Guidelines for Hospitalization for Chemotherapy

Abstract

Administration of cancer chemotherapeutic agents has shifted from the hospital to outpatient settings, usually the oncologist's office. Hospitalization for chemotherapy is now limited to specific situations, reflecting the need for prolonged direct observation, prevention or treatment of anticipated or real side effects, the use of special facilities and the minimization of certain treatment risks which cannot be effectively dealt with in an outpatient setting. New financial guidelines also have a significant impact on the location of chemotherapy administration. Outpatient chemotherapy has the advantages of allowing safe, easy drug administration, respecting the patient's wish to avoid hospitalization and providing a familiar facility, which enhances the patient's physical comfort and psychological well-being. The oncologist has direct and immediate control of drug administration, assistance is immediately available if problems arise, care is less expensive than inpatient care and overnight stay can be avoided. It also facilitates monitoring and control of treatment costs and allows treatment to be administered at the patient's convenience. Specific circumstances which justify hospitalization for chemotherapy, as detailed in Table 1, include: higher dosage cisplatin, special procedure chemotherapy, induction therapy for acute leukemia, high-dosage chemotherapy with or without stem cell/bone marrow transplantation, severely emetogenic chemotherapy, ifosfamide therapy, combination radiation therapy plus chemotherapy programs, coexistent medical problems (comorbidities), complex chemotherapy programs, the initial dose of chemotherapy while hospitalized for diagnosis of cancer, a scheduled dose of chemotherapy occurring during hospitalization for an unrelated problem, special measures required to prevent significant side effects, high-dose methotrexate protocols, intraperitoneal chemotherapy, certain investigational treatment protocols, and if chemotherapy administration is mandatory despite comorbidities that would ordinarily delay or contraindicate chemotherapy.

Evaluation of an Outpatient Model for Treatment of Acute Myeloid Leukemia

“…While limitations on health care expenditures have played a role in this transition, improved abilities to provide supportive care, to monitor patients regularly, and to expedite admission to hospital when necessary have also facilitated change in practice. Outpatient management of solid tumor malignancies is well described [3]. Ambulatory programs for high-dose chemotherapy followed by autologous hematopoietic stem cell rescue represent a viable option [4][5][6].…”

Multidisciplinary Prognostication Using the Palliative Prognostic Score in an Australian Cancer Center

“… 21 Given that palliative care is increasingly integrated into the outpatient setting in cancer centers, it is important to have prognostic tools that are useful for this population of patients. 22 …”

Cisplatin, tegafur, and leucovorin

“…The administration of higher doses of cisplatin (75 mg/m 2 or more) still requires hospitalization for prolonged hydration and management of emesis. 23 Because no evidence of dose dependency of cisplatin activity in advanced SCCHN has been noted, 24 we prescribed cisplatin in the dose of 50 mg/m 2 biweekly. This dosage could be used in an outpatient setting.…”