Studying chemotherapy toxicity levels in district cancer care delivery model.

e18003 Background: To increase the access to cancer care an innovative delivery model has been initiated in 77 district general hospitals of India , empowering general duty medical officers and offering 24x7 technology based backup. All the districts along with other care also offer chemotherapy services. Major concerns raised by medical community were of toxicity associated with administration of chemotherapy. Methods: Data from chemotherapy patients undergoing chemotherapy over short period of three months in one of the district hospital was collected using proforma and common terminology criteria for adverse events(CTCAE v. 4).Data was recorded in all patients by personal interview and clinical examination when patient reported for next c0urse of chemotherapy and during the administration. Results: Total number of 196 patients (136 female and 60 male) taking chemotherapy in district were evaluated. Majority of them had breast( 92), lung (24) head and neck cancer(18).A total number of 285 cycle in all lines –first, second, etc were administered. In breast cancer majority cycles were of adjuvant chemotherapy. Chemotherapy regimens in use included all standard combinations of Doxorubicin cyclophosphamide, docetaxel ,carboplatin , 5FU, paclitaxel . Commonest toxicity included nausea , vomiting, fatigue, diarrhea and anemia. Nausea was commonest (181 events)followed by vomiting (179) diarrhea (122) fatigue, anemia and neutropenia. Most toxicity was grade 1 and 2 only. Only 3 cases of febrile neutropenia were reported and there were 3 emergency admissions for vomiting ,diarrhea. No patient had to be shifted out for medical emergency to higher center. Conclusions: The level of toxicity in peripheral center matches that of standard toxicity levels reported in literature .It is feasible to safely manage chemotherapy at peripheral centers with training generalist and offering distant supervised care. For achieving universal health core goals, with extreme shortage of oncology personnel and services specially in in LMIC only such models appear to be feasible and practicable.