Home management of acute medical complications in cancer patients: a prospective pilot study
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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).
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.
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.
KeywordsHome hospitalization in cancer Alternatives to conventional hospitalization Home health care, patient-centered care New models of cancer care
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
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.
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