is also not required for
home healthcare services.
Giving chemotherapy and immunotherapy medications in the
home requires not only an in-depth knowledge of all the national and
international guidelines around the safe prescribing, dispensing and
administration of these highly specialised medications, but the skill and
experience to implement the same.
I was speaking with a researcher recently who was involved
in a trial giving an immunotherapy medication at home. The nursing staff administering the
medication in the home did not carry with them any resuscitation equipment. No adrenaline. No defibrillator. Two of the most important things needed if a patient’s
heart stops. When I asked why, the answer was, “there is less than a 1% chance
of a reaction, so it wasn’t deemed necessary”. I then asked, “so how many
infusions did you given in the trial?”
The answer was, “120”. 120
infusions, 1% reaction rate. So, this begs the question, what happened to the
The reality is portable “pocket-sized” defibrillators are
expensive. Adrenaline is expensive and has
a short expiry. Having a protocol to use
both takes expert input on resuscitation procedures. Being competent in using the protocol
requires the nursing team to be trained and skilled. As a health service provider,
you can either put patient safety first and invest in these aspects of care, or
not. chemo@home is committed to
providing the safest environment possible and will not compromise the safety of
our patients because the alternative is easier of cheaper.
Additionally, to my knowledge, there have been five major
chemotherapy errors in Australian Hospitals over the last 10 or so years. By
major I mean that there was a breakdown in the system which lead to multiple
patients in the hospital being given the wrong dose of a chemotherapy
medication. In each of these situations
a review of the errors pointed to a lack of “governance”, over how chemotherapy
protocols were managed as being the major reason these occured.
chemo@home has robust processes around how we chose which chemotherapy
and immunotherapy treatments we give at home, and how we administer these to
make it as safe as possible. Currently,
we give around 140 different chemotherapy and immunotherapy regimens at home,
and we continually improve our processes if, or when, problems arise. We pride ourselves on having one of the most
advanced cancer management systems in Australia.
The government is very keen to develop the home healthcare
market as it is a more sustainable way of delivering care.
Private Health Insurers are keen to have home healthcare as
part of their offering, to give their members choice.
Hospitals are now seeing it as a way to cope with the
increasing numbers of patients that are putting their day-units and wards under presssure.
Patients and their families want treatment at home as is it
is a kinder, more convenient and comfortable way to receive care.
It is clearly the way of the future.
But without appropriate regulation and legislation in place,
is it really safe for patients to have their chemotherapy and immunotherapy
treatments at home? The answer is, unless they are receiving their home healthcare
from an experienced, reputable, accredited service like chemo@home, maybe not.
Federal and state government need to step up and plug the gaps
in the regulations and legislation.
Private health insurers and hospitals need to be very careful who they
contract with. Patients need to be aware
that not all healthcare services provide care to the same standard.
The last thing we want is for home chemo to
become the next “pink batts disaster”.
The patients are relying on us to keep them safe. We have a duty to do so. Julie
I am frequently
asked, as a pharmacist who specialises in cancer medicine, what do I think
about the use of marijuana for medical conditions?
I often reflect back
to dispensing dronabinol (a synthetic THC product) for chemotherapy induced
nausea and HIV related wasting syndrome, when I first started working as a
pharmacist in a hospital in the early 90s. Back then it was no big
deal, the hospital pharmacy imported the medication from overseas, just like we
did many other medications which were not marketed in Australia, and supplied
it on a doctor’s prescription. We didn’t stop
supplying it because it was difficult to get hold of, rather it just wasn’t
very useful any more. New anti-nausea medications came on the
market, and these were much more effective at controlling the nausea and
vomiting associated with chemotherapy, and, a new class of medications known as
antiretrovirals became available and these were so effective at treating HIV we
thankfully were no longer seeing the devast…
As a woman I have
breasts. As a white, western, woman I have
about a 1 in 8 chance of getting breast cancer.If I get breast cancer, I really don’t want chemotherapy, if I can avoid
it.Not unless it will make a
significant difference to my outcome. Until recently, knowing if this was the
case, was difficult. Rarely does a study comes
out and say that chemotherapy is not needed; that it does not reduce the
likelihood of the cancer coming back and does not increase survival. But that is exactly what has
happened in a large trial on breast cancer patients with hormone-receptor–positive,
human epidermal growth factor receptor 2 (HER2)–negative, axillary
node–negative breast cancer, who would have until now, been given what is known as adjuvant chemotherapy. Adjuvant chemotherapy is chemotherapy
which is given after a potentially curative procedure (in the case of breast
cancer this is surgery) to mop up any remaining cancer cells in the body that
we can’t see. It’s a tricky business. We’ve
When I am asked why we started chemo@home, I often talk
about how when my Dad was sick, some 20 odd years ago, that there was no “@home”
services but that I was lucky enough to work in a hospital where the nursing
staff taught me (the pharmacist) how to give the antibiotics my Dad needed, and
this allowed us to take him home over Christmas. This was to be his last Christmas with us and
I am forever grateful that he spent it with us, his family, at home, and not in
a hospital. This is absolutely true.There are however, two other reasons that I was led down this path.Today I’ll talk about one of these. I've worked in a number of hospitals, both public and private, for
around 25 years.I loved everything
about working in a hospital.There is a comradery
amongst the staff, one which is built on working hard, doing a difficult job
under challenging circumstances, which is hard to find outside of a hospital
environment.I think, maybe, serving in the
military may provide a similar feeling. …