Information
Hycamtin at home
Merck Oncology has formed a partnership with "Healthcare at Home" to provide specialist nursing staff who are trained to administer chemotherapy in the home environment.
Healthcare at Home is a recognised provider of specialist nursing care and treatment at home, with the main focus on delivering quality patient care.
Healthcare at Home has considerable experience in the provision of home healthcare, and is currently working with leading consultants and hospitals throughout the country, both within the NHS and through private health schemes.
Hycamtin (topotecan) is a second-line chemotherapy which has NICE approval.
Fully trained oncology nurses provide the necessary standard of care and are experienced in administering infusion therapy.
The assigned nurse monitors the drug administration very closely, ensuring compliance with the prescription, and can observe both efficacy and possible side effects on a regular basis. Where possible, side effects can be treated as and when they occur.
The Consultant remains responsible for the treatment at all times.
Hycamtin at home is not available in all areas, but it is recommended that you discuss this option with your consultant, as it may well be available to you.
For information and advice about Hycamtin therapy: Telephone: 01895 452212
e-mail: medinfo@merckpharm.co.uk
For advice on Healthcare at Home: Telephone: 0800 917 7536
Visit: www.healthcare-at-home.com
Laura is a single 39-year-old lady with recurrent ovarian carcinoma, previously treated unsuccessfully with carboplatin chemotherapy. She was referred to Healthcare at Home for home administration of Hycamtin (topotecan) chemotherapy.
Laura lives at home with her parents, approximately one and a half hours drive away from the treatment centre. Recent surgery, including the formation of a colostomy, and multiple hospital admissions meant problems with altered body image, and sexuality which developed into a hospital phobia.
When Laura was told about Hycamtin and the possibility that it might be administered at home she was over the moon, the thought of no more visits to the hospital for chemotherapy enhanced her quality of life.
The initial treatment had to be administered in hospital, Laura then went on to have three of the remaining five cycles at home. Despite numerous physical symptoms, i.e. constipation and nausea, etc., she has tolerated the treatment very well.
Phyllis is a 68-year-old lady with recurrent carcinoma, previously treated unsuccessfully with Carboplatin chemotherapy. She was referred to Healthcare at Home for home administration of Hycamtin (topotecan) chemotherapy.
Phyllis is a housewife who lives at home with her husband. She has three grown-up children and four grandchildren, and lives approximately ten miles away from her treatment centre.
Phyllis had already had her first treatment of Hycamtin in hospital when she was referred to Hycamtin at Home. Her first treatment had been poorly tolerated mainly due to a hypersensitivity reaction to the antiemetic therapy (anti-sickness medication) which caused muscle twitching. Phyllis found that the journey from home exacerbated this, making the journey extremely traumatic as well as exhausting.
Phyllis was having to rely heavily on her husband for support and to drive her to and from hospital and felt that the experience had disrupted her life for the whole week of treatment.
Phyllis went on to have her remaining five cycles at home which were tolerated extremely well without the need for dose reduction or deferral of treatment.
Both Laura and Phyllis agreed that the benefits of receiving chemotherapy at home were many, but the main benefits included:
*No travelling
*Improved psychological support - close relationships developed between the nurses and the patients
*Increased family time, as Phyllis in particular cared for her grandchildren three days a week
*Increased privacy - home treatment allows privacy, convenience and improved quality of life. The patient can eat and rest when required, in the comfort of her own home.
The most important factor for both ladies was that they knew exactly what time the treatment would be starting, there was no waiting around because of lack of staff to administer the treatment, or, as often happens in hospital, there was 'no bed available'.
The family can continue with their work commitments and social life, alleviating the stress and anxiety which often accompany having time off work for travelling to the hospital for treatment.
Homecare nurses are available to answer questions and give assurance 24 hours a day, seven days a week.
The patient will always remain under the supervision of her own consultant and nursing staff at all times.
An article on the Caelyx Support Nurse programme will appear in our next issue.
Windeeze doesn't cure cancer
Jan was one of the ladies featured in The Times article on 4th March this year. She has written several articles for her local paper about her experience of ovarian cancer and her treatment at Derriford Hospital here in Plymouth. She wrote: "I have enclosed an overall positive story which you might like to print, even though my experience has left me with a profound distrust of the medical profession generally."
We all know what we're up against when we have this disease, but the point that comes over more than anything else in everything I read about ovarian cancer is the serious lack of knowledge that most GPs have about the disease. I agree with Professor Gordon Rustin that it's easy to get obsessed with CA 125 readings and that one has to try and get on with the business of living. However, being offered a blood test at some stage during my all-too-obvious symptoms might have been helpful.
