chemo@home

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 unde...

Recent media reports have highlighted the somewhat complex and hidden costs associated with health care.   The Four Corners report “Mind the Gap” focused on out-of-pocket expenses and hidden fees from surgeons.   Whilst the ABC medical report on “Secret Pacemaker Payments Boosting Private Hospital Coffers” focused on the hidden rebates hospitals receive for using various medical devices. The two issues are separate, but very much related.  Both point to the lack of transparency of financial interactions between specialists, hospitals and a variety of other stakeholders in the health care market. The first media report highlighted the issue around “informed financial consent”.   It is mandatory for all patients receiving care from a specialist in a private hospital to sign a document stating that they agree to the charges related to the procedure or care for which they are being admitted.   But how “informed” is the financial consent?   At a vulnera...

In 1997 a study was published in “Blood”, arguably the most respected medical journal on blood cancers on planet earth.   The study was about the effect of exercise on treatment related fatigue after a type of bone marrow transplant called a peripheral blood stem cell transplant.   The study peaked my interest, not just because of the positive benefits of exercise on reducing fatigue, but because it also showed a benefit in other somewhat more unexpected areas.   It also reduced the length of time a patient’s white blood cell count is low after transplant, the severity of diarrhoea and the severity of pain.   Of these the one that interested me most at the time, was the effect on the white blood cell count.   The white cells are the part of your blood system which fight infection; without them the body is more prone to getting nasty bugs and less able to fight them off. So, what was so interesting about this finding?   In the early 80’s a medicat...

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 c...

Have you ever believed in something, something you thought everyone else believed in as well; only to find out that in fact nothing could be further from the truth? Just after we started chemo@home 5 years ago, a very high up health executive said to us during a meeting, "It's not about the patients, don't bring emotion into this".  It was possibly the first time (but definitely not the last time) that such a jaw dropping statement like this was said to us. We had started chemo@home on the entire principle that treatment WAS ALL ABOUT THE PATIENT.  For us, the patient and their family are at the centre of everything we do.  Their choices, about their treatment, is what matters most. To find out that there were health managers and executives who put other concerns before the patient was, for us, mind blowing.  What are these concerns you might ask.... well let’s just say that a lot of emphasis is placed on a health services "activity", the nu...

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, serv...

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 we...

There have been many advances in cancer treatments since I started working in the area of cancer care, nearly 30 years ago.  Back then, patients with metastatic colon cancer were treated with a simple (but reasonably ineffective) chemotherapy regimen and the average life expectancy was 6 months.  Now the treatment is more complex, uses new medications, and the life expectancy is 5-fold! So, what has changed.  Essentially, many of the advances made over the last 10-15 years have come down to a new class of medications called immunotherapy. Immunotherapy, or the use of medications to modify the body’s own immune system to treat illness, is such an exciting development.  Immunotherapy is not only being used to treat cancer, but many other illnesses as well, such as multiple sclerosis, Crohn's disease and rheumatoid arthritis. The body’s immune system is truly remarkable.  A finely tuned, interconnected "ecosystem" of hundreds or maybe even thousands o...