1
|
Villegas E, Arruñada M, Casado MÁ, González S, Moreno-Martínez ME, Peñuelas MÁ, Torres AM, Sierra Y, Seguí MA. National expert consensus on home-administered oncologic therapies in Spain. Front Oncol 2024; 14:1335344. [PMID: 38434688 PMCID: PMC10905380 DOI: 10.3389/fonc.2024.1335344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 03/05/2024] Open
Abstract
The diagnosis and treatment of cancer impose a significant emotional and psychological burden on patients, families, and caregivers. Patients undergo several interventions in a hospital setting, and the increasing number of patients requiring extended care and follow-up is driving the demand for additional clinical resources to address their needs. Hospital at Home (HaH) teams have introduced home-administered oncologic therapies that represent a new model of patient-centered cancer care. This approach can be integrated with traditional models and offers benefits to both patients and healthcare professionals (HCPs). Home-administered treatment programs have been successfully piloted globally, demonstrated as a preferred option for most patients and a safe alternative that could reduce costs and hospital burden. The document aims to establish the minimum recommendations for the home administration of oncologic therapies (ODAH) based on a national expert agreement. The expert panel comprised seven leading members from diverse Spanish societies and three working areas: clinical and healthcare issues, logistical and administrative issues, and economic, social, and legal issues. The recommendations outlined in this article were obtained after a comprehensive literature review and thorough discussions. This document may serve as a basis for the future development of home-administered oncologic therapy programs in Spain. .
Collapse
Affiliation(s)
| | - María Arruñada
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | | | - Sonia González
- Innovation in Clinical Pharmacy Research Group (i-FARMA-Vigo), Vigo, Spain
- Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain
- University Hospital Complex of Vigo (SERGAS-UVIGO), Vigo, Spain
| | | | | | | | | | - Miguel Angel Seguí
- Parc Taulí Foundation, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
“It is a Part of Me”: The Experiences of Patients with Cancer Undergoing Home-Based Chemotherapy. Asia Pac J Oncol Nurs 2022; 9:100072. [PMID: 35692730 PMCID: PMC9184288 DOI: 10.1016/j.apjon.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/15/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Home-based chemotherapy is widely used and offers advantages in terms of patient-centeredness, hospital capacity, and cost-effectiveness. However, in practice, patients experience difficulties with self-management and handling the elastomeric infuser. In this study, we aimed to explore the experiences of patients undergoing home-based chemotherapy based on patients’ and nurses’ perspectives. Additionally, we aimed to identify patients’ unmet needs. Methods A qualitative descriptive study was conducted in a tertiary hospital in South Korea. Ten patients undergoing home-based chemotherapy and ten nurses with experience in home-based chemotherapy participated. Data were collected by using semi-structured individual interviews and analyzed by using inductive content analysis. Results Four main categories were identified based on the interviews: (1) ambivalence regarding comfort vs. enduring the discomfort, (2) acceptance of the discomfort as a part of them, (3) the need for more precise, numerical measurements, and (4) the realization that they need similar hands-on care at home as in a hospital. Conclusions Although patients were satisfied with home-based chemotherapy, they were enduring the difficulties they experienced at home alone. Nurses should make an effort to identify patient needs and devise tailored nursing interventions to improve their safety.
