Evaluating patients’ experiences of home and hospital chemotherapy

Hall, Melanie; Lloyd, Hilary

doi:10.7748/cnp2008.02.7.1.35.c6469

Cited by 14 publications

(27 citation statements)

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“…4,24,29,30,32,39,41,51,[55][56][57][58][59][60][61][62][63][64] The studies were conducted in Canada (four [55][56][57]60 ), the USA (one 59 ), the UK (nine 4,24,29,30,39,51,62,63 ), Denmark (two 41,61 ), Iceland (one 64 ) and Australia (one 32 ). UK studies were in England (six 4,24,29,30,39,62 ) and one in each of Wales, 51 Northern Ireland 63 and Scotland. 58 Table 6 displays a summary of the included study characteristics.…”

Section: Overview Of Study Characteristics and Qualitymentioning

confidence: 99%

“…4,29,39,51,57,58 Eleven papers contributed data on the home setting 4,24,30,32,41,55,56,59-61 and one paper was a theoretical discussion of a proposed service.…”

Section: Overview Of Study Characteristics and Qualitymentioning

confidence: 99%

“…Three studies were conducted in the UK (England), 4,29,30 two were conducted in Australia, 31,32 and one study was conducted in each of Canada, 33 Denmark, 28 France, 34 Japan 27 and Spain. 35 Eight studies 27,28,[30][31][32][33][34][35] compared chemotherapy in the home setting with chemotherapy in a hospital outpatient setting. One study 29 compared a community setting with a hospital outpatient setting.…”

Section: Systematic Reviewmentioning

confidence: 99%

“…Fifteen studies 4,24,30,39,41,51,55-58,60-64 used interviews to gather data (one study used telephone interviews 58 ), and two used open-ended questions on a questionnaire. 29,32 One study collected data through focus groups, open-ended questionnaires and telephone interviews.…”

Section: 66mentioning

confidence: 99%

“…Studies were also conducted solely in populations with ovarian, 27 colon 28 or breast cancer. 30 The study in children was of a population with acute lymphoblastic leukaemia.…”

Section: Systematic Reviewmentioning

confidence: 99%

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The delivery of chemotherapy at home: an evidence synthesis

Corbett

Heirs

Rose

et al. 2015

Health Services and Delivery Research

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BackgroundRecent policy and guidance has focused on chemotherapy services being offered closer to home, but the clinical and economic implications of this are uncertain.ObjectivesTo compare the impact of delivering intravenous chemotherapy in different settings on a range of outcomes, including quality of life, safety and costs.DesignMultimethods approach: systematic review of clinical effectiveness, qualitative and cost-effectiveness studies; description of the patient pathway and brief survey of current provision; and development of a decision model to explore aspects of cost-effectiveness.SettingProvision of intravenous chemotherapy.ParticipantsChemotherapy patients.InterventionsSetting in which chemotherapy was administered (home, community or outpatient).Outcome measuresSafety, quality of life, preference, satisfaction, opinions/experiences, social functioning, clinical outcomes, costs and resource/organisational issues.Data sourcesSixteen electronic databases (including MEDLINE, EMBASE and The Cochrane Library) were searched from inception to October 2013 for published and unpublished studies.Review methodsTwo reviewers independently screened potentially relevant studies, extracted data and quality assessed the included studies. Study validity was evaluated using appropriate quality assessment tools. Clinical effectiveness and cost-effectiveness studies were summarised narratively, and qualitative studies were synthesised using meta-ethnography.ResultsOf the 67 eligible studies, 25 were comparative, with nine including a concurrent economic evaluation. Although some of the 10 randomised trials were designed to minimise avoidable biases, slow recruitment rates and non-participation of eligible patients for setting-related reasons meant that trial sample sizes were small and populations were inherently biased to favour the home or community settings. There was little evidence to suggest differences between settings in terms of quality of life, clinical outcomes, psychological outcomes or adverse events. All nine economic evaluations were judged as having low or uncertain quality, providing limited evidence to draw overall conclusions. Most were cost–consequence analyses, presenting cost outcomes alongside trial results but deriving no summary measure of benefit. Poor resource use reporting and use of different perspectives across settings made results difficult to compare. Seventeen qualitative studies (450 participants) were judged as moderate to good quality, although all compared new or proposed services with existing outpatient facilities and biased samples were used. The three main lines of argument were barriers to service provision, satisfaction with chemotherapy and making compromises to maintain normality. Most patients made explicit trade-offs between the time and energy required for outpatient chemotherapy, which reduced quality of life, and an increased sense of safety. A patient pathway was described, informed by expert advice and a brief survey of NHS and private providers, which identified wide variation in the ways in which home and community chemotherapy was delivered. Considering limitations of the available data and variation in provision, cost-effectiveness modelling results were not robust and were viewed as exploratory only; the results were highly unstable.ConclusionsPrimary studies comparing settings for administering intravenous chemotherapy appear difficult to conduct. Consequently, few robust conclusions can be made about the clinical effectiveness and cost-effectiveness. Qualitative studies indicate that the patient time and energy required for outpatient chemotherapy reduces quality of life. A nested randomised controlled trial within a larger observational cohort of patients is proposed to enhance recruitment and improve generalisability of results. Future economic evaluations require detailed patient characteristic, resource use, cost and quality-of-life data, although their results are likely to have limited generalisability.Study registrationThis study is registered as PROSPERO CRD42013004851.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Overview Of Study Characteristics and Qualitymentioning

confidence: 99%

“…4,29,39,51,57,58 Eleven papers contributed data on the home setting 4,24,30,32,41,55,56,59-61 and one paper was a theoretical discussion of a proposed service.…”

Section: Overview Of Study Characteristics and Qualitymentioning

confidence: 99%

Section: Systematic Reviewmentioning

confidence: 99%

Section: 66mentioning

confidence: 99%

“…Studies were also conducted solely in populations with ovarian, 27 colon 28 or breast cancer. 30 The study in children was of a population with acute lymphoblastic leukaemia.…”

Section: Systematic Reviewmentioning

confidence: 99%

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