I started to feel ill in April 2001. I was suffering neighbour harassment at the time and this was offered as an answer to my sleepless nights and nauseous days. I couldn't face food and could barely drink at times. My whole perspective on life changed. The world looked different, people seemed strange and I moved through each day hardly knowing who or where I was, I felt so ill. I was, by turns, 'depressed, anxious and stressed'. I was given Prozac and other SSRIs. I took the neighbours to mediation, the harassment stopped but I continued to get worse. By October my tummy was swollen, and I noticed a small lump in my navel, which I assumed to be an umbilical hernia (afterwards confirmed by the hospital doctor). "No," my doctor said, "it's just muscle". The swollen tummy was 'tension'. By November 2001 I had lost over 3 stone. I didn't mention this to my doctor, because I assumed it was to do with 'depression'. Conversely I was asked about weight loss and it wasn't noticed. There was an upside to this: I went down four sizes in clothes and felt much better bodywise, if not healthwise. I went to Prague that Christmas, by then I couldn't eat, my peristalsis had virtually packed up. Though Prague was beautiful, the trip was a nightmare, made worse by my luggage going to Paris. By then I was moving through each day like a robot. After returning, I went back to the doctor yet again. I can't count the number of visits I made during that summer, at least two a week, and I phoned the Devon Doctors nightline on a regular basis, too. Everyone must have been thoroughly fed up with me.
By now my tummy was so swollen I couldn't turn over in bed or bend down to pick things up. "It's wind", said my doctor, "listen to that, it's hollow, I can't prescribe anything that you can't buy over the counter." Of course 'Windeeze' doesn't cure cancer, so three days later, after pondering on what I could possibly do next, I phoned the surgery on a whim and got the number of an emergency clinic I didn't even know existed. If only I'd done this weeks before! The duty doctor listened to my symptoms, then said immediately "I want you to get into a taxi straight away and come over here". He examined me thoroughly. I was in a lot of pain and could hardly bare him to touch me. "What is it?" I asked. He paused, then said, "it's too early to speculate, but I'm sending you straight into hospital". He knew, of course. He probably saved my life. He was an older doctor and had maybe seen the symptoms before. As I laid down on the hospital bed I knew I had cancer, although I didn't have a clue where it was coming from. I was examined within minutes by a team of doctors ("Did you know you had an umbilical hernia?" one of them asked. Yes, I did know, but my doctor didn't!).
Everything snapped into action. I was in hospital for four weeks and within a week I'd had an x-ray, which didn't pick anything up, a CT scan which did, an internal examination and a biopsy. The first chemo followed within two weeks, and I had nine enemas in all. Boy, did I need those enemas! The shock of having cancer was tremendous and still is. Never a day goes by when I don't think of what I've had. My hospital consultants were marvellous, the chemo had shrunk the tumour 'by a huge amount' (it was 2.4 cm to start with) and there was only partial spread, to my omentum. I think the reason the disease gave me so many warnings was because my right ovary was stuck to my appendix. This made me feel so terrible, because I know that many women don't get any symptoms for a long time. By the second chemo the fluid had all gone and by the third I felt much better. Then came the bilateral oophorectomy and three more chemos. It's taken me over a year to feel normal again.
We're told that ovarian cancer symptoms can also indicate other less serious conditions. However, my main points are these. If one in three of us gets cancer, and one in four of us dies from it, wouldn't it be sensible to rule out the possibility of deadly illnesses with similar symptoms first? If someone is going back to the surgery week after week, isn't further investigation called for, especially if conventional treatments aren't working? My CA125 was 744 when I got in to hospital. Some time during the summer of 2001 it would have been rising. A blood test would have revealed this and I wouldn't then have been in Advanced Stage Three. This is why I feel angry towards my doctor. If there is the slightest possibility of doubt, there should be further investigation. I have recently lost a friend to ovarian cancer, she had been ill for two years, presenting tiredness as her main symptom. Her doctor told her to go home and lose weight. He has since left general practice and gone into cancer research!
On the positive side, I have no sign of the disease at present. The hospital here in Plymouth is excellent and my consultants are very pleased with my progress. They are truly dedicated and professional people, life savers. They at least knew what they were dealing with. I may be one of the lucky ones. I'll just have to wait and see.
Jan Crocker
Greenbank, Plymouth
