Outpatient chemotherapy, family-centered care, electronic information, and education in adolescents and young adults with osteosarcoma

Abstract

Current osteosarcoma chemotherapy is "standard" (doxorubicin, cisplatin, high-dose methotrexate ± ifosfamide-mesna, and etoposide ± mifamurtide), but current regimens have many short-term, medium-term, and long-term side effects. Generally 12-15 cycles of chemotherapy are given in the hospital over 7-10 months. Even in the absence of new research protocols, improvement in quality of life is now possible, with all osteosarcoma chemotherapy agents now being able to be administered in the outpatient setting. Outpatient chemotherapy is not only less expensive, but in the adolescent and young adult population can result in better quality of life for some. In this paper, we share information to help reduce the frequency of hospitalization and review some tools and strategies to facilitate communication when providing outpatient chemotherapy, family-centered care, and information/education. These include antiemetics with both longer-acting 5HT antagonists and aprepitant, outpatient chemotherapy guidelines, and a 5-week editable calendar that is part of our electronic medical record. Sharing information on absolute lymphocyte count recovery is another means of maintaining hope and increasing understanding of the prognosis of osteosarcoma. Finally, this paper shares an advanced directive/palliative care "checklist" of issues for patients and caregivers to consider at end of life, ie, when "cure of cancer is not the answer". In summary, better communication at all stages of osteosarcoma care can help reduce hospitalization, improve quality of life, and maintain hope in the adolescent and young adult population with osteosarcoma.

Letting Kids Be Kids: A Quality Improvement Project to Deliver Supportive Care at Home After High-Dose Methotrexate in Pediatric Patients With Acute Lymphoblastic Leukemia

“…Organizations looking to replicate this system must take location and variables of processing into account when considering impact on duration of hospitalization. Patient and caregiver preference toward ambulatory HD MTX plays an instrumental role in the success of the transition to the outpatient setting (Anderson et al, 2013;Evans et al, 2016;Hansson et al, 2011;Holdsworth et al, 1997;Stevens et al, 2006). Patient and family preferences guided the decision to receive supportive cares in the ambulatory setting for this project.…”

“…These educational efforts laid the foundation and provided standardized education for stakeholders to be successful in planning and implementation. Anderson et al (2013) and Matziou et al (2012) recommended that patient and family feedback be obtained throughout the transition to improve the process. A discussion with families after each cycle allowed for modifications to be made to the system as needed.…”

“…Hospitalization disrupts family cohesion, a known indicator of QOL (Santos et al, 2015). While hospitalized, families abandon rituals including mealtimes and sleep routines, putting them at risk for a loss of stability and support (Anderson et al, 2013). Risk factors for decreased QOL included HR diagnoses, intensive phases of treatment, related toxicities, and duration of hospitalization (Fardell et al, 2017).…”

Future Directions in the Treatment of Osteosarcoma

“…Such changes include reducing treatment related toxicity, such as nausea, and mucositis [ 29 ] and improving immune function via better nutrition [ 29 ]. There is also an increased focus on outpatient therapy using chemotherapy pumps with supportive medication regimens during this period [ 30 ]. For patients with metastatic disease, local control of metastases (surgery, SBRT and/or cryoablation) can be considered to reduce disease burden.…”

Mifamurtide in metastatic and recurrent osteosarcoma: A patient access study with pharmacokinetic, pharmacodynamic, and safety assessments

“…Initial treatment of osteosarcoma takes 32–48 weeks and involves many hospitalizations and/or clinic visits for chemotherapy administration, surgery, and close monitoring of chemotherapy‐related side effects such as anemia, neutropenia, thrombocytopenia, nausea and vomiting . Outpatient chemotherapy for osteosarcoma is now possible; this can improve quality of life .…”