Being cared for at home is an added value for all patients. Even more so in this period of Covid epidemic when being able to avoid, or at least limit, visits and checks in the hospital is important to stem the chances of contracting Covid-19. For patients with advanced or metastatic cancer, then, the possibility of receiving home care acquires even more value, both to avoid contagion of the virus and because it considerably simplifies and improves the lives of patients and family members, who already have to deal with a complex situation. It is with these premises that OncoHome was born, the pilot project developed by the National Cancer Institute of Milan (Int) together with the IRCCS San Raffaele Hospital of Milan and the ASST of Cremona, with the patronage of the Italian Medical Oncology Association (Aiom ) which provides for remote assistance management for 70% of the 300 participating patients and for the remaining 30% direct home visits.
Open track project for 300 patients
Today, a priority is to guarantee cancer patients the necessary therapies, as has always been the case, but at the same time, take all the necessary measures to protect them from Covid-19 – he comments Marco Votta, President of the National Cancer Institute of Milan -. OncoHome is the right strategy to bring the hospital to the home of the sick, guaranteeing all the assistance they need through home visits, but also to offer words of comfort and physical closeness that, now more than ever, are essential for those who lives an oncological disease. The initiative currently envisages the involvement of 300 patients with an advanced or metastatic solid neoplasm who receive oral anticancer therapy, assisted by the three hospitals: 100 are followed by Int, 100 by the San Raffaele hospital and 100 by the hospital of Cremona. It is an opening project for a different assistance modality to be implemented in the territory – he underlines Filippo de Braud, director of the Department and Division of Medical Oncology and Int Hematology -. The goal of reducing hospital admissions by 50% and consequently protecting cancer patients from the risk of infection by providing them with the same level of care they would receive in a hospital setting. The data we will collect will allow us to evaluate the possibility of creating a national assistance network.
More human-sized therapies and hospitals
It is estimated that in 2020 about 377 thousand new cases of cancer were diagnosed in Italy, more or less 1,030 a day. According to statistics, 60% of patients live five years after diagnosis and the number of recoveries is increasing. This is also due to the improvements in therapies, which aim to be not only increasingly effective, but also less toxic. And, whenever possible, more comfortable for the sick: an example is the growing number of new drugs in tablets or in methods of administration that can be taken at home The OncoHome medical-health service allows de-hospitalization of oncological care and treatment with a positive psychological impact on the patient, who feels cared for and safe at home in a moment of great difficulty like the one we are experiencing – say the specialists of IRCCS San Raffaele, Stefano Cascinu, chief physician of Medical Oncology, and Vanesa Gregorc, director of the Strategic Program for oncological diagnostic-therapeutic innovation -. Thanks to the support of telemedicine, which allows to reduce the doctor-patient distances, a direct integrative relationship is established between the territory and the specialized centers.About a third of cancer patients suffer from anxiety and depression. Humanizing their path in the hospital means offering psychological support, but also improving communication, making the necessary information easily available and optimizing the times and methods of visits and checks: strategies which, also shown by various studies, concretely help to improve the lives of patients and those who care for them.
Too few Italian centers with active home care
OncoHome for us the right continuation of home assistance activated in emergency in mid-March 2020 in full pandemic, for the assistance of our cancer patients, including those with Covid-19 infection – clarifies Rodolfo Passalacqua, director of Oncology in Cremona -. As part of this pilot project, the patient takes an active part and has the task of filling in questionnaires cyclically which, through questions concerning the impact on the quality of life of ongoing treatments, we need to better understand the real toxicity of drugs. the latest findings contained in the White Book Aiom 2020, 369 oncologies are active in our country: 83% have a psychological support service, but still too few centers, only 68%, have activated a path of home cancer care. A gap that widens moving along the Peninsula: in the North, home care is in fact activated by 75% of the structures compared to 58% in the South. Strengthen the network of home care, with particular attention to palliative care active in the most advanced stages of the disease, a goal that specialists have been aiming for for some time. The territorial management of cancer patients is one of the problems that will become more important in the future, in consideration of the increasing number of patients who become chronic the disease and who can use oral or subcutaneous cancer treatments which, in themselves, do not require the need for a hospital administration – explains Giordano Beretta, Aiom national president and head of Medical Oncology at Humanitas Gavazzeni Bergamo -. The OncoHome project represents one of the first examples of the use of IT tools and of a new way of administering drugs for the cancer patient to limit the number of accesses to hospital facilities. An attempt is thus made to create a new reality, territorial oncology, in which the patient maintains contact with the center that is treating him, also through access to the home of the oncologist and nurse. The level of innovation of this project could, over time, radically change the way in which cancer patients are managed, to the advantage of greater safety and a reduction in travel.
Remote assistance or home control
The analysis of medical records has allowed us to identify cancer patients who can be followed in teleassistance (about two thirds of the total) and those who need home checks – chairman Giuseppe Procopio, head of Genitourinary Medical Oncology at the Int -. It should be clarified that this is not home care for the terminally ill. The substantial difference: with OncoHome, patients do not receive palliative care, but real oncological therapies. Medicines are prepared by the hospital pharmacy and sent to the home of patients followed in remote assistance, or delivered directly if home assistance has been activated. The team made up of a nurse and an oncologist who go to the sick once a week, separately – concludes Valentina Guadalupi, oncologist in the same Unit -. They are articulated visits, which include the physical examination of the patient, the detection of vital parameters, any medications and if necessary, also the education of the patient and family member in the management of side effects related to taking the drug. A dedicated number was also activated, in case of emergencies or doubts.The OncoHome pilot project was made possible thanks to a fundraising campaign to which numerous companies and associations contributed: Ipsen, Janssen Oncology, Roche, Pfizer, Amgen, Novartis Farma , Bayer and MEDeA. The contributions collected will be used to support the assistance and care activities of the project.
April 11, 2021 (change April 11, 2021 | 17:12)