Active home-based cancer treatment

Abstract

BackgroundActive home-based treatment represents a new model of health care. Chronic treatment requires continuous access to facilities that provide cancer care, with considerable effort, particularly economic, on the part of patients and caregivers. Oral chemotherapy could be limited as a consequence of poor compliance and adherence, especially by elderly patients.MethodsWe selected 30 cancer patients referred to our department and treated with oral therapy (capecitabine, vinorelbine, imatinib, sunitinib, sorafenib, temozolomide, ibandronate). This pilot study of oral therapy in the patient’s home was undertaken by a doctor and two nurses with experience in clinical oncology. The instruments used were clinical diaries recording home visits, hospital visits, need for caregiver support, and a questionnaire specially developed by the European Organization for Research and Treatment of Cancer (EORTC), known as the QLQ-C30 version 2.0, concerning the acceptability of oral treatment from the patient’s perspective.ResultsThis program decreased the need to access cancer facilities by 98.1%, promoted better quality of life for patients, as reflected in increased EORTC QLQ-C30 scores over time, allowing for greater adherence to oral treatment as a result of control of drug administration outside the hospital. This model has allowed treatment of patients with difficult access to care (elderly, disabled or otherwise needed caregivers) that in the project represent the majority (78% of these).ConclusionsThis model of active home care improves quality of life and adherence with oral therapy, reduces the need to visit the hospital, and consequently decreases the number of lost hours of work on the part of carers. Management of the service by the professionals involved revealed excellent control of the process by nursing staff, with minimal visits involving doctors.

Oral Cancer Chemotherapy Adherence and Adherence Assessment Tools: a Report from North Central Cancer Group Trial N0747 and a Systematic Review of the Literature

“…Although other studies on adherence sometimes included small sample sizes, it remains important to recognize his limitation here and to point out that this small sample size enables us to draw only preliminary observations [5–7, 10, 17, 20, 21, 23]. In addition, the fact that this study was slow to accrue suggests that the patients enrolled in this trial might not be representative of a more general group of patients with metastatic cancer.…”

Importance of adherence to BCR-ABL tyrosine-kinase inhibitors in the treatment of chronic myeloid leukemia

“…While oral agents engineered for cancer treatment are far more convenient for patients, and generally yield remarkable time and cost savings to the healthcare system, the optimization of treatment results eventually relies on adequate patient compliance to the prescribed therapy. This scenario highlights the importance of measuring, monitoring, and ensuring effective adherence to TKI treatment regimens, allowing CML patients to achieve the best possible outcomes 1 ,4., 5., 6.…”

“…The presence of depression, disbelief in the benefits of the drug, having to take other drugs for comorbidities, chronicity of disease, and length of treatment, are all important factors that may contribute to nonadherence in cancer patients 1., 4.. In addition, TKIs Adverse Events (AEs), clinicians’ and site staff experience, practice behavior, and setting, and patients’ level of knowledge, were also all shown to have an impact on adherence 7 .…”

“…Among the socioeconomic factors, although low economic status has not been considered an independent predictor of adherence, this status may induce patients to favor family needs over the best treatment available. In that regard, cancer treatment, particularly in elderly, usually demands substantial effort on the part of patients and caregivers, including many sacrifices in terms of economic resources to meet the cost of therapy 4 . It has been shown that economic factors can indeed influence cancer patients’ decisions about their treatment,1., 20. with those taking oral biologic agents being more inclined to restrict or discontinue doses when faced with situations of economic deprivation 1., 20.…”

Effectiveness of a standardized patient education program on therapy-related side effects and unplanned therapy interruptions in oral cancer therapy: a cluster-randomized controlled trial

“…On the one hand, this advancement of therapy is an important step in cancer treatment. On  C. Riese riese@winho.de 3476 the other hand, it poses a challenge for oncology care [6]. In the case of intravenous chemotherapy, the drug is administered under the supervision of the oncology team.…”