Home-based care—the most traditional type of health care—is making a comeback, especially for cancer patients. This is even more true for patients with hematologic malignancies, for whom there is no clear-cut distinction between the curative and end-of-life phases of disease. In an effort to keep patients comfortable and out of medical facilities, several hospitals have initiated Hospital at Home programs to provide a combination of acute, palliative, and hospice care needs. Some industry experts speculate that telehepatology may even join the mix.
In many cases, advanced cancers are incurable and the patients are transferred to hospice care. However, advanced hematologic cancers often remain potentially curable; to further complicate matters, regular transfusions can ease discomfort and prolong the patient’s lifespan. Thus, many hematology-oncology programs focus on palliative care rather than end-of-life care. By keeping patients at home, the Hospital at Home program hopes to make them feel more comfortable while lightening the burden and cost of traveling to receive health care.
The Hospital at Home program aims to provide the same level of care they would receive at the hospital but at home. A pilot study demonstrated that the program is feasible and cost-effective and suggested that patients experienced fewer complications, better functional outcomes, greater satisfaction, and lower costs.
As noted by Laurence J. Heifetz, MD, FACP, medical director of Gene Upshaw Memorial Tahoe Forest Cancer Center, the initial visit with a hematologic oncology patient must occur face-to-face due to the aggressiveness of the therapy. Midcycle visits, though, can take place via telemedicine because the purpose of the visit is to monitor the patient for side effects; locally, the patient only needs a clinical laboratory and nurse practitioner while interacting remotely with the physician. After patients have completed therapy and entered the observation phase, telemedicine can be used to monitor their status every 3 months for the rest of their lives.
With telehepatology, the goal is for the patient and doctor to initially meet in person to form the human relationship that is so essential for a healthy doctor-patient experience. Afterward, midcycle visits and follow-ups can all occur from the patient’s home area, reducing the costs associated with traditional visits such as lost wages, travel time, family members taking time off to drive the patient, etc.
With a trained nurse practitioner and laboratory work conducted locally, Heifetz said, there is no risk to the patient in making medical decisions based on telemedicine visits.