Effect of a structured, active, home-based cancer-treatment program for the management of patients on oral chemotherapy

Abstract

S Bordonaro,1 F Romano,1 E Lanteri,1 F Cappuccio,1 R Indorato,2 A Butera,2 A D’Angelo,3 F Ferraù,3 P Tralongo11Medical Oncology Unit, Umberto I Hospital, Rete Assistenza Oncologica, Siracusa, 2Medical Oncology Unit, S Giovanni di Dio Hospital, Agrigento, 3Medical Oncology Unit, S Vincenzo Hospital, Taormina, ItalyIntroduction: The advent of oral chemotherapy agents has had a strong impact on several aspects of the management of cancer patients, including survival rates, health-care expenditure, and health-related quality of life. However, access to care and adherence to oral chemotherapy are central to optimal outcomes.Patients and methods: In this multicenter observational study, we assessed the effect of the “Active Home Care” initiative – a structured, active, home-based cancer-treatment program – on quality of life, health-care utilization, and patient adherence and satisfaction using self-administered questionnaires. Sixty-two patients treated with oral chemotherapy (capecitabine, vinorelbine, imatinib, sunitinib, sorafenib, temozolomide, ibandronate) were enrolled in the program. Weekly home visits were scheduled, each one with a trained nurse who delivered the home-based chemotherapy and reviewed patients’ compliance and treatment toxicity. An oncologist evaluated patients and modified the dosage of oral chemotherapy based on toxicity reported during the previous cycle at bi-weekly visits.Results: A total of 460 home visits were performed between April 2012 and February 2013. The Active Home Care initiative was associated with significant improvements in physical functioning and symptoms, and reductions in the access to cancer facilities. Satisfaction with oral chemotherapy and care received was high. All patients reported having taken their medications according to their prescription, and no patient reported difficulties in managing the oral chemotherapy regimen. Conclusion: The Active Home Care program was associated with improvements in the quality of life of patients and caregivers, better adherence to treatment, and the effective management of therapy and cancer-related symptoms. Home-based cancer treatment may also optimize the utilization of health-care resources.Keywords: advanced cancer, home-based care, quality of life, adherence, patient satisfaction, effective therapy management