scholarly journals Patient-Focused Benefits of at-Home Versus in-Clinic Administration of Cancer Therapy: New Considerations for the COVID-19 Era

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 35-36
Author(s):  
Karen E. Sandman ◽  
Timothy J. Bell
Keyword(s):  
Cancer Therapy ◽  
Literature Review ◽  
Cancer Treatment ◽  
Healthcare Resource Utilization ◽  
Home Treatment ◽  
Clinical Settings ◽  
Home Based ◽  
Home Administration ◽  
At Home

Introduction: Cancer treatment includes conventional clinic-based infusions and various options for home administration of medication. Clinic-based treatment can be disruptive and costly to patients and caregivers, requiring transportation, time away from work/family responsibilities, and stressful clinical settings. The COVID-19 pandemic has increased concerns that patients may be exposed-or experience anxiety about exposure-to viruses and other pathogens. Potential benefits to home-based chemotherapy include cost/healthcare resource utilization savings and decreased infection exposure by avoiding clinical settings. In the COVID-19 era, ASH, ASCO, ESMO, and other groups have recommended home administration of chemotherapy, including infusions at home and self-administered oral and subcutaneous treatments, for certain cancer types where feasible. This literature review evaluated patient- and caregiver-relevant advantages of home-administered cancer therapy. Methods: A strategic literature review was conducted using the pearl growing/snowball method, wherein core publications were identified using an initial PubMed search strategy with the MeSH heading "Antineoplastic Agents/Administration & Dosage" and the search terms "Home Care Services" and "Patient Satisfaction." Results were limited to English-language publications dated January 2000 to July 2020, ≥10 study subjects, adult subjects only, with no limits for geography or cancer type. A total of 21 initial results were retrieved in PubMed. Six core publications were used to establish keywords and for bibliographic and prospective citation searches to identify additional relevant publications relating to patient preference and patient/caregiver-reported outcomes regarding cancer treatment administration settings. In addition to PubMed, the following congresses were searched: ASH (2004-2019), ASCO (2011-2020), EHA (2016-2019) and ESMO (2010-2019). Results: Thirty-one studies involving both hematologic cancers and solid tumors were identified from North and South America, Europe, Asia, and Australia. Cancer therapy was administered by patients/caregivers (ie, oral or subcutaneous) or a visiting nurse. All the studies reviewed reported benefits for home- vs clinic-based treatment. Patient expressed preference/satisfaction and willingness to continue with home-based regimens; while methodologies varied among studies, 70% to 100% of patients preferred home administration. Across studies, over half of patients receiving home treatment cited improvement in outcomes including well-being, activities of daily living, and family/social life, with benefits including convenience, comfort, reduced travel/financial burden, limited waiting time, and greater ability to maintain daily family/social activities. The impact on patient health-related quality of life (HRQoL) could not be compared quantitatively among studies as <25% of the studies used validated tools, e.g., EORTC-QOL-C30. Among studies using validated tools, HRQoL outcomes were generally similar for patients treated at home or in-clinic. There were very few reports of patients needing or choosing to return to clinic-based care after initiating home treatment. Studies that captured safety outcomes did not report increased adverse effects or emergency room visits among patients treated at home. Of the 3 studies reporting caregiver outcomes, most caregivers expressed satisfaction with and preference for home treatment. Conclusions: The prioritization of therapies that can be administered at home has been proposed as a strategy for infection control in the COVID-19 era, but it is not currently a standard approach in the US. This targeted literature review consistently found patient-relevant benefits with home-administered chemotherapy. The identified studies provided minimal information on caregiver-reported outcomes, which is a limitation given that home-based cancer treatment impacts caregivers as well as patients. Home-based treatment may enhance quality of survival time and reduce healthcare resource utilization while maintaining clinical benefits of treatment and reducing contact with people in a busy clinical setting. While treatment decisions should consider patient preference for home-based treatment, some patients' treatment pathways will require care at an outpatient or inpatient facility. Disclosures Sandman: Pfizer Inc.: Consultancy. Bell:Pfizer: Current Employment, Current equity holder in publicly-traded company.

