By Annie Tan, Singapore Health

Some cancer patients can opt to be treated at home rather than at a hospital, under a new Singapore General Hospital (SGH) service offered to multiple myeloma patients who receive chemotherapy via injection.

The initiative is an example of the way that healthcare is changing. Devolving care from hospitals as the focal point to increasingly involving the home and community benefits patients without jeopardising their safety, while preparing the healthcare sector for a rapidly ageing society.

In this instance, having an SGH nurse visit the home to administer treatment saves these blood cancer patients weekly visits to the hospital, and among other benefits, reduces their chance of catching an infection from other patients.

“Subcutaneous chemotherapy is relatively simple to administer – the injection can be done within a minute and the side effects are minimal. However, if patients have to come to the hospital, travel and waiting time can amount to a few hours,” said Mr Jordan Hwang, Senior Nurse Clinician (Advanced Practice Nurse), SGH.

“Since this type of cancer is more common among those above the age of 60 years, many patients have to be accompanied by relatives who often have to take leave. There is also the added risk that cancer patients, who have lower immunity, might catch an infection while waiting at the clinic,” he added.















Available since March 2017, the pilot programme has been taken up by close to 60 patients or 50 per cent of patients receiving this particular treatment at SGH. Patients don’t pay anything extra for now, as the programme is supported by a Ministry of Health research grant and a pharmaceutical company. However, they must have a blood pressure monitoring set and a thermometer, as they have to alert the nursing team if their blood pressure is high and/or if they have a fever before their scheduled visit.

Home visits typically last for 10 to 25 minutes, during which the nurse will check the patient’s temperature, blood pressure, lungs and heart, and look out for symptoms such as rashes and stomach ache. A haematologist is consulted by phone where necessary, and if all is well, the patient is given an injection of the cancer drug in the abdominal region.

The nurse monitors the patient for five minutes or so to make sure that he doesn’t suffer any ill effects, before leaving for the next home appointment. Treatment risks are minimal and may include numbness in the fingers and constipation.

Although giving an injection is easy, only trained healthcare professionals are allowed to administer chemotherapy, as cancer drugs are cytotoxic – toxic to living cells – and require proper storage and disposal.

“Used needles are collected in a sharps box, while waste products are brought back to hospital for proper disposal,” said Mr Hwang, adding that nurses making home visits are also given a spillage kit for emergencies, and trained to wipe up spills according to strict hospital protocol to reduce environmental risk.

Nurses go on home visits a couple of days a week, and each nurse is scheduled to visit at least six patients. Multiple myeloma patients on this scheme have the first of four weekly treatments of each chemotherapy cycle at the hospital, and the subsequent three at home.

Although nurses are able to see more patients at the hospital, Mr Hwang said there are advantages of having home visits. Besides the benefits and convenience to patients, visiting a patient at home allows the nurses to assess the patient’s home environment, which adds to a fuller and better understanding of the patient’s overall health. Nurses can also highlight potential hazards in the home, such as clutter.

“From an economic perspective, it may not be so efficient. But from an altruistic point of view, there are multiple benefits to home-based chemotherapy,” said Mr Hwang.

Not all patients are keen on this scheme. Some take their hospital appointments as a chance to leave the house, while others are wary of having their neighbours know of their condition.

But the overall response from patients and their carers has been warm, and this has encouraged the team to explore the possibility of providing a similar service for two other groups of patients – those suffering from myelodysplastic syndrome (MDS) and certain stable leukaemias.

They are also looking to have some treatments done at a hospital clinic instead of having the patient admitted, said Mr Hwang. Patients who need a chemotherapy infusion, where the drugs are delivered into a vein in the arm, and those undergoing stem cell transplants may require a lengthy stay in hospital. If they can have their treatments done at an outpatient clinic, it would save them time and money, he added.

Nurses providing home treatment get a chance to check out their patients’ surroundings for potential problem areas like clutter.