Tag: Patient Care

Cancer care is steadily shifting out of the hospital and into the home. For many patients that is a welcome change. It also raises a question we cannot ignore.

Care travels — do the skills?

When treatment moves home, the side effects move with it. But the concentrated expertise that lives in an oncology ward does not automatically follow. A patient managing a reaction at their kitchen table needs the same quality of guidance they would receive on the ward.

That gap is where avoidable dose reductions and unnecessary suffering creep in.

Building expertise that scales

Closing the gap means equipping more people — homecare nurses, patients and their families — with clear, structured ways to recognise and respond to side effects early. It means accredited training and shared methods, not ad-hoc advice.

This is precisely why I built the Dutch Centre of Expertise for Side Effects of Cancer Medicines: to make sure expertise scales as care decentralises.

An opportunity, not just a challenge

Handled well, the shift home is a chance to make side-effect care more proactive and more personal than it ever was in the hospital. Side effects don’t have to be a barrier — they can be an opportunity to care better.

Learn how I help care teams

When people first meet the TARGET System, they are often surprised that the first step is not an intervention at all. It is terminology.

Shared language comes first

If a nurse, an oncologist and a patient each use a different word for the same reaction — or the same word for different things — the whole chain of care wobbles. Assessment, reporting and grading all depend on everyone meaning the same thing.

That is why TARGET begins with T for Terminology. Get the language right, and everything downstream gets easier.

The six steps, briefly

TARGET stands for Terminology, Assessment, Reporting, Grading, Education and Treatment. It is a six-step method for handling adverse events — built for the skin and mucosal side effects of targeted therapy, but applicable to almost any adverse event.

Crucially, its aim is to bring reactions under control without immediately reaching for a dose reduction or interruption.

From method to muscle memory

A system only helps if a team can actually run it. TARGET is designed to become second nature — a shared workflow that turns scattered, reactive side-effect care into a repeatable standard.

Explore the full TARGET System

The most powerful side-effect tool a clinician has is not a cream or a pill. It is a conversation held before treatment even begins.

Ask what they know

Patients arrive with very different levels of understanding. Some have read everything; some have avoided reading anything. Asking what a patient already knows tells you where to start — and surfaces misunderstandings before they become problems.

Ask what they expect

Expectations shape experience. A patient who expects a manageable skin reaction responds very differently from one who fears the worst. Knowing what someone expects lets you set realistic markers together — and agree on what ‘normal’ looks like.

Ask what they fear

Fear is where silent non-adherence begins. A patient afraid of a particular side effect may quietly stop treatment rather than report it. Naming the fear out loud makes it something you can plan for together.

Three short questions — what do you know, what do you expect, what do you fear — turn the patient into an expert in their own care. That partnership is the foundation of everything that follows.

Read more about my approach

Modern cancer medicines are remarkable. But their promise depends on one thing we talk about far too little: whether the patient can actually stay on them.

The number that should stop us in our tracks

In practice, more than half of patients treated with modern anticancer drugs experience a dose delay, and roughly one in three need a dose reduction. Frequently the reason is not the tumour — it is a side effect.

Every unplanned reduction or interruption is a small compromise to the treatment plan. Enough of them, and a therapy that could have worked never gets a fair chance.

Why prevention beats reaction

Too often side effects are treated as something to react to once they arrive. By then the options narrow, the patient is already suffering, and the dose is the first thing to give way.

The alternative is to anticipate: to know which reactions a given therapy tends to cause, to prepare the patient before treatment starts, and to intervene at the earliest sign. Small, low-cost actions — taken early — keep patients on track.

A different starting question

Instead of asking ‘how do we reduce the dose?’, the better question is ‘how do we control this side effect so we don’t have to?’ That shift changes everything about how a care team plans treatment.

It is the question at the heart of my work — and of the TARGET System, a six-step method for bringing adverse events under control.

See how the TARGET System works