SG cancer care model continues to gain traction

In Singapore, NCIS* on-the-go (NOTG) – a network of community cancer treatment clinics within 20 km of the hospital – draws out workload from the NUH** NCIS Cancer Centre, with a high patient satisfaction rate and significant time and cost savings.

NOTG offers low-risk cancer treatments or supportive therapies administered subcutaneously or intramuscularly that can be completed within 15–30 min. It also provides procedures such as blood tests, simple nursing care, vaccinations, chemotherapy pump removals, and central line flushing.

“Our experience in operating NOTG for the past 6 years proves that there is a subgroup of low-risk cancer patients whose treatment can be safely administered by well-trained nurses in the community,” the researchers said. “By diverting them to NOTG, we have successfully decanted ~10 percent of our workload, allowing us to streamline our resources for optimal utilization, without compromising patient care.”

From phlebotomy to cancer Tx

Starting as a pilot project in 2016, NOTG initially offered phlebotomy services at different satellite sites. Following positive reception and success, NOTG was officially incepted in February 2017 and now provides 17 low-risk treatments and nursing services by oncology-trained nurses without onsite physicians. [ESMO Open 2024;9:103633]

Since 2017, workload in the three NOTG sites (KHFMC, JMC, FFMC***) increased significantly, with the number of visits jumping from 1,081 in 2017 to 7,520 in 2022, and the number of unique patients utilizing NOTG increasing from 406 in 2018 to 1,425 within the first half of 2023. Subsequently, this reduced the Cancer Centre load, freed up expensive resources to deliver more complicated therapies, and cut overall waiting times.

According to the researchers, the sites are currently operating at over 80-percent capacity. Plans to increase KHFMC’s existing capacity and a fourth clinic to serve Northeastern residents are in the offing. “Our long-term vision is for each Singapore resident to have a community treatment clinic located within 5 km of their home.”

User satisfaction, costs

The survey, which included 155 NOTG users and 51 non-users (median age 60 years), revealed cost and time savings benefits, with an overwhelming 96.8 percent user satisfaction rate.

Among NOTG users, about three-quarters opted in for blood taking, 41 percent for medication administration, 17 percent for line care, and 6 percent for chemo pump removal. The main reasons for choosing NOTG were proximity to patients’ homes (88.4 percent), shorter waiting times (80.6 percent), and travel convenience (65.8 percent).

Among non-users, about 86 percent have never visited an NOTG (59 percent had no prior knowledge of it). Of the 41 percent who were aware of the programme, nearly 60 percent reported they were more comfortable at the Cancer Centre. Other reasons for choosing the Cancer Centre were travel convenience (50 percent), proximity to home (44.4 percent), and cheaper travel cost (16.7 percent).

The initial NOTG utilization fee (S$5/visit) has been waived, thanks to sponsorship from pharmaceutical companies.

A win-win situation

The researchers said that NOTG represents an innovative model of delivering cancer care designed to meet the growing demands of the increasing population of cancer patients.

“While specific technicalities will need to be modified depending on local needs, we hope our experience will provide confidence that this right-siting model can be implemented easily and safely, is feasible and sustainable, and will be an ideal win-win situation benefiting both the healthcare system and individual patients,” they concluded.

Other plans

In March 2023, the NOTG received licensing approval from MOH^# to administer IV zoledronate (can be completed within 15 min). Initiated at JMC, this has been met with positive feedback.

The researchers also noted NCIS’s plans to incorporate other IV cancer treatments with short infusion times and low extravasation risk into the NOTG. This includes chemo (eg, eribulin, pemetrexed), and non-chemotherapies (eg, immunotherapy).