Oral anticancer therapy project: Clinical utility of a specific home care nursing programme on behalf of Italian Association of Medical Oncology (AIOM)

Abstract

Aims and objectives To assess the effectiveness of a specific home care nursing programme in addition to standard care in patients (pts) receiving oral anticancer treatments. Background Oral anticancer therapy present challenges for pts since treatment is a home‐based therapy. This study evaluates the potentiality of a home care nursing programme in decreasing hospital accesses for not severe toxicity. Methods This is an open‐label, multicentre, randomised trial including pts who were receiving an anticancer oral drug. The study complies with the CONSORT checklist published in 2010. Concomitant use of radiation therapy, intravenous or metronomic therapies, or the intake of previous oral drugs was not allowed. Pts were randomly assigned to home care nursing programme (A) or standard care (B). In arm A, dedicated nurses provided information to pts, a daily record on which pts would take note of drugs and dosages and a telephone monitoring during the first two cycles of therapy. The primary outcome was the reduction in improper hospital accesses for grade 1–2 toxicity according to CTCAE v4.0. Results Out of 432 randomised pts, 378 were analysed (184 pts in arm A and 194 in arm B). Hospital accesses were observed in 41 pts in arm A and in 42 pts in arm B (22.3% vs. 21.6%, respectively). No difference was detected in proportion of improper accesses between arm A and arm B (29.3% vs. 23.8%, respectively). Conclusions Our experience failed to support the role of a specific home care nursing programme for pts taking oral chemotherapy. An improved attention to specific educational practice and information offered to pts can explain these results. Relevance to clinical practice Our results underline the role of nurse educational practice and information offered to patients. A careful nurse information of patients about drugs is essential to reduce toxicities avoiding the opportunity of a specific home monitoring.

Nurse-led telehealth interventions for symptom management in patients with cancer receiving systemic or radiation therapy: a systematic review and meta-analysis

“…Eight RCTs and 2 quasi-experimental studies (CBA design) were included, which evaluated 2315 participants (Table 1 ). Five studies were conducted in the USA [ 11 , 17 , 41 – 43 ] and one each in Canada [ 14 ], France [ 38 ], Italy [ 39 ], Hong Kong [ 23 ], and Turkey [ 40 ]. Seven studies evaluated heterogeneous samples of patients with cancer, two studies included patients with lung cancer [ 40 , 43 ], and one study included women with breast cancer [ 23 ].…”

“…Most studies received funding from hospitals, universities, or national-level granting agencies [ 11 , 14 , 17 , 23 , 38 , 40 – 43 ]. One study reported industry funding [ 38 ], and another did not report funding [ 39 ].…”

“…Due to the nature of the telehealth intervention, nearly all studies were high risk due to limitations in blinding participants. Many studies did not clearly state if HSU information was collected from administrative databases or provided by participants [ 38 , 39 , 43 ]. Basch et al collected admissions data through medical records, but did not provide clear results on this outcome [ 17 ].…”

“…Four RCTs reported HSU as secondary outcomes [ 17 , 38 , 39 , 43 ]. Three of these studies reported ED visits [ 17 , 39 , 43 ], three reported hospitalizations [ 17 , 38 , 43 ], and two reported unscheduled clinic visits [ 39 , 43 ]. Two studies had reactive interventions [ 17 , 43 ], and two had scheduled interventions [ 38 , 39 ].…”

“…Three of these studies reported ED visits [ 17 , 39 , 43 ], three reported hospitalizations [ 17 , 38 , 43 ], and two reported unscheduled clinic visits [ 39 , 43 ]. Two studies had reactive interventions [ 17 , 43 ], and two had scheduled interventions [ 38 , 39 ]. One study reported HSU as combined outcome (clinic and ED visits) [ 39 ].…”