1925 - Homcology: home chemotherapy delivery in a simultaneous care project for frail advanced cancer patients

Background

Limited researches evaluate effectiveness of cancer patients-centered home care management. In this context, patients’ needs rather than prognosis should be considered. Our project represents an opportunity for patients who may benefit from chemotherapy, but with physical and social problems that prevent day-hospital access, and a model of no profit contribution to the Public Health System.

Methods

Our Medical Oncology Department, supported by a no-profit organization and according to the GP, conducted the project from May 2014 to March 2019. We included frail patients selected with G8 score (<14), with advanced disease, treated with oral, subcutaneously or parenteral biological agents, with limitations to day-hospital access, comorbidities and at least six months life expectancy. A multidisciplinary team, coordinated by three oncologists, included also four nurses, a pain therapist, a psychologist and a physiotherapist. Satisfaction was evaluated with the FAMCARE scale.

Results

A total of 161 patients (median age of 71 years, range 38-93), were enrolled. Ninety percent of patients had metastatic disease and median G8 score of 8.8 (2.5-13.5). All of them received home cancer treatments and concomitant supportive cares, if necessary; 24 patients received two or more lines of cancer treatment. Considering 148 concluded taking care, median time was 175 days (7-1200). A median number of 254 (195-325) nursing home visits and 164 (139-190) medical home visits were performed each year, with an average of 1.6 and 1.1 visits per month per patient, respectively. Median number of in-line patients was 20 (17-25). Hospitalization occurred in 19.3%. Home blood transfusions were delivered in 6 patients, paracentesis in 8. One third of them died at home. FAMECARE assessed high satisfaction.

Conclusions

Our experience demonstrates that the integration of home cancer treatment and supportive care is feasible and effective. Hospitalization rate is lower than data reported in literature. If confirmed in perspective pharmaco-economics studies, our data suggest that home cancer treatments provide high quality assistance to frail patients. Integration with no-profit organization was successful. Our model could be applied in other settings.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.