Collapse
|
3
|
Cool L, Missiaen J, Debruyne P, Pottel H, Foulon V, Lefebvre T, Tack L, Archie P, Vandijck D, Van Eygen K. Oncologic Home-Hospitalization Delivers a High-Quality and Patient-Centered Alternative to Standard Ambulatory Care: Results of a Randomized-Controlled Equivalence Trial. JCO Glob Oncol 2021; 7:1564-1571. [PMID: 34797697 PMCID: PMC8613347 DOI: 10.1200/go.21.00158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Given the increasing burden of cancer on patients, health care providers, and payers, the shift of certain outpatient procedures to the patients' homes (further indicated as oncologic home-hospitalization [OHH]) might be a high-quality, patient-centered, and cost-effective alternative to standard ambulatory cancer care (SOC). METHODS A randomized-controlled trial was conducted to evaluate the quality of a locally implemented model for OHH (n = 74) compared with SOC (n = 74). The model for OHH consisted of home administration of certain subcutaneous cancer drugs (full OHH) and home nursing assessments before ambulatory systemic cancer therapy (partial OHH). Quality was evaluated based on patient-reported quality of life (QoL) and related end points; service use and cost data; safety data; patient-reported satisfaction and preferences; and model efficiency. An equivalence design was used for primary end point analysis. Participants were followed during 12 weeks of systemic cancer treatment. RESULTS This trial demonstrated equivalence of both models (OHH v SOC) in terms of patient-reported QoL (95% CI not exceeding the equivalence margin of 10%). Full OHH resulted in significantly less hospital visits (mean of 5.6 ± 3.0 v 13.2 ± 4.6; P = .011). Partial OHH reduced waiting times for therapy administration at the day care unit with 45% per visit (2 hours 36 minutes ± 1 hour 4 minutes v 4 hours ± 1 hour 4 minutes; P < .001). No safety issues were detected. Of the intervention group, 88% reported to be highly satisfied with the OHH model, and 77% reported a positive impact on their QoL. At study end, 60% of both study arms preferred OHH above SOC. CONCLUSION The shift of particular procedures from the outpatient clinic to the patients' homes offers a high-quality and patient-centered alternative for a large proportion of patients with cancer. Further research is needed to evaluate potential cost-efficiency. Oncological home-hospitalization delivers a high-quality and patient-centred alternative to ambulatory care![]()
Collapse
Affiliation(s)
- Lieselot Cool
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Jana Missiaen
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Philip Debruyne
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium.,Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Hans Pottel
- Department of Public Health and Primary Care @ Kulak, Catholic University Leuven Kulak Etienne Sabbelaan, Kortrijk, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, Catholic University Leuven, Leuven, Belgium
| | - Tessa Lefebvre
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Laura Tack
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Petra Archie
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Dominique Vandijck
- Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Koen Van Eygen
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| |
Collapse
|
4
|
Sirilerttrakul S, Wannakansophon N, Utthiya P, Ckumdee S, Tangteerakoon P, Chansriwong P. Evaluation of adverse events and health-related quality of life in patients with colorectal cancer receiving ambulatory home-based chemotherapy in Thailand. Nurs Open 2021; 8:3036-3044. [PMID: 34382364 PMCID: PMC8510724 DOI: 10.1002/nop2.1016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/27/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022] Open
Abstract
Aims To compare adverse events and health‐related quality of life in ambulatory home‐based chemotherapy with those in inpatient. Design Prospective non‐randomized observational study. Methods Participants were divided into two groups according to patients’ preference receiving chemotherapy. Results Sixty‐four participants were enrolled in the inpatient, and 111 were in an ambulatory home‐based chemotherapy. The frequency of anaemia, neutropenia and thrombocytopenia was significantly higher in inpatient group than in ambulatory home‐based chemotherapy group (p < .001, <.001 and .002, respectively). Nausea, mucositis, and fatigue were more common in ambulatory home‐based chemotherapy group than in inpatient group (p < .001, .022, and .005, respectively). Patients in the ambulatory home‐based chemotherapy group showed higher social well‐being (SWB) scores than inpatient group (coefficient 1.92, 95% confidence interval [CI] 0.65 to 3.19, p .003).
