Immunotherapy is an exciting field of cancer treatment where the medicine gives the immune system a boost to fight off the cancer itself, rather than killing the cancer cells and other healthy rapidly dividing cells. The immunotherapy medicine is commonly infused directly into the patient’s bloodstream intravenously through a drip.
In June 2011, the first immunotherapy was approved by the Therapeutic Goods Administration (TGA) in Australia for the treatment of patients with unresectable or metastatic melanoma.
Immunotherapy is currently available in Australia for many types of cancer, and there are a number that are available and subsidised under the Pharmaceuticals Benefits Scheme (PBS).
Common side effects of immunotherapy include rashes, diarrhea, and inflammation. Immunotherapy could take longer to reduce tumour size than chemotherapy, however side effects are generally less severe and patients generally do not experience hair loss or immunosuppression.
Cancer patients undergoing immunotherapy are often required to attend multiple infusion appointments each month. This limits their ability to work and impacts their quality of life.
Cancer Australia estimates that 145,483 Australians will be diagnosed with cancer in 2020.
Bristol-Myers Squibb is one of the global leaders in cancer therapy development and is committed to taking actions to address all aspects of cancer care, from diagnosis to survivorship.
For the last couple of years, at-home infusion has been offered on a case-by-case basis to Australian oncology patients undergoing immunotherapy. In the time of COVID-19, BMS saw an uptake of at-home infusion in patients undergoing cancer treatment.
Marc Mikhail, Head of Medical Operations and Effectiveness at BMS Australia and New Zealand ANZ, said: “In this current world of COVID, the convenience of being able to be treated at home prevents those extra hospital admissions and potential risks of attending a clinical setting for treatment.
From a quality-of-life perspective, it gives patients that extra freedom by not being tied down to fortnightly or monthly visits to the clinic and more time to do the things they love not the things have to do as part of their treatment.”
The grim reality is that even today, people living in regional and rural Australia have shorter lives, higher levels of disease and injury, and less access to and use of health services than their metropolitan counterparts. The five-year survival rate for any type of cancer decreases as remoteness increases. To make matters worse, people are also more likely to be diagnosed with cancers that have poor survival rates in regional and rural parts of Australia.
At-home infusion programs are extremely beneficial to patients who live outside of metropolitan areas. Research has shown that patients have to drive on average 100km to access a Centre of Excellence.
Mr Mikhail said: “You might find that a rural patient has been attending a Centre of Excellence in one of the major cities and therefore travelling for a few hours every fortnight or every four weeks.
There is also a financial burden when attending clinics, with parking, fuel and potentially time off work. The stress of arranging to have a carer come with them, or patients needing to take a day off work, all create an extra burden for them, their family and community. These are reduced by having an option of being infused at home.
The model works very well for immunotherapy. You don’t have to worry about the challenges of cytotoxic handling precautions that you do have with traditional chemotherapy.”
At-home infusion simply requires a drip to be set up at the patient’s house, making it easy to organise once the patient is deemed eligible for this program. Then, a nurse will visit the patient undergoing treatment from home on a regular basis to prepare the compound for the infusion and administer it safely.
Rebecca Johnson is a Clinical Nurse Consultant at Melanoma Institute Australia, a not-for-profit organisation with the objective of zero deaths from melanoma in Australia this decade. Melanoma is a type of cancer which can be treated under at-home infusion programs.
Ms Johnson said: “A lot of our role is over the phone to essentially try and keep people managed at home rather than presenting to hospital for treatment. Where possible, people can have infusions at home to keep them out of hospital environments.
Once patients have had treatment at home, they often reflect on the comparison with hospital, saying it’s much more flexible, it’s much more comfortable being in their own environment, feeling much less clinical and people feel less like a cancer patient.”
Not only can patients receive their immunotherapy from home, but they can also decide to be treated from their place of work if appropriate.
This means patients are less likely to take time off work or reduce their hours to be able to keep up with their treatment plan.
Ms Johnson said: “We’ve definitely had people have infusions at work previously. And the ability for people to work from home now means that many are having their home infusions with fewer interruptions to their workday.”
The additional benefit of nurse visits to the patient is that this regular human interaction could impact on patients’ mental health and quality of life.
Ms Johnson said: “The benefit of having the same nurse come and do their treatment every time means the patients feel safe and know what’s happening. Patients always want to have an extra appointment to see the nurse one more time when they’re finishing up, which is nice and obviously shows how excellent the nursing staff are.”
Mr Mikhail said: “The patients have developed quite close relationships with the nurses because they’re seeing them so regularly.”
Although immunotherapy is not able to treat every type of cancer yet, new indications are regularly being approved for usage and reimbursement for available compounds.
With the introduction of immunotherapy for new indications and with regular breakthroughs in this field, it is hoped that more patients will benefit from at-home infusion and improved quality of life in years to come.