Hospital and home chemotherapy for children with leukemia: A randomized cross‐over study

Stevens, Bonnie; Croxford, Ruth; McKeever, Patricia; Yamada, Janet; Booth, Marilyn; Daub, Stacey; Gafni, Amiram; Gammon, Janet; Greenberg, Mark

doi:10.1002/pbc.20598

Cited by 58 publications

(74 citation statements)

References 26 publications

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“…In some studies, differences between the quality of life of hospitalized patients and those receiving ambulatory chemotherapy were reported (35,36). In this study, though not statistically significant, in patients receiving therapy while hospitalized lower quality of life scores were detected when compared with other groups.…”

Section: Discussionmentioning

confidence: 43%

A prospective follow-up of quality of life, depression, andanxiety in children with lymphoma and solid tumors

Yildirim¹,

Demirkaya²,

Sevinir³

et al. 2017

Turk J Med Sci

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The aim of this study was the determination and prospective follow-up of quality of life, depression, and anxiety in pediatric patients with cancer under chemotherapy, as well as the evaluation of related factors.Materials and methods: Fifty newly diagnosed pediatric cancer patients and their parents were prospectively monitored before, during, and after therapy, and tests were used.Results: Significantly lower quality of life scores were recorded during treatment, in the group with CNS tumors, in the group receiving chemotherapy plus radiotherapy plus surgery, in the inpatient-only treatment group, in the group receiving treatment for longer than 6 months, and in the group of patients whose diagnosis was delayed for more than 3 months. Total quality of life scores for children and their parents were 82.

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Section: Discussionmentioning

confidence: 43%

A prospective follow-up of quality of life, depression, andanxiety in children with lymphoma and solid tumors

Yildirim¹,

Demirkaya²,

Sevinir³

et al. 2017

Turk J Med Sci

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show abstract

“…In the Greater Toronto Area, pediatric patients with acute lymphoblastic leukemia were enrolled onto a randomized crossover study in which patients acted as their own controls, receiving chemotherapy at home for 6 months and subsequently in hospital for 6 months, and vice versa. The study included administration of two different chemotherapeutic agents (cytosine arabinoside and low-dose methotrexate) 5 . In that study, the IV chemotherapy was prepared by the community pharmacy, delivered to the patient's home, and administered by a trained community nurse 5 .…”

Section: Discussionmentioning

confidence: 99%

The Hospital at Home Program: No Place Like Home

et al. 2017

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BackgroundThe treatment of children with cancer is associated with significant burden for the entire family.Frequent clinic visits and extended hospital stays can negatively affect quality of life for children and their families.Methods Here, we describe the development of a Hospital at Home program (H@H) that delivers therapy to pediatric hematology, oncology, and blood and marrow transplant (bmt) patients in their homes. The services provided include short infusions of chemotherapy, supportive-care interventions, antibiotics, post-chemotherapy hydration, and teaching.Results From 2013 to 2015, the H@H program served 136 patients, making 1701 home visits, for patients mainly between the ages of 1 and 4 years. Referrals came from oncology in 82% of cases, from hematology in 11%, and from bmt in 7%. Since inception of the program, no adverse events have been reported. Family surveys suggested less disruption in daily routines and appreciation of specialized care by hematology and oncology nurses. Staff surveys highlighted a perceived benefit of H@H in contributing to early discharge of patients by supporting out-of-hospital monitoring and teaching. ConclusionsThe development of a H@H program dedicated to the pediatric hematology, oncology, or bmt patient appears feasible. Our pilot program offers a potential contribution to improvement in patient quality of life and in cost-benefit for parents and the health care system.

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“…Studies have shown improved QOL parameters when patients are offered ambulatory and home chemotherapy [3,22,23]. Further studies may be needed to confirm this assumption among patients from underserved communities.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory high‐dose methotrexate administration among pediatric osteosarcoma patients in an urban, underserved setting is feasible, safe, and cost‐effective

Mahadeo

Santizo

Baker

et al. 2010

Pediatric Blood & Cancer

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Background. We describe the safety, feasibility, and provide a cost-estimate of outpatient high-dose methotrexate administration (HDMTX) among an urban, underserved population. Procedure. A retrospective analysis of ambulatory HDMTX administration among osteosarcoma patients, at Montefiore Medical Center's Children's Hospital (Bronx, NY) was performed. HDMTX (12 g/m 2 ) was given intravenously (IV) over 4 hr after urine alkalinization. Patients were discharged home to continue IV hydration and alkalinization delivered via a home infusion pump. Families were instructed to monitor urine pH overnight and management was adjusted according to our institution's treatment algorithm until MTX level ≤0.1 mol/L. A cost estimate was performed to assess the difference in costs for outpatient versus hypothetical inpatient administrations. Results. Of the 97 ambulatory HDMTX administrations, 99% were successfully completed. One patient failed outpatient administration secondary to home infusion pump malfunction. This patient successfully completed subsequent courses as an outpatient. Most patients (72%) had a MTX level of <10 mol/L at 24 hr post-HDMTX. No patients were found to have a MTX level of >50 mol/L at 24 hr. About 26% of courses were associated with grade III or IV neutropenia, 4% were associated with grade III or IV thrombocytopenia and 1% were associated with grade III/IV leukopenia. Compared to a hypothetical hospital inpatient stay, the hospital costs for ambulatory HDMTX were an average of $1400 less per cycle. Conclusion. Ambulatory HDMTX administration among an underserved, urban population is safe, feasible, and cost-effective. Pediatr Blood Cancer.

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Hospital and home chemotherapy for children with leukemia: A randomized cross‐over study

Cited by 58 publications

References 26 publications

A prospective follow-up of quality of life, depression, andanxiety in children with lymphoma and solid tumors

A prospective follow-up of quality of life, depression, andanxiety in children with lymphoma and solid tumors

The Hospital at Home Program: No Place Like Home

Ambulatory high‐dose methotrexate administration among pediatric osteosarcoma patients in an urban, underserved setting is feasible, safe, and cost‐effective

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