Continuous-infusion and outpatient setting: A chance for patients, a challenge for hospital pharmacists

Abstract

The use of continuous-infusion in outpatient setting could be widely used in oncology and haematology care. Many times the lack of data stability about single drug or admixture of drugs, together with patient education and safety, make difficult the transition from inpatient to outpatient setting. Nowadays, this is a big challenge for hospital pharmacists, who must take into consideration the critical issues related to chemical and physical stability, besides microbiological one, in order to ensure high quality preparations and guarantee the safety and quality of care, to protect patients and their health. The aim of this article is to highlight the critical issues concerning the transition from inpatient to outpatient setting, with particular interest regarding chemotherapy protocols, which require preparation with long-term continuous-infusion.

Continuous 14 Day Infusional Ifosfamide for Management of Soft-Tissue and Bone Sarcoma: A Single Centre Retrospective Cohort Analysis

“…High-dose ifosfamide (>9 g/m 2 /cycle) is an active agent but its use can be challenging, particularly in the palliative setting, because of toxicities including myelosupression, nephrotoxicity and neurotoxicity. One attempt to mitigate these toxicities is through the use of continuous infusional ifosfamide [ 6 , 7 , 8 ], which can be administered via a continuous ambulatory delivery device (CADD) [ 9 ], concurrently with mesna to minimise the risk of urothelial toxicity [ 10 , 11 ]. In addition to better tolerability, it has been proposed that this delivery method may possess superior cytotoxicity [ 12 ] and can be used as an outpatient regimen, whereas conventional fractionated ifosfamide is predominantly used in the ambulatory setting.…”

“…Patients had either oligometastatic disease (four patients) or local recurrence (five patients) with SS (four patients) and ES (two patients) the most common histological subtypes treated. The median number of cycles of infusional ifosfamide given was five (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], and all patients achieved disease control either with radiological and/or metabolic improvement (67%) or stable disease (33%). Median OS for these patients at the date of analysis was 24 m (range 12-32).…”

Not only a time-saving approach: Is it the time of subcutaneous formulation for daratumumab administration?

“…Subcutaneous injection might also potentially allow home administration, promoting a transition from inpatient to outpatient setting: several studies have shown cost, resource, and quality-of-life benefits. 1 This way, efforts are underway to assess the feasibility of administering monoclonal antibodies at home.…”