Protocol for the OUTREACH trial: a randomised trial comparing delivery of cancer systemic therapy in three different settings - patient's home, GP surgery and hospital day unit

Abstract

BackgroundThe national Cancer Reform Strategy recommends delivering care closer to home whenever possible. Cancer drug treatment has traditionally been administered to patients in specialist hospital-based facilities. Technological developments mean that nowadays, most treatment can be delivered in the out-patient setting. Increasing demand, care quality improvements and patient choice have stimulated interest in delivering some treatment to patients in the community, however, formal evaluation of delivering cancer treatment in different community settings is lacking. This randomised trial compares delivery of cancer treatment in the hospital with delivery in two different community settings: the patient's home and general practice (GP) surgeries.Methods/designPatients due to receive a minimum 12 week course of standard intravenous cancer treatment at two hospitals in the Anglia Cancer Network are randomised on a 1:1:1 basis to receive treatment in the hospital day unit (control arm), or their own home, or their choice of one of three neighbouring GP surgeries. Overall patient care, treatment prescribing and clinical review is undertaken according to standard local practice. All treatment is dispensed by the local hospital pharmacy and treatment is delivered by the hospital chemotherapy nurses. At four time points during the 12 week study period, information is collected from patients, nursing staff, primary and secondary care teams to address the primary end point, patient-perceived benefits (using the emotional function domain of the EORTC QLQC30 patient questionnaire), as well as secondary end points: patient satisfaction, safety and health economics.DiscussionThe Outreach trial is the first randomised controlled trial conducted which compares delivery of out-patient based intravenous cancer treatment in two different community settings with standard hospital based treatment. Results of this study may better inform all key stakeholders regarding potential costs and benefits of transferring clinical services from hospital to the community.Trial registration numberISRCTN: ISRCTN66219681

Is community treatment best? a randomised trial comparing delivery of cancer treatment in the hospital, home and GP surgery

“…The trial had ethics committee approval and was registered as ISRCTN66219681. Full descriptions of the protocol and methods have been published previously (Corrie et al , 2011). In brief, cancer patients over 18 years of age with an ECOG performance status 0–2 and living within a 30-min drive of recruiting hospitals were eligible.…”

Ventajas de la quimioterapia domiciliaria en los enfermos adultos con neoplasias: revisión sistemática

“…En esta línea, hasta hace unos años el tratamiento farmacológico contra la neoplasia se había administrado tradicionalmente en unidades especializadas dentro de las instalaciones hospitalarias. Pero, los avances tecnológicos y la mejora en la calidad de la atención han hecho posible que, hoy en día, la mayoría de la quimioterapia ya se pueda administrar de manera ambulatoria (4).…”

Comparison of chemotherapy treatment administration via venous port and peripheral vascular access in terms of quality of life and costs

“…However, there are also studies stating the opposite of these findings and that the costs of home-based chemotherapy treatment are lower [ 29 , 35 , 38 , 42 ]. In addition to these two perspectives, two different studies conducted in the United Kingdom showed that there is no difference in cost between the hospital, outpatient, and home-based chemotherapy administration [ 22 , 43 ]. Hirtzlin and Préaubert Hayes [ 44 ], on the other hand, with a different perspective from all of these, stated that the cost of outpatient chemotherapy treatment is higher than the cost of home-based treatment.…”