scholarly journals Acceptability, Feasibility and Preliminary Evaluation of a Novel, Personalised, Home-Based Physical Activity Intervention for Chronic Heart Failure (Active-at-Home-HF): a Pilot Study

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Nduka C. Okwose ◽  
Leah Avery ◽  
Nicola O’Brien ◽  
Sophie Cassidy ◽  
Sarah J. Charman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Heart Failure ◽  
Pilot Study ◽  
Chronic Heart Failure ◽  
Physical Activity Intervention ◽  
Step Count ◽  
Home Based ◽  
At Home

Abstract Purpose Less than 10% of heart failure patients in the UK participate in cardiac rehabilitation programmes. The present pilot study evaluated feasibility, acceptability and physiological effects of a novel, personalised, home-based physical activity intervention in chronic heart failure. Methods Twenty patients (68 ± 7 years old, 20% females) with stable chronic heart failure due to reduced left ventricular ejection fraction (31 ± 8 %) participated in a single-group, pilot study assessing the feasibility and acceptability of a 12-week personalised home-based physical activity intervention aiming to increase daily number of steps by 2000 from baseline (Active-at-Home-HF). Patients completed cardiopulmonary exercise testing with non-invasive gas exchange and haemodynamic measurements and quality of life questionnaire pre- and post-intervention. Patients were supported weekly via telephone and average weekly step count data collected using pedometers. Results Forty-three patients were screened and 20 recruited into the study. Seventeen patients (85%) completed the intervention, and 15 (75%) achieved the target step count. Average step count per day increased significantly from baseline to 3 weeks by 2546 (5108 ± 3064 to 7654 ± 3849, P = 0.03, n = 17) and was maintained until week 12 (9022 ± 3942). Following completion of the intervention, no adverse events were recorded and quality of life improved by 4 points (26 ± 18 vs. 22 ± 19). Peak exercise stroke volume increased by 19% (127 ± 34 vs. 151 ± 34 m/beat, P = 0.05), while cardiac index increased by 12% (6.8 ± 1.5 vs. 7.6 ± 2.0 L/min/m2, P = 0.19). Workload and oxygen consumption at anaerobic threshold also increased by 16% (49 ± 16 vs. 59 ± 14 watts, P = 0.01) and 10% (11.5 ± 2.9 vs. 12.8 ± 2.2 ml/kg/min, P = 0.39). Conclusion The Active-at-Home-HF intervention is feasible, acceptable and effective for increasing physical activity in CHF. It may lead to improvements in quality of life, exercise tolerance and haemodynamic function. Trial Registration www.clinicaltrials.gov NCT0367727. Retrospectively registered on 17 September 2018.

Home-Based Educational Programs for Management of Dyspnea: A Systematic Literature Review

2020 ◽  
Vol 32 (4) ◽  
pp. 211-217
Author(s):  
Aristides Chorattas ◽  
Evridiki Papastavrou ◽  
Andreas Charalambous ◽  
Christiana Kouta
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Cancer Patients ◽  
Educational Programs ◽  
Poor Quality ◽  
Chronic Obstructive ◽  
Greek Language ◽  
Home Based ◽  
At Home

Dyspnea or breathlessness is a symptom of a plethora of diseases; despite that its management poses a challenge, it leads to frequent hospitalizations and a poor quality of life. In lung cancer, dyspnea may appear at any time of the disease but mainly during the end-of-life period. This article aims to explore the effectiveness of home-based educational programs for the management of dyspnea. This is a systematic review. The inclusion criteria were studies published between 2000 and 2018, and structured nurse-led home educational programs for the management of dyspnea due to cancer. The search via PUBMED, COCHRANE, EBSCO, and Google Scholar was worldwide for English- and Greek-language articles. The keywords included “education, program, intervention, patient, dyspnea, breathlessness, cancer, home, nurse.” The review was expanded to dyspnea being due to any chronic disease as it gave only one research article for lung cancer. The review identified seven research articles evaluating the effectiveness of various home-based educational programs for dyspnea management due to chronic obstructive pulmonary disease, heart failure, and lung cancer. They showed that a structured home-based educational program is of benefit for the patients by improving their dyspnea levels and their quality of life. There is the need to evaluate the benefits of home-based educational programs for cancer patients with dyspnea at home either as part of a symptom alone support program or as part of the general support given to cancer patients at home.

