Evaluation of quality of life, satisfaction and cost of care in metastatic colorectal cancer patients receiving ambulatory chemotherapy.

Abstract

6536 Background: Colorectal cancer is an important health problems in Thailand; chemotherapy remains the most suitable treatment for metastatic patients. 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. Aims: Compares the QOL score, patients’ satisfaction and cost difference in treating ambulatory chemotherapy (AC) patients compared with inpatient treatment. Methods: An observational cohort which enrolled 156 patients at the Ramathibodi hospital from Dec 2015 to Nov 2016. 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. Nurse coordinators followed up with the patients by phone. The FACT-G and FACT-C scale, patients’ satisfaction and cost of treatment questionnaire were collected at time of enrolment, 2 months and end of treatment. Results: 156 patients are enrolled that 111 patients treated with AC and 45 patients treated with inpatient. 134 returned the questionnaire (response rate 86%). Intention to treat analysis revealed significantly improved in social wellbeing and FACT-G (p <0.001) in AC group. Significant higher administration, service and overall satisfaction score in AC group. The AC reduced cost about 483 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 especially in social wellbeing and more satisfaction. Moreover, ambulatory chemotherapy reduced cost of chemotherapy treatment.

Home‐based chemotherapy for stage III colon cancer patients in Thailand: Cost‐utility and budget impact analyses

“…QALYs was used as the measure of health outcomes and was calculated from the utility score (quality‐of‐life weight) multiplied by a 6‐month time horizon (12‐cycle cancer treatment). Utility scores were calculated based on the Functional Assessment of Cancer Therapy‐Colorectal score and these data were collected from patients diagnosed with colorectal cancer at the Ramathibodi Hospital 6,11 . AE rates associated with HC and IP were collected from the electronic medical records of HC and IP patients.…”

“…When the medication is complete, the pump can be removed via an outpatient visit. 5,6 Thus, for patients receiving the mFOLFOX6 regimen, there is no need for hospitalization. The previous study showed that the implementation of HC has substantially improved patients' quality of life and their satisfaction.…”

“…The services progress from IP practice since 5‐FU is available in a portable pump connected to a central venous access port (CV port) that can perform the ongoing infusion for patients at their home. When the medication is complete, the pump can be removed via an outpatient visit 5,6 . Thus, for patients receiving the mFOLFOX6 regimen, there is no need for hospitalization.…”

“…6 Other evidence has shown that HC is safe and offers potential benefits in both clinical and humanistic aspects compared to traditional chemotherapy administrated in hospital settings. 6,7 However, an analysis of the economic and financial aspects of HC is still lacking. The lack of evidence affects the decisions regarding an HC reimbursement policy in Thailand.…”

“…The previous study showed that the implementation of HC has substantially improved patients' quality of life and their satisfaction. In addition, the cost of chemotherapy treatment can be reduced with HC 6 …”