Supportive home care service: A home-based simultaneous care intervention

Background

An increasing amount of scientific evidence has confirmed the utility for cancer patients, in terms of quality and quantity of life, performance of therapeutic results, and gradual transition of care, of a simultaneous care approach. In a period of human and financial resource constraints innovative forms of cooperation between oncologists and palliative care providers are needed.

Methods

The Oncology Department in the Florence Health District with the support of the Tuscany Tumors Association, a non-profit organization, has conducted, from March to December 2015, a pilot project to test the feasibility of a Supportive Home Care Service, a dedicated home-based service for the prevention and treatment of severe cancer symptoms, and of the side effects and toxicities secondary to palliative cancer therapies. Home care was guaranteed by a highly qualified staff, and was available 24 hours a day, every day of the year.

Results

A total of 28 patients, median age 75 years (range 46-85), affected by advanced solid tumors were enrolled. The majority of patients had metastatic disease (82%), and they all received palliative and supportive care in the home setting and active anticancer treatment as outpatient. A total of 153 (range 1-27) medical and 146 (range 1-37) nursing visits were perfomed, respectively. The average number of medical and nursing visits per patient was 6.95 and 9.73, respectively. Infusional therapy was administered in 28% of the patients for a total of 105 days of treatment. The average duration of care as of January 2016 was 122.67 days (range 13-311). The average number of intervening hospital admissions due to severe toxicity was 0.14 (calculated as the ratio between the number of admissions and the number of patients). Thirteen patients (46% of the total) have died at the time of this analysis, with an average duration of care of 76.92 days. The place of death was home in 92% of the cases. A pharmacoeconomic analysis of this intervention is currently ongoing.

Conclusions

In our experience early integration of simultaneous care and active cancer treatments is effective. A home-based intervention guarantees personalization and humanization of cancer treatments, and reduces hospitalization, potentially leading to a more wise use of human and financial resources.

Clinical trial identification

Legal entity responsible for the study

Oncology Department, Azienda USL Toscana Centro, Florence

Funding

Associazione Tumori Toscana

Disclosure

All authors have declared no conflicts of interest.