As Shift Toward Telemedicine Continues, In Home Infusions Remain a No Go

The coronavirus disease 2019 (COVID-19) pandemic is drastically changing how cancer is being treated, with an emphasis on triaging patients for in-clinic visits, as well as using home care and telemedicine when possible. Although keeping patients at home decreases their risk of contracting the virus, it can also create challenges and safety issues for procedures like infusions.

The Community Oncology Alliance (COA) recently issued a statement that they are against in-home infusions of chemotherapy, immunotherapy, and cancer supportive drugs.¹

Adverse Event Risk of Home Infusions

“Oncology is a special niche, and the nurses who deliver infusions to oncology patients in the infusion centers are highly skilled, and most often nationally certified to care for these special patients,” Marta Bauman RN, BSN, OCN, nursing manager of infusion services, New Mexico Oncology Hematology Consultants in Albuquerque, said in an interview with ONCOLOGY Nurse Edition®. “The importance of delivering multidrug regimens in the correct order cannot be overstated.”

The COA statement explains that adverse events from cancer treatment can happen quickly and could potentially be life-threatening to a patient.

Further, in-home infusions might not be administered by a trained oncology nurse, and unlike at a clinic, there is not a team of knowledgeable and skilled clinicians on standby if something goes wrong.

“Oncology nurses are trained to notice these often-subtle reactions, before a patient is even aware of a change in their status,” Bauman said. “Having multiple staff members and emergency medications on hand is paramount to delivering safe and quality oncology care.”

Telemedicine Has Benefits and Limitations

Clinicians are also seeing patients virtually—through phone calls or video chats —as another way to limit the number of people coming into the clinic.

“During this time of fear and uncertainty, I believe a telemedicine visit with a trusted physician is important because it allows the physician to address the patient’s overall well-being, it enables the patient to voice their concerns, and it keeps an open line of communication between the caregiver and the patient,” Bauman said. “It is important to let patients know we are still caring for them and to keep them from feeling isolated during the pandemic.”

However, telemedicine has drawbacks as well, because it is difficult to collect important patient data over the phone or video call.

“The biggest disadvantage to telemedicine is the lack of a good physical exam and the difficulty with obtaining vital signs,” Bauman explained. “The art of touch is so important to the practice of medicine and healing in general; it’s something we are all lacking during this era of screen time only.”

Cancer Care Beyond the Pandemic

Although many clinicians may be eager to see their patients face-to-face again, the COVID-19 crisis may have changed cancer care forever, as telemedicine has been placed under the spotlight.

“I believe most practices will return to hands-on medicine because it is most beneficial. However, I think we have also discovered that telemedicine has opened a way to reach the homebound and rural patient populations,” Bauman said.

In light of recent events, 1 thing is sure: Health care providers remain dedicated and passionate about what they do.

“This pandemic has allowed the true strength of health care workers everywhere to be recognized. For Oncology Nursing Month [held in May]…, I want to say I have never been more honored to be part of such a passionate, hardworking group of nurses,” Bauman said.

REFERENCES

1. COA’s position statement on home infusion. Community Oncology Alliance. April 9, 2020. Accessed April 27, 2020. https:// communityoncology.org/coas-position-statement-on-home-infusion/