All aboard the chemo bus

By Dr Ayan Panja
BBC Health Check

image copyrightHope for Tomorrow
image captionTaking treatment to the people - the chemotherapy bus

Chemotherapy is a harrowing experience but it becomes even harder to endure when such potentially lifesaving treatment lies in a hospital hours away from home. However, there is now a solution that brings chemo to the heart of the community.

The chemotherapy bus, run by local NHS Trusts and a charity called Hope for Tomorrow, is a fully functioning health unit that allows up to four people to be treated just minutes from their front door.

There are now eight chemotherapy buses in operation around the UK, and the one working around Taunton in Somerset has changed the lives of the people who use it.

"It's brilliant," says Marion Sayer who is recovering after lung cancer. "It makes life so much easier. I used to have to travel to the hospital which would take an hour and now it takes me a few minutes to come here instead."

Around 100,000 people have chemotherapy each year in the UK. Almost all must attend a specialist hospital to have their medication administered.

A typical session usually involves the patient having drugs fed into their body through a vein, and can last anywhere between 30 minutes and four hours.

It works by poisoning rapidly dividing cells, a phenomenon first observed by looking at the effects of mustard gas on soldiers in World War One.

A related chemical, nitrogen mustard, was found to damage DNA in cells. And as cancer cells replicate faster than healthy cells, they - and therefore their DNA - are more likely to be killed off.

Moving forward

Nitrogen mustard soon spawned a group of drugs which became effective treatments for certain cancers.

But while new therapies have since become available, the way they are administered has not changed.

Most chemotherapy needs to be supervised by an oncologist or haematologist and they tend to be based in the bigger regional cancer centres.

For those living far from their nearest specialist hospital, the additional travel can really take its toll. This is an experience that Christine Mills, who founded Hope for Tomorrow, knows all about.

"My husband David had cancer of the spine," Christine told the BBC, "and of the many challenges we faced, the 60-mile round trip to the hospital was particularly stressful.

"I was looking out for every pothole and there were problems like traffic and finding a parking space too."

It was this personal experience that prompted her to start raising funds for the world's first mobile chemotherapy unit.

"I knew that the problem of travelling was something I wanted to help with," she says.

"I wanted to give people time to do other things, to find a life outside cancer."

media captionDr Ayan Panja reports on the chemotherapy clinic that comes to you

All aboard

From the outside, the bus looks like a large white box on wheels.

But once inside it is like any normal clinic, complete with built-in white units, alcohol gel dispensers, a fully equipped trolley with resuscitation equipment, waste facilities and a sink.

Yet there is also something that feels subtly different.

The small kitchen area means that patients can have a cup of tea, and the very fact that the unit is parked up on the patient's home turf automatically makes it less threatening.

image copyrightDiana Rose
image captionDiana Rose's view from the mobile chemotherapy unit

Patients often build close friendships with each other through their visits and some, such as artist Diana Rose, use their time their to create something positive.

"My twin boys bought me an iPad and I would sit and draw on it on the bus," she told the BBC.

"I'd draw the view out of the window. I couldn't do that in the hospital. There were no windows and all I could do was look at the other sick patients."

Marie Ford is the clinic co-ordinator for the chemotherapy bus and has seen the difference it makes.

"Patients all say how pleased they are with the service," she says.

"It saves them time, they are less tired and they find the service really convenient."

Branching out

"From a tiredness point of view, it's enormous," says Wendy Hadley, who has been using the bus for four years.

"[If I go to hospital] it's pretty much four or five hours out of your treatment day."

But it does not come cheap. Each bus is currently made and customised in Wales and costs £260,000 to build, run and maintain over a three-year period.

Also, the service is not suitable for every type of treatment.

The idea of a mobile health unit does not have to be restricted to cancer treatment alone. They could equally be equipped for services such as neuro-imaging and renal dialysis.

For now though, Hope for Tomorrow is looking to expand the chemo bus concept across the UK, with the hope of making the challenge of chemotherapy slightly easier to endure.

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