[Toward effective cancer home therapy--from the nurses point of view]

Home cancer therapy is part of the palliative care intended to enhance the Quality of Life for patients. This treatment in the home should be maintained at the hospital level. The home could be called a "Hospital without walls." Cancer patients, both in the terminal and late stages prefer treatment in their own homes regardless of severity except patients whose cancer is in the early stage. Home treatment primarily relates itself to pain control, TPN, chemotherapy, and symptom control. Our hospital started Home Care Service in 1989, and has since continued work for 18 cancer patients with 122 home visits. Patients in the late stage receiving mostly chemotherapy were treated on an outpatient basis. From August 1990 through July 1991 the patients receiving chemotherapy were 28 in number. Informed consent is essential whenever chemotherapy is involved. Drugs used at home are mostly vescicant or irritant types, in which the route of administration plays a crucial part. But most home cases are given ip treatment. In this process, major efforts have been directed toward flexibility, efficiency, and optimality in providing a support system that responds effectively to multifaceted needs of the community. Clear findings ascertained so far from our experience in this pilot study are as follows. The most urgent needs are 1. Creation of a support system a. A Discharge Planning and Team approach. b. 24-hour support service and emergency care c. A medical and welfare network in the community 2. Education and Training 3. Informed consent 4. Nursing Manual 5. Extensive use of public health insurance, in order to achieve balanced cost sharing.