Ambulatory chemotherapy: Past, present, and future

Ambulatory chemotherapy allows the delivery of short and extended chemotherapy infusions through a portable pump from the comfort of patients’ homes. It is essential to offer it for suitable candidates to ensure both their safety and the success of the treatment session. This requires a delicate balance between clinical assessment and patient acceptance.

The two main components of this treatment modality are the pump and the access device.

There are several pump designs and mechanisms on the market, with the latest being the portable disposable elastomeric one.

Clinicians along with a multidisciplinary medical team often decide upon the type of access device; patients are also involved whenever shared decision making is practiced.

Despite some reports of pump programming errors or malfunctions, research is underway to find innovative solutions to support its use.

Delivering chemotherapy at home: how much do we know?

Ambulatory chemotherapy offers many advantages from supporting a closer to home treatment approach to lowering the cost of care. Ambulatory devices such as elastomeric pumps can deliver prolonged infusions of a variety of chemotherapy agents. Elastomeric pumps are preferred by the patients, as they get them connected at the hospital or cancer centres, then go back home where they can have visits from the district nursing team. This minimises disruption to carers and families. Despite all the advantages, experiments carried out by the authors and others in the literature showed that the performance of these pumps varied depending on the temperature and/or viscosity of the diluent. Interestingly, a two-phase study that was carried out to observe and evaluate patients receiving ambulatory chemotherapy concluded that in 50% of the observed cases the infusion pump did not finish on time. This disrupted the patients' treatment schedule and, in some cases, resulted in sub-therapeutic dosing.

Observations of the communication practices between nurses and patients in an oncology outpatient clinic

PURPOSE

Effective communication in cancer care and treatment is linked to better health outcomes, improved treatment adherence, and improved quality of life for cancer patients. While the characteristics of effective communication have been identified, there is sparse knowledge about the current conditions for providing effective communication especially within the outpatient clinical context, where the majority of cancer patients are currently being treated. This study aimed to explore communication practices between nurses and patients undergoing chemotherapy in an outpatient clinic to gain insight into how patients are supported in this setting.

METHODS

Data were collected through 70 h of participant observations of nurse-patient interactions supplemented with ad hoc interviews with nurses in an oncology outpatient clinic. The methodology and data analysis are guided by interpretive description, thematic analysis and symbolic interactionism.

RESULTS

Three themes were generated that characterised communication in the outpatient clinic: Treatment-centred communication, efficient communication and spatially-bound communication. While there was good opportunity for patients to learn about treatment and side effects during cancer treatment, psychosocial concerns were rarely addressed.

CONCLUSIONS

The outpatient setting influences the type and quality of communication between nurses and patients. Improvement of communication should include not only verbal and written information, but focus on the importance of nonverbal communication in the oncology outpatient clinic. Furthermore, there is a need to make environmental adjustments that can facilitate the opportunity for patients to express their needs and for nurses to respond to them.

Evaluation of the performance of elastomeric pumps in practice: are we under-delivering on chemotherapy treatments?

BACKGROUND AND AIMS

Elastomeric pumps are widely used to facilitate ambulatory chemotherapy, and studies have shown that they are safe and well received by patients. Despite these advantages, their end of infusion time can fluctuate significantly. The aim of this research was to observe the performance of these pumps in real practice and to evaluate patients' satisfaction.

METHODS

This was a two-phase study conducted at three cancer units over 6 months. Phase-1 was an observational study recording the status of pumps at the scheduled disconnection time and noting remaining volume of infusion. Phase-2 was a survey of patients and their perception/satisfaction. Ethical approval was granted.

RESULTS

A total of 92 cases were observed covering 50 cases disconnected at hospital and 42 disconnected at home. The infusion in 40% of hospital disconnection cases was slow, with patients arriving at hospital with unfinished pumps; 58% of these had an estimated remaining volume which exceeded 10 mL with 35% exceeded 20 mL. In 73% of these cases, and regardless of the remaining volume, the patient was disconnected and the pump was discarded.

CONCLUSIONS

The performance of pumps varied, which affected nurse workload and patients' waiting-times. A smart system is an option to monitor the performance of pumps and to predict their accuracy.