Collapse
Affiliation(s)
- Suwannee Sirilerttrakul
- Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Noppaskan Wannakansophon
- Department of Nursing, Somdech Phra Debaratana Medical Center Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pinyo Utthiya
- Department of Nursing, Somdech Phra Debaratana Medical Center Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sineenuch Ckumdee
- Department of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Patamaporn Tangteerakoon
- Chemotherapy Pharmacy Service, Compounding Unit, Department of Pharmacy, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Phichai Chansriwong
- Department of Medicine Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
5
|
Cool L, Brewaeys C, Viaene S, Missiaen J, Lycke M, Lefebvre T, Tack L, Foulon V, Pottel H, Debruyne P, Vandijck D, Van Eygen K. Shifting specialized oncological care from hospital- to home-setting: is there support among patients, specialists and general practitioners? Acta Clin Belg 2020; 75:250-257. [PMID: 31003594 DOI: 10.1080/17843286.2019.1605467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Oncological home-hospitalization (OHH) might be a patient-centred approach to deal with the increasing burden of cancer on health-care facilities and finances. Before implementation into practice, its feasibility, costs and support among stakeholders should be evaluated. The purpose of this trial was to explore patients', specialists' and general practitioners' (GPs) perspectives towards the opportunities of implementing OHH within the Belgian health-care system. METHODS A regional cross-sectional survey study was launched in order to investigate the stakeholders' views on OHH and the current cancer care focusing on integration of primary care and continuous care. RESULTS Of the responders, 37 out of 163 patients (23%), 45 of 62 GPs (73%) and 10 of 15 specialists (67%) feel positive about the opportunities for OHH. Nevertheless, 11/15 specialists (73%) and 51/62 GPs (82%) feel primary care might currently be (too) little involved in order to ensure continuous care for cancer patients. Opportunities for improved continuous care are seen in better communication between primary care and hospital, and more patient contacts for primary care during the cancer treatment process. CONCLUSION The results of this local survey study demonstrated there is support among different stakeholder groups for the implementation of OHH within the Belgian health-care context. However, some barriers impeding transmural continuous care should be tackled before implementing such model into practice. Better communication between health-care professionals and more patients contacts are suggested, and an adjusted legal and financial framework is required.
Collapse
Affiliation(s)
- Lieselot Cool
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium.,Faculty of Medicine and Health Sciences, Ghent University , Gent, Belgium
| | - Celine Brewaeys
- Faculty of Medicine and Health Sciences, Ghent University , Gent, Belgium
| | - Stefaan Viaene
- Association of primary care physicians Zuid West-Vlaanderen , Kortrijk, Belgium
| | - Jana Missiaen
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium
| | - Michelle Lycke
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium
| | - Tessa Lefebvre
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium
| | - Laura Tack
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, Catholic University Leuven , Leuven, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care @ Kulak, Catholic University Leuven Kulak , Kortrijk, Belgium
| | - Philip Debruyne
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium.,Faculty of Health, Social Care and Education, Anglia Ruskin University , Chelmsford, UK
| | - Dominique Vandijck
- Faculty of Medicine and Health Sciences, Ghent University , Gent, Belgium
| | - Koen Van Eygen
- Cancer Centre, General Hospital Groeninge , Kortrijk, Belgium
| |
Collapse
|
6
|
Ben Hassen H, Ayari N, Hamdi B. A home hospitalization system based on the Internet of things, Fog computing and cloud computing. INFORMATICS IN MEDICINE UNLOCKED 2020; 20:100368. [PMID: 32537483 PMCID: PMC7282767 DOI: 10.1016/j.imu.2020.100368] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 02/06/2023] Open
Abstract
In recent years, the world has witnessed a significant increase in the number of elderly who often suffer from chronic diseases, and has witnessed in recent months a major spread of the new coronavirus (COVID-19), which has led to thousands of deaths, especially among the elderly and people who suffer from chronic diseases. Coronavirus has also caused many problems in hospitals, where these are no longer able to accommodate a large number of patients. This virus has also begun to spread between medical and paramedical teams, and this causes a major risk to the health of patients staying in hospitals. To reduce the spread of the virus and maintain the health of patients who need a hospital stay, home hospitalization is one of the best possible solutions. This paper proposes a home hospitalization system based on the Internet of Things (IoT), Fog computing, and Cloud computing, which are among the most important technologies that have contributed to the development of the healthcare sector in a significant way. These systems allow patients to recover and receive treatment in their homes and among their families, where patient health and the hospitalization room environmental state are monitored, to enable doctors to follow the hospitalization process and make recommendations to patients and their supervisors, through monitoring units and mobile applications developed for this purpose. The results of evaluation have shown great acceptance of this system by patients and doctors alike. A home hospitalization system based on the Internet of Things (IoT), Fog computing and Cloud computing, has been proposed. An environmental sensing unit and a vital signs sensing unit were developed. Mobile applications have been developed for doctors, nurses, patients, and their relatives. The proposed home hospitalization system was evaluated by patients and doctors.