scholarly journals Psychological repercussions related to brachytherapy treatment in women with gynecological cancer: analysis of production from 1987 to 2007

2008 ◽  
Vol 16 (6) ◽  
pp. 1049-1053 ◽  
Author(s):  
Gisele Curi de Barros ◽  
Renata Curi Labate
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Literature Review ◽  
Cancer Treatment ◽  
Gynecological Cancer ◽  
Psychological Research ◽  
Psychological Consequences ◽  
Radioactive Materials ◽  
Emotional Issues

One of the radiotherapeutic modalities for gynecological cancer treatment is brachytherapy, characterized by the placement of radioactive materials near the tumor. This treatment can bring side effects for patients. Due to the emotional issues involved, the objective of this research was to apprehend studies about psychological repercussions related to brachytherapy treatment in women with gynecological cancer, through a literature review. The results revealed an embryionic production, with only one study produced in Brazil. A higher concentration of studies was found in the Nursing area. Research focused on psychosocial repercussions, attempting to understand the patients' experiences before, during and after treatment, evidencing physical and psychological consequences that affect their quality of life. It is important to consider the expansion of this production through psychological research that furthers the comprehension about the experience of women submitted to brachytherapy.

Home Azacitidine Administration in High Risk Myelodysplastic Syndromes: Favorable Results of a Pilot Study in 48 Patients

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1719-1719
Author(s):  
Sylvestre Guillevic ◽  
Thibault Comont ◽  
Jonathan Khalifa ◽  
Christian Recher ◽  
Daniel Adoue ◽  
...  
Keyword(s):  
Quality Of Life ◽  
High Risk ◽  
Myelodysplastic Syndromes ◽  
Conflicts Of Interest ◽  
Age Distribution ◽  
Hospital Administration ◽  
Number Of Cycles ◽  
Home Administration ◽  
At Home

Abstract Abstract 1719 Background: Myelodysplastic syndromes (MDS) affect elderly patients. Azacitidine represents the gold standard treatment of high risk MDS. French health organization allows home chemotherapy administration after the first cycle of treatment. We decided to develop a home administration program of this drug. Moreover we hypothesized that this modality of treatment will improve patient's quality of life. Patients and methods: after one cycle in hospitalization, high risk MDS patients who were agree to receive home chemotherapy were included in the study. As recommended each first day of Azacitidine cycle was still administrated at hospital. Due to drug instability a quality statement was created to control all steps of administration (including storage temperature before administration). Feasibility and safety were evaluated. Comparison between home or hospital administration was performed: number of cycles, dose, tolerance, problems of administration. Results: 68 patients were included in the home chemotherapy program, 75% were MDS patients and 48 received Azacitidine. Age distribution was 7 patients 60/69 yrs (14%), 22 patients 70/79 yrs (46%) and 19 patients 80–89 yrs (40%). More than 2000 days of hospitalization were performed at home during a 18-month period. Similar median number of cycles and delays were observed in the two groups as well as same level of adverse events and hospitalizations between 2 cycles. In few cases administration was not possible at home due to unresolved infection, cytopenia or drug availability (excessive time between preparation and distribution). No patient was excluded of this program. Discussion and conclusion: home administration of Azacitidine was safe and feasible. All patients agree to continue this modality of administration and high level of satisfaction was observed. Next step will consist in a randomized study to compare quality of life between home and hospital administration of the drug. For this population of patient home treatment will represent an alternative which could improve quality of life as observed for children in ALL (1) or in colorectal cancer (2). Disclosures: No relevant conflicts of interest to declare.

