Chemotherapy. Our oncology day-units were built around delivering chemotherapy. Our health care professionals trained to manage chemotherapy. Our patient resources to inform about the side-effects of chemotherapy.
But like a cool breeze turning into a brisk wind and then transforming into a howling gale, treatment for cancer and a whole range of medical conditions is changing. Fast.
Last month View Health – chemo@home, for the first time since its inception, saw a significant change in the demographics of our patients. We treated more patients with medical conditions with immunotherapy infusions, than cancer patients. And cancer patients received as many immunotherapy infusions as they did chemotherapy infusions. This means that 64% of the treatments we gave were immunotherapy based. Or flipping it the other way, only 36% of the treatments we gave were “chemotherapy”.
This change, whilst not unique to View Health – chemo@home, offers some significant insight into the challenges for health services. The challenges can be broken down into 3 categories:
From the MBS to DRGs, every funding platform references “chemotherapy”. This terminology potentially limits the funding of treatment to only one therapeutically active treatment option. This must change. Though, even changing the term may introduce a strange dichotomy.
If the term chemotherapy is changed to “antineoplastic agent” or my more favoured term “cancer therapy”, both of which are inclusive of immunotherapy, where do similar drugs used in medical conditions fall?
Some of the medications are literally identical. Why would funding the health service attendance for the administration of rituximab to a patient with lymphoma be treated differently to its use in a patient with rheumatoid arthritis?
Everything in oncology is geared around chemotherapy administration. Especially accreditation, credentialing, training and education. Blood tests. Neutropenic sepsis. Hair loss. Mucositis. Extravasation. Hazardous drug spills. Whilst all are still relevant, they are increasingly less so.
The side effects of immunotherapy are different. They require a modified, but no less vigilant, approach to monitoring and managing.
Immunotherapy is also changing cancer into what we might consider to be a chronic disease. Patients stay on immunotherapy treatment often until the treatment is no longer working, and this is becoming an increasingly longer time.
Add to this the number of patients with immune-based chronic conditions like rheumatoid arthritis, multiple sclerosis and Crohn’s Disease for which the immunotherapy treatment options are increasingly important. Just imagine if other conditions like Alzheimer’s, diabetes or asthma have an infusional immunotherapy option available? The number of patients needing to access services would overwhelm current bricks and mortar health services rapidly.
Additionally, patients really want to live their best life. A life which is productive and is as unencumbered from their medical condition as it can be. Having to attend a health service day-unit monthly, for the foreseeable future, does little to assist them in achieving this.
Last, but by no means least. Ongoing treatment with immunotherapy provides challenges for patients and their families. They suffer anxiety and stress because of the funding issues in 1. If the health service attendance is not funded because of antiquated terminology, who pays?
Because of the inflexible nature of the “work flow” in health services, many patients find themselves tied to time-consuming attendances at health service’s day-units, sometimes with no choice of even which day they receive their treatment. Patients loose valuable time waiting. Waiting for doctors, waiting for a chair, waiting for medication, waiting for a nurse, waiting to be sent home at the completion of treatment. If nothing else, a health service day-unit attendance is a lesson in patience.
For cancer patients who often take a family member with them to their treatments, they are also burdened with the knowledge that their loved one not only loses valuable time as well, they lose something more concrete; money. Lost wages, childcare costs, travel, parking. The cost to the patient, their family and more broadly society, whilst remaining unquantified, is substantial.
So, what needs to change? A realignment to patient needs is required. Terminology which dictates funding needs to be amended (thankfully, some changes in this area are coming). Health services and professionals need to adapt, to change the focus of their operating procedures and learning development. They would also be wise to partner with innovative companies offering patients choices which allow them the freedom and flexibility to live well. After all, patients are our very reason for being.
Julie Adams, Managing Director