According to the World Health Organization, the global cancer burden rose in 2018 to 18.1 million new cases, 9.6 million cancer deaths, and 43.8 million people living with cancer. This increase in the number of cancer patients puts tremendous pressure on the health system, and not only in terms of economics. The pressure impacts quality of treatment, number of patients who can be treated, and the presence – and distribution –of highly qualified staff. The COVID-19 pandemic has only added to that burden.
Measures to alleviate this crunch, of course, are being taken. And as the global burden of cancer grows, these measures must be tailored to regional and national priorities. This is not a one-size-fits-all challenge.
One such measure is the growing trend to move toward home-based cancer treatment. However, a number of parameters must be in place to make this happen.
One European organization is at the forefront of pushing this change. In Demark and Germany, Changing Cancer Care is playing a key role in bringing the concept of home-based care to life. This is a case study that the U.S. health system could potentially learn from.
Changing Cancer Care – A European Initiative to Shift Cancer Care Home
Changing Cancer Care, a European Interreg project, is focused on changing and the way we approach cancer care to progress the shift to home-based treatment. This could mean everything to oncology patients who are immunocompromised, as it would limit their exposure to contagions in a hospital, or, for that matter, to other potential risks in commuting to the hospital. In addition, people undergoing chemotherapy are often physically weaker, making a trip to a clinic that much more difficult and exhausting. The home offers greater comfort and less stress, which can lead to improved outcomes. And for those patients who may already be in an advanced stage of cancer, for whom every additional day with their loved ones is priceless, home diagnostics allows them to stay together.
There are a number of elements that must align to make home-based cancer care possible – from the correct infusion and remote monitoring solutions, to safe ways of disposing of used materials like IV bags, to the importance of administering routine – yet crucial – diagnostic testing.
Oncology Patient Challenges with Routine Diagnostic Testing
Oncology patients require routine diagnostic testing, before, during and post-treatment. Two types of blood tests are typically performed during cancer treatment: the complete blood count (CBC) and a blood chemistry panel. To accommodate the major challenges posed by the increase of cancer globally, new treatment methods and products are needed.
The effects of oncological treatment on patients tend to greatly complicate routine blood tests. Veins are often difficult to find as chemotherapy is tough on the vasculature of the circulatory system, and generally leads to severe weight loss. Oftentimes patients' veins are fragile, small in diameter, prone to collapse, and difficult to anchor. In addition, oncology patients tend to suffer varying degrees of muscle loss, as a cause of which their veins are not supported by tissue and have a tendency to roll. Even if blood has been taken successfully, there could be prolonged bleeding from venipuncture sites, as oncology patients may be depleted of platelets. All this makes it exceptionally difficult for health care practitioners to take blood and underlines the need for an easier, more efficient blood test. It also speaks to how far away the system seems to be, in terms of providing home-based diagnostic testing.
Capillary Blood Tests in Point of Care Testing
Capillary blood sampling is becoming progressively more common globally, partially owing to the increased availability of point-of-care (POC) testing—one of the fastest-growing areas in laboratory medicine. Capillary blood sampling by skin puncture is generally preferred for small blood volumes for laboratory testing as it is less invasive, minimizes pain, and can be performed simply and rapidly. Taking blood via skin puncture rather than venipuncture is especially relevant for patients whose veins are inaccessible, superficial, or fragile, as is often the case with oncology patients.
AI-Driven Hematology Analyzers Provide Greater Accuracy
To ensure more accurate and consistent POC results that are comparable to laboratory techniques, AI-driven hematology analyzers have been developed, which can better cope with highly pathological samples typical of hematooncology patients and are less affected by different interferences common to hematological testing. Combining the robustness offered by AI with portability and simplicity together with capillary blood sampling results in a highly accessible and rapid solution. Making these hematology analyzers accessible may fill the present diagnostic gap in care to enable home-based cancer treatment.
Bringing Patient Care Home
Changing Cancer Care (CCC) is currently running a study with one such hemotology analyzer technology, from Israel-based PixCell Medical. CCC is testing PixCell’s HemoScreen™ hematology analyzer to learn if it can effectively enable home-based testing of blood values to support oncology treatment of cancer patients in homecare settings. CCC hopes HemoScreen can simplify blood testing with its single-drop, three-step testing process.
CCC’s study, led by the Department for Research Projects and Clinical Optimization at Zealand University Hospital in Denmark, includes three phases. In the first phase, which was completed in May 2020, researchers performed validation assessments on the HemoScreen’s measurement accuracy as well as its usability within the hospital’s clinical biochemical department.
By September 2020, the hospital’s clinical oncological department staff will be trained, and additional usability testing will be performed as part of phase 2 of the study. Subsequently, patients will be trained on using HemoScreen to ensure safe use of the capillary self-testing before initiating phase 3. During the third and final phase of the study, which will be completed by December 2021, researchers will assess the feasibility for oncology patients receiving chemotherapy to utilize HemoScreen to perform the CBC monitoring assessment from home.
Through the study, patients will be trained to use the HemoScreen system to perform the 5-part differential CBC required to manage patients’ oncology therapy treatments and support clinical decision making. Health care professionals rely on readings including total white blood cell count, absolute neutrophil count, hemoglobin and platelet levels to make determinations for patients’ treatment plans. HemoScreen’s CBC testing process takes place within six minutes, providing results for 20 standard parameters. The goal will be to enable patients to eventually perform the CBC themselves – or with the support of a family member or caregiver – at home and have results remotely shared with their oncology team to determine the next step in their treatment.
Bringing HemoScreen to American Oncology Patients’ Homes
With the number of cancer patients also on the rise in the US, it would be worthwhile to explore the possibility of replicating this initiative there as well. Many home care services are already available to qualifying cancer patients, from nursing care and physical therapy, to social workers and home health aides. But even under the best of conditions, the current offering still falls short of the goals set by the CCC project, which specifically seeks to develop more effective methods for cancer treatment within a home environment. Given the structure of the health care system in the US, only some oncology patients actually receive true care at home. Given the central role of CBC testing in routine cancer care diagnostics, and the amount of safety and relief a home-based solution can offer, cancer care in the US could greatly benefit from evaluating this FDA-cleared point-of-care option.
Home-based diagnostic testing could save precious time for patients and health care systems in the US, as well as protecting patients from risk of further infection. Currently, patients in large metropolitan areas must travel to clinical centers for blood tests, not knowing if they are ready for treatment, spending hours waiting for their CBC result. Oncology patients in rural parts of the US are even worse off.
Conclusion
As more people are diagnosed with cancer, and the healthcare system is already under pressure, it is paramount that the challenges posed by this trend are accommodated with new treatment methods and products, that allow for home-based cancer care. All technologies needed for this to happen are available today. It is now up to decision-makers, from regulators to payors and those in the hospital C-suite to set in motion the policies and resources that can progress the transition to home-based care models. Both healthcare systems and patients stand to gain from this transition.
About the Author
Avishay Bransky, Ph.D., CEO and co-founder of PixCell, is an expert in microfluidics, with extensive industrial experience in applied physics, software and systems engineering. He is one of the inventors of the Viscoelastic Focusing technique, cell analysis methods and the microfluidic based cartridge. Dr. Bransky holds a B.A. in Physics, B.Sc. in Materials Engineering, and a Ph.D. in Biomedical Engineering, all from the Technion Israel Institute of Technology.