Models of Care Toolkit
Community-based chemotherapy
Community oncology clinics provide high quality care to patients in their local community. Receiving regular care close to home can lessen the burden of the disease while improving resource utilization and reducing healthcare costs both for patients and the system.
Community-based chemotherapy models rely on a team of physicians, nurses, pharmacists, social workers and other staff who have specialized training in cancer services. In the model, the patient’s treatment is monitored by their family physician and cancer specialist to assess changes in their status and adjust care plans if needed.
The model has been shown to improve patient compliance and management of side-effects. Involving a patient’s regular, primary care team can also support the delivery of care that is in line with their culture and values, resulting in better outcomes, patient satisfaction and quality of life.
Virtual chemotherapy supervision for rural patients
While oral-based chemotherapy is amenable to virtual care, remote IV chemotherapy administration can be more challenging. Some IV chemotherapy regimens can be administered in rural hospitals by generalist doctors and nurses under the virtual supervision of a medical oncologist and nurses trained in chemotherapy.
The benefits include patient convenience, enhanced inter-professional communication across disciplines, expanded scope of practice for general practitioners in oncology, continuity of care and maintenance of patient safety and compliance with guidelines while delivering chemotherapy. Ensuring adequate training for rural providers, coordinating between urban and rural sites and between health care providers and documenting clinical encounters are critical to optimize this model.
Through British Columbia’s Community Oncology Network, nurses, family physicians and pharmacists are trained to administer and manage cytotoxic and hazardous products and to conduct clinical diagnostic assessments and monitor patient care. They can also respond to therapy complications and provide 24-hour support for symptom management and toxicity.
This model offers an opportunity to deliver low-risk treatments close to home for common cancers. This enhances access to care in rural and remote communities and can shift the provision of routine cancer care to community-based clinics. The approach ensures that community-based clinics have appropriately trained and competent staff who are able to manage the delivery and monitoring of cytotoxic drugs, access to clinical diagnostic services and the capability to respond to complications 24-hours a day.
LloydsPharmacy Healthcare Centre is located in a community-based pharmacy in Lincolnshire, England. It provides breast cancer treatment, including nurse-administered treatment and a four-chair infusion centre, delivering a variety of treatments for patients. Pharmacists are available to provide advice to patients. The service allows patients in a rural county to receive care closer to home and has freed up 400 hours of infusion time in hospitals.
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- Nelson S, Turnbull J, Bainbridge L, et al. Optimizing Scopes of Practice: New Models for a New Health Care System.; 2014. Accessed November 22, 2021. https://www.cahs-acss.ca/wp-content/uploads/2014/08/Optimizing-Scopes-of-Practice_REPORT-English.pdf