Advertisement

Supportive Care in Cancer

, Volume 24, Issue 5, pp 2129–2137 | Cite as

Home management of acute medical complications in cancer patients: a prospective pilot study

  • C. Font
  • F. Fernández-Avilés
  • C. Calderon
  • T. García-Fernández
  • N. Arab
  • E. Pineda
  • E. Buxó
  • P. Ayora
  • M. Carreño
  • V. Pereira
  • M. Viladot
  • C. Moreno
  • C. Gallego
  • A. Hernando
  • N. Creus
  • C. Barrera
  • R. Alcaraz
  • J. Sanchez
  • A. Prat
  • A. Tuca
Original Article

Abstract

Background

The development of reliable alternatives to conventional hospitalization in patients with cancer would have great clinical and economical value. The aim of the present study was to assess the feasibility of a home-based nursing intervention model as a safe alternative for the management of acute medical complications in cancer patients who would otherwise require conventional hospitalization.

Patients and methods

From October 2013 to October 2014, we prospectively evaluated the outcomes of consecutive acute medical episodes treated at home under the home-based intervention program named the Bridge Project (BP). Episodes were classified as “avoided hospitalization in outpatients” (AHO) vs. “reduced hospitalization in inpatients” (RHI). The primary end-point was to assess the rate and causes of BP intervention failure (unplanned hospital readmission or death).

Results

Two hundred and forty-six consecutive episodes (52 % AHO and 48 % RHI) involving 203 patients (55 % male; mean age 63 years) were enrolled. The main conditions managed at home were non-neutropenic infections (40 %), febrile neutropenia (20 %), and cancer-related complications (28 %). The median duration of the BP intervention was 5 days (range 1–16 days). No deaths were reported at home. Unplanned hospital readmissions occurred in 9 % of episodes (14 % in AHO vs. 4 % in RHI; p = 0.001). Five of the 22 readmitted patients (22.7 % of the BP failures; 2.5 % of the whole series) died during hospitalization. The BP intervention burden was 1353 days, representing a potential saving of 14 % of days of hospitalization during the study period.

Conclusions

The BP is a safe intervention which can potentially avoid or reduce the length of hospitalization in selected cancer patients with acute medical complications. Our findings support further development of innovative home-based clinical approaches to promote potentially avoidable hospitalization in this setting.

Keywords

Home hospitalization in cancer Alternatives to conventional hospitalization Home health care, patient-centered care New models of cancer care 

Notes

Acknowledgments

The study was partially reported as an oral communication at the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) International Symposium on Supportive Care in Cancer in Miami, June 26–28, 2014.

Compliance with ethical standards

Ethical approval

The study was approved by the local ethics committee.

Conflict of interest

The authors declare that they have no competing interests.

The authors also declare that they have full control of all primary data and that they allow the journal to review their data if requested.

