Home care—a safe and attractive alternative to inpatient administration of intensive chemotherapies

Lüthi, François ; Fucina, Nadia ; Divorne, Nathalie ; Santos-Eggimann, Brigitte ; Currat-Zweifel, Christine ; Rollier, Patricia ; Wasserfallen, Jean-Blaise ; Ketterer, Nicolas ; Leyvraz, Serge

In: Supportive Care in Cancer, 2012, vol. 20, no. 3, p. 575-581

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    Summary
    Objective: The objective of this study was to evaluate feasibility, safety, perception, and costs of home care for the administration of intensive chemotherapies. Methods: Patients receiving sequential chemotherapy in an inpatient setting, living within 30km of the hospital, and having a relative to care for them were offered home care treatment. Chemotherapy was administered by a portable, programmable pump via an implantable catheter. The main endpoints were safety, patient's quality of life [Functional Living Index—Cancer (FLIC)], satisfaction of patients and relatives, and costs. Results: Two hundred days of home care were analysed, representing a total of 46 treatment cycles of intensive chemotherapy in 17 patients. Two cycles were complicated by technical problems that required hospitalisation for a total of 5days. Three major medical complications (heart failure, angina pectoris, and major allergic reaction) could be managed at home. Grades 1 and 2 nausea and vomiting occurring in 36% of patients could be treated at home. FLIC scores remained constant throughout the study. All patients rated home care as very satisfactory or satisfactory. Patient benefits of home care included increased comfort and freedom. Relatives acknowledged better tolerance and less asthenia of the patient. Home care resulted in a 53% cost benefit compared to hospital treatment (€420 ± 120/day vs. €896 ± 165/day). Conclusion: Administration of intensive chemotherapy regimens at home was feasible and safe. Quality of life was not affected; satisfaction of patients and relatives was very high. A psychosocial benefit was observed for patients and relatives. Furthermore, a cost-benefit of home care compared to hospital treatment was demonstrated