Could pre-filled safety syringes facilitate the adoption of home administration for cancer patients?

2020 ◽  
Vol 26 (8) ◽  
pp. 1934-1936
Author(s):  
George I'ons
Keyword(s):  
Cancer Patients ◽  
Chronic Conditions ◽  
Active Role ◽  
Chronic Illnesses ◽  
Ease Of Use ◽  
Clinical Settings ◽  
Self Administration ◽  
Health Crisis ◽  
Home Based ◽  
Home Administration

Today, healthcare systems around the world are under increasing pressure, not least with the current health crisis. One of the leading efforts to relieve this burden in recent years has been through the promotion and facilitation of self-administration, particularly for patients with chronic illnesses. By relocating certain treatments to patients’ homes, hospitals are minimizing the risk of over-crowding and giving patients a more active role in their own medication regime. Fuelled by this trend toward self-care, the prefilled safety syringe market has seen exponential growth in recent years – providing greater ease-of-use and safety for all carers and self-administering patients in non-clinical settings. When looking at the benefit of switching intravenous hospital-based to subcutaneous home-based administration while maintaining the same clinical outcomes, a similar change is also being considered in some areas of oncology. Drawing on the experience of home-treatment for chronic conditions, this article looks at the challenges and considerations of extending this to eligible cancer patients in the future.

A Decade of Research on the Quality of Systemic Cancer Therapy in Routine Care: What Aspects of Quality Are We Measuring?

2015 ◽  
Vol 11 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Shixin Shen ◽  
Monika K. Krzyzanowska
Keyword(s):  
Cancer Therapy ◽  
Early Stage ◽  
Routine Care ◽  
Cytotoxic Chemotherapy ◽  
Clinical Settings ◽  
Early Stage Disease ◽  
Stage Disease

Most studies evaluating quality of systemic cancer therapy have focused on access to cytotoxic chemotherapy in early-stage disease. Studies on other aspects of quality and in different clinical settings are needed.

scholarly journals Family Preparedness in Caring Patients with Cancer : A Literature Review

2020 ◽  
Vol 3 (2) ◽  
pp. 143-152
Author(s):  
Akbar U Saun ◽  
Erna Rochmawati
Keyword(s):  
Quality Of Life ◽  
Literature Review ◽  
Patient Care ◽  
Family Quality Of Life ◽  
Inclusion Criteria ◽  
Optimal Care ◽  
Patients With Cancer ◽  
Family Readiness ◽  
At Home

Background: Cancer patients choose to understand at home. Families have an important role in the care of clients specifically at home. Readiness is needed in order to provide optimal care and will be able to improve the quality of life of patients. This literature review aims to see how families are prepared to care for patients with cancer at home. Method: Writing this journal literature uses study literature originating from the database, namely EBSCO, PROQUEST, PubMed, and Google Scholar using the keywords Family Preparedness, Family Caregiver, Symptom Management, Palliative Care, family quality of life, Care Parenting. Using inclusion criteria that contain literature sources taken from 2009 to 2019, inclusion criteria, using English, conformity of approval keywords, linkages between the results of literature research and the discussion raised.Results: There are 4 themes found in this literature review, namely family care in patient care, instruments in measuring family readiness, self-affection for families who care for patients at home, and psycho-education in increasing family readiness to care for patients at home. Conclusion: Family readiness to treat patients at home needs to be considered. Nurses play an important role in providing education to the family in providing patient care at home so that the patient's welfare is fulfilled.