References

  1. 1.
    Smith TJ, Hillner BE (2011) Bending the cost curve in cancer care. N Engl J Med 364:2060–2065CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Decoster L, Van Puyelde K, Mohile S et al (2015) Screening tools for multidimensional healths problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations. Ann Oncol 26:288–300CrossRefPubMedGoogle Scholar
  3. 3.
    Siegel R, Ma J, Zou Z, Jemal A (2014) Cancer Statistics, 2014. CA Cancer J Clin 64:9–29CrossRefPubMedGoogle Scholar
  4. 4.
    Sanchez MJ, Payer T, De Angelis R et al (2010) Cancer incidence and mortality in Spain: estimates and projections for the period 1981–2012. Ann Oncol 21(Suppl 3):iii30–36PubMedGoogle Scholar
  5. 5.
    De Azambuia E, Ameye L, Paesmans M, Zielinsky CC, Piccart-Gebhart M, Preusser M (2014) The landscape of medical oncology in Europe by 2020. Ann Oncol 25:525–528CrossRefGoogle Scholar
  6. 6.
    Creditor MC (1993) Hazards of hospitalization of the elderly. Ann Intern Med 118:219–223CrossRefPubMedGoogle Scholar
  7. 7.
    Hassett MJ, Rao SR, Brozovic S et al (2011) Chemotherapy-related hospitalization among community cancer center patients. Oncologist 16:378–387CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    McKenzie H, Hayes L, White K et al (2011) Chemotherapy outpatients’ unplanned presentations to hospital: a retrospective study. Support Care Cancer 19:963–969CrossRefPubMedGoogle Scholar
  9. 9.
    Shepperd S, Doll H, Broad J et al (2008) Admission avoidance hospital at home. Cochrane Database Syst Rev 4:CD007491Google Scholar
  10. 10.
    Shepperd S, Doll H, Broad J et al (2009) Early discharge hospital at home. Cochrane Database Syst Rev 21(1):CD000356Google Scholar
  11. 11.
    Leff B (2009) Defining and disseminating the hospital-at-home model. CMAJ 180:156–157CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Montalto M, Leff BA (2012) Hospital in the home: a lot’s in a name. Med J Aust 197:479–480CrossRefPubMedGoogle Scholar
  13. 13.
    Jones J, Wilson A, Parker H et al (1999) Economic evaluation of hospital at home versus hospital care: cost minimization analysis of data from randomized controlled trial. BMJ 319:1547–1550CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Escalante CP, Rubenstein EB, Rolston KV (1996) Outpatient antibiotic treatment in low-risk febrile neutropenic cancer patients. Support Care Cancer 4:358–363CrossRefPubMedGoogle Scholar
  15. 15.
    Gome B, Callanzani N, Curiale V et al (2013) Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 6:CD007760Google Scholar
  16. 16.
    Wiencek C, Coyne P (2014) Palliative care delivery models. Semin Oncol Nurs 30:227–233CrossRefPubMedGoogle Scholar
  17. 17.
    Porzio G, Aielli F, Verna L et al (2013) Integrating oncology and palliative home care in Italy: the experience of the “L’Aquila per la Vita” Home Care Unit. Tumori 99:225–228PubMedGoogle Scholar
  18. 18.
    Mercadante S, Porzio G, Valle A et al (2012) Emergencies in patients with advanced cancer followed at home. J Pain Symptom Manag 44:295–300CrossRefGoogle Scholar
  19. 19.
    Fernández-Avilés F, Carreras E, Urbano-Izpizua A et al (2006) Case-control comparison of at-home to total hospital care for autologous stem-cell transplantation for hematological malignancies. J Clin Oncol 24:4855–4861CrossRefPubMedGoogle Scholar
  20. 20.
    Brooks GA, Abrams TA, Meyerhardt JA et al (2014) Identification of potentially avoidable hospitalization in patients with cancer. J Clin Oncol 32:496–503CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Nourois J, Novitzky-Basso I, Gill MJ et al (2010) Management of febrile neutropenia: ESMO Clinical Practice Guidelines. Ann Oncol 21(Suppl 5):v252–v256CrossRefGoogle Scholar
  22. 22.
    Flowers CR, Seidenfeld J, Bow EJ et al (2013) Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 31(6):794–810CrossRefPubMedGoogle Scholar
  23. 23.
    Hannon B, Zimmermann C (2013) Early palliative care: moving from ‘why’ to ‘how’. Oncology 27(1):168738PubMedGoogle Scholar
  24. 24.
    Nordly M, Benthien KS, Von Der Maase H et al (2014) The DOMUS study protocol: a randomized clinical trial of accelerated transition from oncological treatment to specialized palliative care at home. BMC Palliat Care 13:44CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    McCorkle R, Dowd M, Ercolano E et al (2009) Effects of a nursing intervention on quality of life outcomes in post-surgical women with gynecological cancers. Psyconcol 18:62–70CrossRefGoogle Scholar
  26. 26.
    Thokala P, Baalbaki H, Brennan A et al (2013) Telemonitoring after discharge from hospital with heart failure: cost-effectiveness modeling of alternative service designs. BMJ Open 3:e003250CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Kinnane NA, Milne DJ (2010) The role of the Internet in supporting and informing carers of people with cancer: a literature review. Support Care Cancer 18:1123–1136CrossRefPubMedGoogle Scholar
  28. 28.
    Alanee S, Dynda D, LeVault K et al (2014) Delivering kidney cancer care in rural Central and Southern Illinois: a telemedicine approach. J Cancer care (Engl) 23:739–744CrossRefGoogle Scholar
  29. 29.
    Girault A, Ferrua M, Lalloué B et al (2015) Internet-based technologies to improve cancer care coordination: current use and attitudes among cancer patients. Eur J Cancer 51:551–557CrossRefPubMedGoogle Scholar
  30. 30.
    Carmona-Bayonas A, Jimenez-Fonseca P, Virizuela-Echaburu J et al (2015) Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the Clinical Index of Stable Febrile Neutropenia in a prospective cohort of patients from the FINITE study. J Clin Oncol 33:465–471CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • C. Font
    • 1
    • 2
    • 3
  • F. Fernández-Avilés
    • 2
  • C. Calderon
    • 1
  • T. García-Fernández
    • 2
  • N. Arab
    • 1
    • 2
  • E. Pineda
    • 2
  • E. Buxó
    • 2
  • P. Ayora
    • 2
  • M. Carreño
    • 2
  • V. Pereira
    • 1
    • 2
  • M. Viladot
    • 1
    • 2
  • C. Moreno
    • 2
  • C. Gallego
    • 2
  • A. Hernando
    • 2
  • N. Creus
    • 2
  • C. Barrera
    • 1
    • 2
  • R. Alcaraz
    • 2
  • J. Sanchez
    • 2
  • A. Prat
    • 1
    • 2
    • 3
    • 4
  • A. Tuca
    • 1
    • 2
  1. 1.Supportive and Palliative Care Unit (SPCU), Medical Oncology DepartmentHospital Clínic de BarcelonaBarcelonaSpain
  2. 2.Institut Clinic de Malalties Hemato-Oncològiques (ICMHO)Hospital Clínic de BarcelonaBarcelonaSpain
  3. 3.Translational Genomics and Targeted Therapeutics in Solid TumorsIDIBAPSBarcelonaSpain
  4. 4.Medical SchoolUniversity of BarcelonaBarcelonaSpain

Personalised recommendations