More cancer patients in Singapore being treated at home by visiting nurses

Madam Ang Tua Moi receiving treatment at home by nurse June Tang from Jaga-Me Medical Home Care on April 1, 2022. ST PHOTO: THADDEUS ANG

SINGAPORE - For three years, Madam Ang Tua Moi, 84, would have to go down to the National Cancer Centre Singapore (NCCS) every three weeks to get treated for stage 4 breast cancer.

But her back condition makes it difficult for her to walk, stand, and even sit, and she relied on her daughter to take leave from work to go with her to the centre.

So when she was told in mid-2020 that she could receive her treatment at home, she was happy.

"I'm very relieved that my daughter doesn't need to take me to the centre for treatment every month," Madam Ang said in Mandarin on Friday (April 1).

She is one of about 330 cancer patients who are now being treated for their condition at home under a programme launched by NCCS in 2020.

Dr Elaine Lim, a senior consultant at NCCS' Division of Medical Oncology, said that the centre had already intended to extend its clinical services to the community, in particular the elderly, before the start of the Covid-19 pandemic.

"We were aiming for better access to care for patients, greater convenience, and improved treatment compliance.

"When Covid-19 happened, it accelerated the implementation of NCCS Home Care as it dovetailed nicely into the slew of physical distancing measures that came into effect on a national level," she said.

She added that some younger patients also opted for home treatment to avoid potential exposure to the coronavirus.

Dr Lim said that before the home care programme, breast cancer patients who are positive for the human epidermal growth factor receptor 2 (HER2) had to visit the cancer centre every three weeks for about a year to have drugs administered intravenously (IV).

While the administration of the drug itself lasts about an hour, Dr Lim said such visits would often last longer due to waiting times.

However, she highlighted that innovation in alternative modes of drug administration, such as under the skin, and into the muscles, has shortened the time for certain treatments compared with using the IV method, without compromising efficacy or safety.

NCCS piloted the home care programme in July 2020 with seven breast cancer patients, who had Trastuzumab administered under the skin via injection.

Following the success of this pilot, the programme was expanded to include more drugs, including immune boosters, bone-modifying agents and hormonal therapy drugs.

During the home visit, a nurse from mobile health company Jaga-Me will assess the patient's vitals before injecting the required drug. The patient is then monitored for at least 15 minutes before the nurse leaves.

Each visit lasts about half an hour, including post-injection monitoring time, said Dr Lim.

She pointed out: "There are no queues to wait in and the drugs are delivered to the patient's home. The patient could be doing work or tending to other matters during the home visit by the nurse.

"There is also no travelling expense and no need for the patient or caregiver to take time off work or arrange for alternative childcare."

Madam Ang's daughter, practice manager Stephanie Lee, 54, who has been caring for her, said: "It feels like a heavy load has been lifted off my shoulders. Now she doesn't have to wake up so early to go to the hospital. I also don't have to rush up and down to the hospital as well... She can wait here in comfort."

Patients need to pay for only the cost of the drug. The home visit by the nurse is free as it is fully sponsored by grants.

Dr Lim said NCCS is in discussions with the authorities to see if the service can be claimed under MediShield Life, or be made MediSave-deductible.

All cancer patients are eligible for the home care programme if their treatments can be administered at home.

Patients who need IV treatment are currently not eligible for the programme, but the option is being actively explored, said Dr Lim.

The NCCS hopes to expand the types of drugs that can be administered under the programme, Dr Lim said, adding: "This service helps enable Singapore to be pandemic-ready, minimising disruption of care for cancer patients."

Join ST's Telegram channel and get the latest breaking news delivered to you.