Blood cancers

Insurer’s at-home chemo program “will have limitations”

A private health insurer is offering members access to chemotherapy in their own homes, though clinicians warn only a small number of protocols can be safely delivered in this way.

In a two-year trial, eligible Medibank members in WA, SA and Victoria who gain approval from their treating doctors will be able to choose to have chemotherapy at home delivered by contracted providers.

Medibank is also offering at-home palliative care and dialysis, as the broader private health insurance industry moves to expand at-home offerings.

Cancer Council Australia CEO Professor Sanchia Aranda said home chemotherapy had been around for some time and offered potential benefits such as privacy and reduced travel.

“Clearly its more convenient for patients, they can stay in their pyjamas and don’t have the trip home where they may be feeling drowsy or nauseated,” she told the limbic.

“Transport to treatment is a difficult thing, so for many people who live alone or don’t have access to private transport that could be real advantage.”

But the home chemotherapy model was limited to a few chemotherapy protocols that use drugs that are stable, have a low-risk of side effects and a short duration for delivery, she said.

“For example, the CMF protocol  (cyclophosphamide, methotrexate and fluorouracil) for breast cancer may be suitable, while Herceptin (trastuzumab), treatments for leukaemia and most immunotherapies probably are not.”

Only around 10% of cancer patients in Australia would be prescribed chemotherapy protocols that are candidates for 100% at-home delivery Professor Aranda said, while a larger group would be able to have a portion of treatment at home.

Professor Aranda believed many oncologists would be willing to sign off on the very low-risk protocols but “will feel much more cautious about knowing something about the quality of the staff before enabling patients to receive other treatments at home”.

Overall, she said the Cancer Council was would want to see modelling before publicly-funded trials of home chemotherapy are rolled out, to make sure it is both cost-effective and safe.

“We certainly have no objections to chemotherapy in the home as a general principle, it’s just recognising there are limits to what can be done”.

At-home chemotherapy was likely to be more cost-effective in densely-populated metropolitan centres rather than in the regional Australia where nurses would have to spend hours in travel time between patients’ homes, suggested Professor Aranda.

Telehealth models – such as one Queensland model in which patients receive chemotherapy in small local “bush hospitals” backed up by telehealth specialist support – are “probably a better use of resources” in regional areas, she said.

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