Effect of an e-home based symptom management and mindfulness training program on quality of life in breast cancer survivors: A randomized clinical trial.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12080-12080
Author(s):  
Karis Kin-Fong Cheng ◽  
Rosalind Siah ◽  
Melvyn Zhang ◽  
Shian-Ling Keng ◽  
Wan-Hua Wong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Clinical Trial ◽  
Cancer Treatment ◽  
Training Program ◽  
Cancer Survivorship ◽  
Symptom Management ◽  
Mindfulness Training ◽  
Home Based

12080 Background: The first five years post-treatment for breast cancer are a critical phase, when the survivors may face a multitude of physical and psychosocial problems. We aimed to develop an e-home based symptom management and mindfulness training program to support women with breast cancer in transition to survivorship and to determine its effect on the endpoints including quality of life, symptom distress, psychosocial adjustment, and psychological morbidity. Methods: This parallel 4-arm, superiority randomized clinical trial together with a process evaluation using semi-structured interview recruited women who had completed cancer treatment for stage 0 to 3 breast cancer between 6 months to 5 years previously, from November 2016 through March 2020 at two tertiary hospitals. A total of 593 women were eligible, of these, 402 refused to participate and 191 women were randomized. However, 19 subjects withdrew from the study without completion of baseline assessments. Hence, 172 subjects were included in the intention-to-treat analysis (e-home based breast cancer survivorship program, experimental group; n = 44), comparison group 1 (online symptom management program only; n = 41), comparison group 2 (online mindfulness training program only; n = 44) or the usual care group (n = 43). The e-home based breast cancer survivorship program involved 5 weekly online education module regarding self-management strategies of common symptoms + various online self-administered mindfulness exercises. The primary endpoint included change of Quality of Life-Cancer Survivor Scale (QoL-CS) score measured at 8, 12 and 24 weeks from baseline. Secondary endpoints were changes of Social Support Questionnaire, Breast Cancer Survivor Self-Efficacy Scale, Memorial Symptom Assessment Scale, Psychosocial Adjustment to Illness Scale, Fear of Recurrence Scale, Hospital and anxiety Depression Scale, and Five Facet Mindfulness Questionnaire scores. Results: Of 172 subjects, mean ± SD age was 51.2 ± 9.4 years; 118 (77.7%) were in the first two years of cancer treatment completion; 165 (98.2%) underwent surgery; and 111 (73.5%) treated with adjuvant chemotherapy. All demographic and clinical characteristics were comparable among the four groups ( p>.05). There was no between-group difference in the primary endpoint; QoL-CS scores among groups at 8, 12 and 24 weeks from baseline ( p>.05). Secondary endpoints were also not different among groups ( p>.05). Two main themes; positive impact and gap/barrier, emerged from process evaluation data. Conclusions: In women who were in the first five years post-breast cancer treatment, an e-home based multidimensional cancer survivorship program did not affect outcomes. Nevertheless, the interview data revealed a positive experience in regards to the home-based approach in cancer survivorship care program. Clinical trial information: NCT02931864.

Home-Based Exercise for People With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-12
Author(s):  
Renata Valle Pedroso ◽  
Miguel Adriano Sanchez-Lastra ◽  
Laura Iglesias Comesaña ◽  
Carlos Ayán
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Home Based ◽  
The Impact ◽  
At Home

Background: Exercise performed at home could be a useful therapy for people with chronic kidney disease. This systematic review and meta-analysis aimed at describing the characteristics, main findings, methodological quality, and adherence rate reported in the existent randomized controlled trials that have provided information regarding the impact of home-based exercise programs on people with chronic kidney disease. Methods: Electronic databases (MEDLINE/PubMed, SPORTDiscus, Scopus, and CENTRAL) were searched up to April 2021, using the keywords: “Exercise”; “Home”; “Kidney Disease.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was adopted. Jadad scale and Cochrane’s tool were used to assess the methodological quality and risk of bias. Results: Out of the 14 studies finally selected, 11 were included in the meta-analysis and most presented high methodological quality. The meta-analysis showed significant effects of home-based exercise on fitness and quality of life, but a little impact on renal function. Although exercise performed at home was mostly feasible and safe, adherence was not high and a considerable number of dropouts were observed. Conclusion: Home-based exercise has positive effects on the fitness’ level and on the quality of life on people with chronic kidney disease. Future studies are needed to identify whether exercise performed at home is a better physical therapy option than center-based exercise.

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