Scope of Home Care in Oncology

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There is nothing equivalent to staying at home for actual comfort. Recent studies have shown that standard treatment with appropriate home care helps to remarkably improve the quality of life of an individual afflicted with cancer. Home care engages supportive and trained health care services provided at home for those who need care. A person might require home care during particular times to recover from a long stay in hospital or surgery. Home care is a choice for patients who are vigorously receiving rehabilitation services or treatments for all or selective stages of cancer. Those who need help with daily tasks and also those who need skilled care interventions might be considered for home care. Patients who are at advanced stage of cancer require home-based hospice care.

Diagnosis and treatment of cancer patient involve teamwork. It requires experience and skills of numerous diverse medical professionals like GP, Medical Oncologist, Radiation Oncologist, Radiologist and Nuclear Medicine, Surgeon, Psychologist, Physiotherapist, Breast Nurse, Social Worker, Research Assistant, Occupational Therapist and home care. Home care plays an important role as emotional and supportive care is vital to battle the disease and improve the quality of life.

Oncological surgeries form an important part of cancer care which can be physically and emotionally draining and Home Health Care (HHC) can help in this regards. Oncologic surgery is used to stage, identify and treat cancer, and cancer-associated symptoms. There are three types of surgical interventions employed for the elimination of cancerous tumours – laparoscopy, open surgery, and robotic surgery.

Phases in a Surgical Case

  • Preoperative Preparation –During this phase, patient is informed of the dos and don’ts before the surgery. Essential preoperative tests are performed to determine if the patient is fit for the surgical procedure. These are few points consideredin the pre-operative phase:
    • Spirometry & respiratory exercise- This is a breathing exercise aimed to assist you to take long, deep breaths.
    • Physiotherapy regime– This therapy aimed to improve and care for patient’s health.
    • Nutrition – A nutritious and balanced diet helps in speedy recovery

Pre-operative preparation of the patient is the key to complication free recovery especially prior to supra-major surgery.

  • Few of the major surgeries are Laparoscopic surgery, Laser surgery, Natural orifice surgery, Cryosurgery, Mohs micrographic surgery, and Endoscopic surgery. During this phase,the surgery is performed to remove thelump or cancerous cell.
  • Postoperative Care–During this phase patients are given extra care with regards towound care, antibiotics (IV), IV medications (calcium), Physiotherapy and Equipment requirement

Reasons for Prolonged Discharge from the Hospital

Generally, a patient is discharged if he/ she fulfil most of the below-listed criteria:

  • Tolerance and improvement in oral intake
  • Recovery of gastrointestinal function
  • Adequate wound healing
  • Adequate pain controlleris given with oral analgesia
  • Capability to mobilise and self-care
  • There is no evidence of untreated medical problemsorcomplications till now

These criteria vary from person to person, some patients will take longer time and others shorter.

Why Medical Oncology Care at Home?

At times, cancer patients might become excessively nervous, depressed, or fearful and might find it difficult to perform simple day-to-day activities. They will require a professional caretaker who can support them emotionally and physically. Patients who have undergone oncosurgery are required to visit the hospital several times for monitoring and follow up. Home care professionals will also serve as supportive partners assisting these patients with their travel needs to the hospital. Home care professionals support the patient as well as their families by educating them about the nuances of care with regards to the various health issues that can crop up in a cancer patient.  This inturn aids the patientin minimizing visitsto the hospital, reducing the financial burden, travel time, and waiting times. Here are a few important oncology-related therapies that can be easily provided in the comfort of your home by professionally trained persons: Chemotherapy, Immunotherapy or biologic therapy, Blood transfusions, Pain management,Antibiotic treatment, Nutritional support, Anti-emetic therapy, and Hydration. This therapy can be given at home with thehelp of trained professionals which helps patients to reduce commuting to hospitals to perform above therapies.

Pilot Programs on Oncology Medical Home Care

Few pilot programs were conducted to assess the effectiveness and the outcomes of home care in cancer patients. A pilot study conducted in an Oncology Patient-Centred Medical Home situated in Pennsylvania reported a 68% reduction in emergency room (ER) visits and 51% decrease in hospitalisations per chemotherapy patient with an estimated savings of $1million for each doctor per year. Another, study by Wilshire Oncology Medical Oncology Home observed fewer ER visits and hospitalisations (10% v 30%), fewer end of life in hospitals and high acquiescence with nationally authenticated measures. Michigan Oncology Medical Home Demonstration project revealed that fewer ER visits and hospitalisations in cancer patient compared to control group and an estimated saving of $550 per patient in the first year of the study.

Advantages of Hospice Care

Hospice care is a philosophy and type of care which emphases on extremely ill patient’s pain and symptoms, and attending to their spiritual and emotional needs. Hospice care idea is if someone we love has an incurable illness and treatment for prolonged life and for that illness is no longer under control, there is something still health care professionals can do. Even if life cannot be prolonged, comfort can virtually always be provided, and it should be provided effectively whenever possible. Hospice care has bonus advantages where patient gets thefollowing care under one roof:

  • Medical, psychological, and spiritual care can be provided under one roof
  • Allows the family to participate in giving care to the patient care
  • Keep the patient as functional and free from pain and other symptoms as possible
  • Easy to provide 24-hour support by skilled experts and volunteers

What you can expect from Home Care Agencies

Home care agencies provides following assistances:

  • Assist in preparing the patient to return back home
  • Considerably reduce hospital stay when hospice care can provide most services at home.
  • Provide services and personnel that can help in recovery of the patient at home
  • Help to keep the doctor updated about the health status of the patient on a day-to-day basis

Home care provides psychological and medical support to the patient which helps them to recover faster compare to hospitalisation. Such individuals tend to live longer than those who have spent most time recuperating at the hospital. We can safely conclude that home care for oncology patients provides superior outcomes both in terms of improvement in the quality of life of the individual and mitigates the need for high expenditure.  

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Dr. Sandeep Nayak has graduated from Kasturba Medical College and has done his post-graduation in General Surgery from Govt. Medical College, Calicut. He has taken postdoctoral training in Surgical Oncology from Chittaranjan National Cancer Institute, Kolkata. He has also done a fellowship in laparoscopic and robotic onco-surgery. He is a member of Royal College of Surgeons of Edinburgh, UK. He is also an active member of many national and international professional associations like ASI, ASCO, SSO and IASO. He is a consultant robotic and laparoscopic onco-surgeon at MACS Clinic, Near Ashoka Pillar, Jayanagar, Bangalore and a teacher at Department of Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore

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