“Chemotherapy in the community has been one of our big success stories, not only for patients but for staff as well. The fact that we’ve been able to do this using Clatterbridge nurses and Clatterbridge pharmacists rather than a home care company is fantastic.

“It’s part of a wider strategy – the more patients we treat at home, the more clinic capacity we have. We’ve also been the first cancer centre in the country to offer treatment at patients’ workplaces, and I’m really proud of that. Our patient satisfaction has been fantastic, and that’s the main reason we’re doing this.

“We talk about putting people first, and this has been fantastic for our staff as well. We’ve done this utilising our chemo nurses, and it’s a great diversification of their skills.”
Helen Poulter-Clark, Chief Pharmacist at The Clatterbridge Cancer Centre NHS Foundation Trust
Overview

The delivery of chemotherapy treatment at home for people with cancer in Cheshire and Merseyside is estimated to have saved the NHS nearly £400,000 – with almost all patients saying they preferred receiving their treatment at home.

A trial of chemotherapy treatment at home was delivered by The Clatterbridge Cancer Centre NHS Foundation Trust with the support of the Innovation Agency, the Academic Health Science Network for the North West Coast, who funded a nursing post for delivery of the treatment during the trial.

The Clatterbridge Cancer Centre now provides chemotherapy treatment at home for nearly five per cent of all treatments, delivered by a team of five nurses and three administrators. Within the next three years the trust plans to expand the service to 10 per cent of all treatments.

Challenge / problem identified

The Clatterbridge Cancer Centre provides oncology services in Merseyside, Cheshire and the Isle of Man, serving a population of 2.3 million over seven district hospitals. It is one of the largest cancer centres in the UK, registering nearly 10,000 patients every year.

Attending hospital for chemotherapy treatment can often be challenging for patients. Many rely on public transport, which for some patients can be costly and involve long journeys. Some patients are carers themselves, and have to make special arrangements so that they can leave home for their treatment. For some patients with severe learning difficulties it can be stressful to be outside the home environment.

In 2014 the NHS England Five Year Forward View advocated reducing pressures on hospital wards by, where appropriate, bringing care closer to home.

The Clatterbridge Cancer Centre initially trialled a mobile chemotherapy unit but didn’t move forward with this option as the feedback from patients receiving care in the mobile units was similar to the feedback from patients treated in an outpatient clinic, and there was still a requirement for some travel.

The 2015 trial of chemotherapy treatment at home was undertaken to evaluate its effectiveness, both for patients and for the trust.

Actions taken

From April 2015 to March 2016 the Innovation Agency funded a band 5 nursing post to support a trial of a chemotherapy treatment at home service with The Clatterbridge Cancer Centre. The treatment involved the subcutaneous administration of trastuzumab in patients’ homes.

After evaluating the success of the trial The Clatterbridge Cancer Centre expanded the service to nearly five percent of all treatments with a team of five nurses and three administrators. Additional treatments included lanreotide, niyolumab, octreotide and pembrolizumab. For particular patients who met the trust’s compassionate use criteria, the administration of denosumab, fulvestrant and goserelin was also delivered at home.

The Innovation Agency commissioned the Royal College of Physicians to undertake an economic analysis of the service over the course of 2017, during which 298 patients received 2,106 treatment episodes at home.

In 2018 The Clatterbridge Cancer Centre started delivering chemotherapy treatment in the workplace, the first trust in the UK to do so. The service is for patients who are receiving trastuzumab and has so far been delivered across 10 workplaces in Cheshire, Merseyside and Lancashire – including warehouses, offices, shops and cafes.

Impacts / outcomes

Research by the Royal College of Physicians over the course of 2017 estimated savings to the trust of £182 per treatment episode at home compared to in the hospital, resulting in total estimated savings of nearly £400,000. The research did not take into account NHS patient transport costs or missed appointments, meaning that total savings to the NHS are almost certainly higher.

83 out of 84 home treatment patients who responded to a survey said they preferred treatment at home, and all respondents said they preferred treatment outside the hospital.

“The aim of chemotherapy at home is to reduce the travelling time for patients. For nurses it’s an opportunity to work in a different environment. I think as a nurse job satisfaction is really important. Being able to see patients have their treatment in a place where they prefer to have it, either their home or workplace, is really satisfying.” Dorothy Probert, Manager of Clatterbridge in The Community 

“Parking was always a problem, and the ward I attended could be very busy. I would have to attend for treatment every third and fourth week, and have to go and have blood taken the day before my fourth week appointment.

“Treatment at home is so much better. I know in advance when to expect the nurse. They also take bloods the same day as the treatment, and ring me with the results. I can very easily fit treatments around my daily routine as I’m informed by the Home Treatment Office a week in advance whether my appointment will be in the morning or the afternoon.” Rosemary Jones, who has received chemotherapy treatment at home 

Plans for the future

The Clatterbridge Cancer Centre has completed a business case for expanding their chemotherapy treatment at home service to an additional 300 patients by 2022, equivalent to 10 per cent of all treatments given by the trust. The trust’s compassionate criteria, which help establish the eligibility of patients to receive treatment at home, are also being expanded in line with equality and diversity policies.

The trust is also planning a trial for the delivery of a course of treatment at home for lymphoma to a cohort of patients. The treatment comprises a subcutaneous injection every two months for two years. The pilot will take place across six months, equivalent to three cycles of treatment, and if effective will be expanded.

Start and end dates

The Innovation Agency funded nursing post commenced in April 2015 and ended in March 2016. The post has since been taken up by The Clatterbridge Cancer Centre and the delivery of the treatment at home service is ongoing.

Contacts

Project contact 

Sue Critchley ,Programme Manager for Innovation Adoption,Innovation Agency
E: [email protected]

Media contact

Michael Sullivan, Senior Communications Officer, Innovation Agency
E: [email protected]

Chemotherapy at home in Cheshire and Merseyside