One of Europe’s largest cancer centers, The Christie NHS Foundation Trust, has become the first in the country to provide a treatment called Phesgo for breast cancer patients in their own homes. Phesgo is a combination of Herceptin
Image Credit: The Christie NHS Foundation Trust
Trastuzumab and Pertuzumab are two very effective cancer drugs used to treat one of the more aggressive types of breast cancer (the HER2-positive genetic variant) once it has spread throughout the body.
The Christie in Manchester became the first cancer center in the UK to offer this treatment in patients’ homes last week.
Around 250 patients each month throughout Greater Manchester and Cheshire will be potentially eligible for the at home service, with those who choose not to take up the offer being provided with the treatment through a network of local treatment centers closer to home or at The Christie’s Withington site. Previously the treatment was given as an intravenous infusion in a healthcare setting, but will now be given as an injection.
The new drug treatment means that not only can many patients have the treatment at home, but it also reduces the time they spend having the treatment and under clinical observation afterwards. For a typical maintenance dose, previously a patient would spend around four hours in a healthcare setting, but this can now be safely delivered at home in just 30 minutes.
This is the latest step in an ambitious expansion plan for ‘at home’ treatments offered by The Christie and ensures that the cancer center now provides the most comprehensive range of drug treatments at home for cancer patients and treats more patients at home than any other cancer center in the UK.
As a pioneer in providing chemotherapy treatments at home, The Christie has almost doubled the number of treatments offered to patients in their own home the last three years and hopes to have trebled the number in the next 18 months.
In 2017-18, The Christie at Home service provided 3,280 treatments in patients’ homes. This has risen to over 6,000 treatments in the current year (2020-21) and if all current expansion plans are delivered, should result in over 9,000 patient treatments being delivered by March 2022. Since establishing The Christie at Home service in 2015, 24,000 patient treatments have been provided at home.
The first Christie patient to have Phesgo at home was retired store manager Jean Woods from Rochdale. She said: “I was diagnosed with HERS-2 positive breast cancer in November 2020 and have been travelling to Oldham for chemotherapy and hormonal treatments. Initially, this was once every three weeks but more recently it has been once a week.
“I’m thrilled that I’ll be able to have my treatment at home once every three weeks. It will be so much more convenient and a lot less stressful. It will take about 30 minutes from start to end to get the injection I need. You know that the nurse will come at a particular time and I can then get on with the rest of the day.”
Jean (74), who is married to Steve has two daughters, a stepdaughter and seven grandchildren, said: “It was a big shock when I was first diagnosed, as I always thought cancer was something that happened to other people, not me. I cannot fault the care I have had from everyone at The Christie, it has been excellent. The nursing team has been very caring. When I first came in, I felt very vulnerable and they made me feel comfortable and secure, they even made me laugh.”
Jean enjoys watercolor painting, gardening, reading and cooking.
The service has proved to be ideal during the COVID-19 pandemic as patients can be treated while shielding and it reduces footfall at The Christie. The nurses wear more PPE, but otherwise, the service is much the same as it was before COVID-19. For some patients, our nurse might be the only visit they get in weeks, so they look forward to it. Our patients find it much more convenient and it saves them long journeys and long waits. For those who are working, we try to be as flexible as possible and work around their commitments.”
Stephanie Hechter, Chemotherapy outreach manager
Patient satisfaction with the service has grown steadily, from 86% who rated it as excellent in 2016 to 96% currently.
The Christie at Home service currently provides eight different drugs for patients with a range of different tumors including lung, breast, melanoma, renal and urology cancer. Patients usually become eligible for the at home service after two treatments in a healthcare setting, unless they had an adverse reaction to the therapy.
Christie at Home nurses complete a thorough patient assessment over the telephone, ensuring patients are well and their blood results are satisfactory prior to a homecare visit. The cancer treatments are then delivered to patients’ homes by courier to be stored in their fridge ahead of the nurse arriving.
Each Christie at Home nurse can typically treat around seven patients each day requiring an injection, or four to five patients if they need an intravenous treatment. There are now 12 Christie at Home nurses, with further recruitment planned.
A dedicated pharmacy team provides support for the service by clinically screening prescriptions and coordinating with The Christie’s pharmacy and courier service.
The Christie selects the treatments that can be offered at home if they are well tolerated by patients, carry a low risk of adverse reactions, can be given to a patient in less than an hour and help to improve the quality of life for patients. If a patient experiences any adverse reaction to the treatment, they will be treated at The Christie rather than in their home.
The Christie NHS Foundation Trust was the first specialist trust to be rated as ‘Outstanding’ twice (in 2016 and 2018) by the health regulator the Care Quality Commission (CQC). It referred to The Christie as ‘a leader in cancer care’ and ‘a pioneer in developing innovative solutions to cancer care.’ The CQC praised the Trust’s staff which it said ‘go the extra mile to meet the needs of patients and their families’ and that they were ‘exceptionally kind and caring.’ In 2017, the CQC rated The Christie as the best specialist trust in the country, and one of the top three trusts overall in England.
How AI is advancing mammographic density-based breast cancer risk prediction