Collapse
Affiliation(s)
- Hafedh Ben Hassen
- University of Monastir, Electronic & Microelectronics' LAB, Faculty of Sciences of Monastir, Monastir, 5000, Tunisia.,University of Monastir, Department of Electrical Engineering, National Engineering School of Monastir, Monastir, 5000, Tunisia
| | - Nadia Ayari
- University of Monastir, Electronic & Microelectronics' LAB, Faculty of Sciences of Monastir, Monastir, 5000, Tunisia
| | - Belgacem Hamdi
- University of Monastir, Electronic & Microelectronics' LAB, Faculty of Sciences of Monastir, Monastir, 5000, Tunisia.,University of Sousse, Higher Institute of Applied Science and Technology of Sousse, Sousse, 4000, Tunisia
| |
Collapse
|
7
|
Cool L, Callewaert N, Pottel H, Mols R, Lefebvre T, Tack L, Lycke M, Missiaen J, Debruyne P, Vandijck D, Van Eygen K. Quality of blood samples collected at home does not affect clinical decision making for the administration of systemic cancer treatment. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:215-221. [PMID: 32282290 DOI: 10.1080/00365513.2020.1716267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The aim of this exploratory clinical study was to evaluate whether the preanalytical quality of blood samples subjected to delayed centrifugation and transport - as a result of home-sampling - is affected in a way it alters the clinical decision-making for patients under systemic cancer therapy. This evaluation is part of a comprehensive investigation of the opportunities for oncological home-hospitalization. Forty-nine patients with cancer donated two additional blood samples during their ambulatory hospital visit. Fifteen blood analytes were compared between routine blood samples and samples that were subjected to transport and delayed centrifugation in order to mimic a locally implemented model for oncological home-hospitalisation. Deviations were analysed by means of Deming regression. For those analytes showing statistically significant intercepts and/or slopes, the mean deviations were compared to the desirable analytical bias; and the intra-individual differences were compared with the limits for clinical decision-making. Statistically significant intercepts and/or slopes were observed for haematocrit (HCT), mean cellular volume (MCV), platelets count (PLT) and C-reactive protein (CRP). Differences exceeding the allowable margins of desirable analytical bias were observed for HCT and MCV. Risk of different clinical decision-making couldn't be observed for any of the analytes showing statistically significant differences. These results demonstrate that home-collection of blood samples, transported at room temperature and centrifuged within a mean time of five hours after sampling, has no effect on clinical decision-making with regards to systemic cancer therapy. However, attention should be paid to the potential occurrence of haemolysis during the preanalytical phase, which can negatively influence haemolysis-dependent variables.
Collapse
Affiliation(s)
- Lieselot Cool
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Nico Callewaert
- Clinical Laboratory, General Hospital Groeninge, Kortrijk, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care @ Kulak, Catholic University Leuven Kulak, Kortrijk, Belgium
| | - Ruth Mols
- Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Tessa Lefebvre
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Laura Tack
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Michelle Lycke
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Jana Missiaen
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Philip Debruyne
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium.,Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Dominique Vandijck
- Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Koen Van Eygen
- Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| |
Collapse
|