Showing your chemo awareness

There's more than one way to learn more

Attracting referrals from local oncologists (see related story, p. 56) requires that you address two areas. First, you'll have to show the oncologist you can save them time and money through your business expertise. But forget that clinical expertise goes hand-in-hand with cost, and the potential referral source won't likely become a source of income.

Debbie Schmid, BSN, a clinical home infusion consultant based in Philadelphia, notes that treatments for chemotherapies are rapidly evolving. This month, she'll address the National Home Infusion Association conference on the latest clinical developments in the field, as well as how to best get up-to-date.

Two areas are worth watching for future developments, says Schmid. The first is the use of new combination therapies, many of which are now being done in the home even as clinical trials.

"We're watching the new combination chemotherapies; once patients have been monitored in a hospital, the patients are sent home if they can be monitored there," she says.

Schmid notes that it is important to note that not all chemotherapy can be done in the home, and some therapies could be but aren't.

"Different combinations present different side effects and require different actions in order to safely administer that combination in the home," she says. "A lot depends on the therapy surrounding the drug, whether it goes home or not."

Other times, it's simply reimbursement issues that prevent a drug from being given at home.

Many of the new drugs are being trialed at ambulatory infusion centers, but the patients are in the center for several hours, so nursing hours also have to be considered.

"You have to know what managed care will pay for," says Schmid. "You have to consider the drugs, the delivery system, and the amount of time the patient must be monitored at home."

Lastly, you may have to educate a physician regarding the acceptance of providing certain chemotherapies in the home.

In addition to combination therapies, there are two specific drugs that are getting plenty of attention for their effectiveness treating certain types of cancer.

"For nonsmall cell lung cancer patients, we're doing navelbine in the home," says Schmid. "It is a fairly new drug that we're seeing in the home."

Navelbine is approved for nonsmall cell lung cancer patients but is also being used as a "salvage therapy" for patients who have failed other courses of chemotherapy.

A second drug getting widespread use is topotecan. Schmid notes that the drug is not new, but it is being used on new patients.

"It was approved initially for ovarian cancer, but the FDA just approved it for breast cancer, so we're now using it for breast cancer patients," she says.

Staying current

If you're actively going to pursue more referrals from oncologists, Schmid recommends two ways of keeping your staff current on the latest drugs:

The Oncology Nursing Society (ONS) has a wealth of information. You can reach them by visiting the ONS Web site at or by calling (412) 921-7373. The ONS sells a publication called Chemotherapy Guidelines for $45.

However, Schmid says home infusion providers have a great source of information within their organization.

"There should be a direct link between the nurse and pharmacist, and not everyone is using the pharmacist to his or fullest capacity," notes Schmid. "It's very important that there's a team effort to provide the appropriate care."

Since pharmacists must prepare a care plan for each patient, they should be kept current on all developments with the patient.

"If the patient is experiencing minor symptoms, it is great to discuss it with the pharmacist because they will be able to tell you if the symptoms are a side effect of the drug or not," says Schmid. "Nurses' main concern is with the patient when they're delivering the drug, but the pharmacist's job is to know all about the drug and what you need to be looking for, so they are a great resource for advice."