Home care versus hospital care in patients with multiple myeloma treated with pamidronate

Abstract

Long-term bisphosphonate therapy has been shown to offer clinical benefit in the management of multiple myeloma. This study sought to explore the feasibility and potential advantages of monthly home-based intravenous infusions of pamidronate in patients with multiple myeloma. In a prospective crossover, multicentre trial, 37 patients were randomly allocated to receive 3 months of treatment with pamidronate given in the home followed by 3 months of treatment with pamidronate given in hospital or vice versa. Results from a patient preference questionnaire indicated most patients preferred treatment at home. Quality-of-life measurement was undertaken using the EORTC QLQ-C30 questionnaire. The results indicated a small, generally consistent, although not statistically significant, trend in favour of home care treatment. Extra nursing specialist time was required for home therapy. Home therapy with pamidronate in patients with multiple myeloma appeared feasible and safe and was preferred by patients in this study.

Health‐related quality of life assessment in randomised controlled trials in multiple myeloma: a critical review of methodology and impact on treatment recommendations

“…In nine of these 13, the authors' recommendations were based on improved HRQOL and better clinical outcomes (18,19,21,23,26,(29)(30)(31)(32). In two of the trials, the decision was based on improved clinical outcomes and no change in HRQOL (24,27). Two of the studies were inconclusive due to lack of effect on clinical and HRQOL outcomes (20,22).…”

“…The 15 RCTs involved about 2200 patients and were published from 1996 to 2008, with only three published before 2000. There were 11 studies with myeloma patients only (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) and four also including patients with different haematological malignancies (29)(30)(31)(32). Eight trials were carried out in Europe, one in USA, one in Australia and five enrolled patients from several continents.…”

“…However, the HRQOL design was 'very limited' (4 ⁄ 11). The study by Smith at al was the only trial in this category that was 'probably robust' (10 ⁄ 11) (27). Patients were randomised to receive 3 months of home treatment with pamidronate followed by 3 months of in-hospital treatment with pamidronate or vice versa.…”

Soins spécifiques et soins de support en cancérologie à domicile: expérience du centre Léon-Bérard sur 751 patients en 2003

“…Elles concernent des pratiques proches des nô tres : perfusion de pamidronate dans le cadre de myé lomes multiples [50], alimentation enté rale ou parenté rale [27,44], soins de support pé diatriques (nutrition parenté rale, transfusions à domicile) [5,17,36]. Le cas de la transfusion à domicile est un peu particulier puisque cette pratique en France est tout à fait spé cifique à l'É tablissement franç ais du sang de Lyon.…”

The use of bisphosphonates in cancer patients

“…The cost of treatment could be reduced by introducing bisphosphonate home therapy as part of long-term therapy [75]. In a multicenter trial, patients with multiple myeloma (n 037) were randomly allocated to receive 3 months of in-home treatment with iv pamidronate, followed by 3 months of in-hospital treatment with pamidronate or vice versa [76]. Home therapy with pamidronate appeared feasible and safe.…”