COVID-19, A Roadmap to Home Care

April 11, 2020

COVID-19 care may show a familiar roadmap to cancer care that some patients and caregivers wish they had.

I recently read an article about the potential benefits of patients being treated at home. While the article discussed how the treatment of patients at home is being utilized due to COVID-19, I think that this same concept could be used for patients with cancer.

In my sister’s case, the hospital was like a vortex for her and when she went in, it was typically weeks until she came out. Time at home was precious, and as her condition changed and worsened, it seemed to become more fleeting. Between clinic appointments and hospital stays, my sister did not get to spend that much time removed from the disease of cancer.

We were lucky enough to be introduced to a palliative care team that was remarkable and preached the importance of spending time at home over the hospital. I did my best as a caretaker to do whatever I could to keep her at home. When she was home, she was at her best.

Nothing about cancer is normal, but at least when she was at home, she got to wake up in her bed, eat food that was not made in a cafeteria and she got to enjoy things like movie nights and time outside. In the hospital, as phenomenal as her care team was, some of those things could not happen.

The concept of "at-home" care does not typically enter the realm of oncology until one begins late-stage or hospice care. Patients usually spend innumerable hours in infusion chairs and clinics for check-ups, fluids, labs and receiving the chemotherapy treatments needed for remission to occur. As I know that some of those things will always need to happen based on where treatments currently are, I think that some things could easily shift to at-home care.

Early on, she required blood thinners, which meant daily INR testing. Her doctors could have chosen any of the medications on the market that do not require INR testing. In that instance, it was merely doctor discretion, but for my sister, it was more than a choice.

It meant 2 hours every day away from home between travel and clinic time. After being discharged from a severe case of pneumonia, she was placed on high levels of oxygen, and they were worried about lung and heart function. Instead of monitoring these remotely, she went to the clinic bi-weekly for testing. After her transplant, my sister got an infection from her triple-lumen catheter. It required daily vancomycin infusions.

It was during that time that I was introduced to elastomeric vancomycin pumps. This allowed me to dose from home, saving not only the travel time to the clinic but also the time that the infusion would've taken to be spent at home.

These are a few examples of when at-home care could have been utilized while my sister battled cancer. I am confident that many other patients have examples of their own, where at-home care may have been an appropriate option. I recognize that these solutions do not mean that time the hospital or clinics are not needed for oncology patients. It very much is, and often, being inpatient is safer for the patient.

That being said, hospitals are breeding grounds for germs. My sister got numerous infections during her cancer battle from the hospitals she was being treated. Oncology patients are immune-compromised, and that makes them far more susceptible to illness than most. As much as hospitals can be safer, sometimes, being home is what is safest for the patient.

I am aware that part of the issue with transitioning to at-home care is bureaucracy and financial burdens because of insurance discrepancies. The fact of the matter is that with so much surrounding cancer, I feel that it should always be about the patient. That may sound naive to some, but sometimes, the conversations only can begin when we start with the solution and then work through the problems.

I know how lucky my family is that my sister gained remission, and we have time on our side to spend with her. So many families are not as fortunate and cannot say the same. And when it comes to weighing time, the more time a patient receives at home, and with the ones that they love, I do not think any argument can ever outweigh the time a family may never get back.

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