Evaluating survival and quality of life with ambulatory chemotherapy in metastatic colorectal cancer.

Abstract

10 Background: Colorectal cancer is an important health problems in Thailand. Chemotherapy treatment that was once delivered only in hospital environments is now administered at patient's home that helping patients to live normal lives during receiving chemotherapy. The chemotherapy regimens are based on a 48 hours 5-fluorouracil infusion combined that need patients to be hospitalized, consequence to decrease QOL and increase cost of treatment. Methods: An observational cohort which enrolled 156 patients at the Ramathibodi hospital from Dec 2015 to Nov 2016. Ambulatory chemotherapy (AC) administered by the central venous access device (CVAD). The regimen as FOLFOX or FOLFIRI, 5-FU were in the elastomeric infusion pump and administered at the patients’ home. The questionnaire of FACT-G and FACT-C scale, cost of treatment were collected at time of enrolment, 2 months and end of treatment. DFS and OS were analyzed in patients who treated with first regimen of metastasis chemotherapy. Nurse coordinator followed up them by phone. Aims: Compares the DFS, OS, QOL score, and cost difference in AC patients compared with inpatient treatment. Results: 156 patients are enrolled that 111 patients treated with AC and 45 patients treated with inpatient. Questionnaire response rate was 86%. Intention to treat analysis revealed significantly improved in social wellbeing and FACT-G (p < 0.001) in AC group. No difference in DFS between AC and inpatient group (12.6 vs 11.9 months, HR 0.82, p = 0.33). Overall survival trended to longer survival in AC arm (2.43 vs 1.83 years, HR 0.78, P = 0.28). The AC reduced cost about 338 US dollars per cycle of chemotherapy. Conclusions: Ambulatory chemotherapy helps colorectal cancer patients to live normal lives by administer treatment at patients' home and results to significantly improve in quality of life . No difference in DFS and OS benefit, but trends in gaining more benefits in ambulatory treatment. Moreover, ambulatory chemotherapy reduced cost of chemotherapy treatment.