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Gil-Candel M, Solana-Altabella A, Vicente-Escrig E, Puplá-Bartoll A, Bodega Azuara J, Pérez-Huertas P, Ferrando Piqueres R. Developing a telepharmacy programme with home medication dispensing and informed delivery in a tertiary hospital: description of the model and analysis of the results. Eur J Hosp Pharm 2023; 30:107-112. [PMID: 35444000 PMCID: PMC9986923 DOI: 10.1136/ejhpharm-2021-003194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/28/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to describe the actions taken to implement a telepharmacy programme with home medication dispensing and informed delivery in an outpatient pharmaceutical care unit of a tertiary hospital, where approximately 5000 patients are treated per year. It also aimed to substantiate the applicability and benefits of the programme through analysing the findings and measuring patient satisfaction. METHODS We identified the operational, logistical, technological and legal needs, as well as the need for training, information and coordination with the care team and patient associations. A standard operating procedure was developed which described the home dispensing model and the profile of patients eligible for telepharmacy. Care activity was evaluated, between the months of July 2020 and January 2021; and a survey was conducted to measure patient satisfaction based on the Enopex project, a cross-sectional observational study of patients who used telepharmacy services during the COVID-19 lockdown period in Spain. RESULTS A total of 2536 medication deliveries were made over 144 working days, with a mean of 18 (standard deviation (SD): 6) deliveries per day, and a total of 2854 dispensings (1.1 drugs per delivery). In total, 197 different types of pharmaceutical formulations were delivered, corresponding to 123 active ingredients. The distance and time avoided during the study period totalled 1 05 624 km and 1 09 452 min (76 days), whereby the median distance and time saved per patient were 66 (interquartile range (IQR):122 km and 90 (IQR:90) minutes, which represents an approximate carbon footprint reduction of 25 kg of CO2 per patient and 16.5 tonnes in total. The satisfaction survey conducted, completed by 134 patients, revealed high satisfaction with the pharmacy service of 9.88 points out of 10. CONCLUSIONS The SARS-CoV-2 pandemic (COVID-19) has provided the pharmacy service with an opportunity to develop and implement a telepharmacy programme that benefits patients, which has enabled better organisation of the unit and greater accessibility for patients attending in person. It is a replicable method that is applicable in other pharmacy services with similar characteristics and requirements.
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Affiliation(s)
- Mayte Gil-Candel
- Pharmacy, Hospital General Universitari de Castelló, Castellón de la Plana, Comunidad Valenciana, Spain
| | - Antonio Solana-Altabella
- Pharmacy, Hospital General Universitari de Castelló, Castellón de la Plana, Comunidad Valenciana, Spain
| | - Esther Vicente-Escrig
- Pharmacy, Hospital General Universitari de Castelló, Castellón de la Plana, Comunidad Valenciana, Spain
| | - Aarón Puplá-Bartoll
- Pharmacy, Hospital General Universitari de Castelló, Castellón de la Plana, Comunidad Valenciana, Spain
| | - Julia Bodega Azuara
- Pharmacy, Hospital General Universitari de Castelló, Castellón de la Plana, Comunidad Valenciana, Spain
| | | | - Raul Ferrando Piqueres
- Pharmacy, Hospital General Universitari de Castelló, Castellón de la Plana, Comunidad Valenciana, Spain
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Sharp R, Xu Q, Corsini N, Turner L, Altschwager J, Marker J, Ullman A, Esterman A. Community-based Intravenous Treatment and Central Venous Access Devices: A Scoping Review of the Consumer and Caregiver Experience, Information Preferences, and Supportive Care Needs. J Community Health Nurs 2023; 40:28-51. [PMID: 36602775 DOI: 10.1080/07370016.2022.2081506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Map existing research and describe the consumer/caregiver experience of community-based intravenous treatment, central venous access devices (CVADs), supportive care needs, and information preferences. DESIGN Scoping review. METHODS Five databases (Joanna Briggs Institute, Cochrane library, Emcare, Embase, and Medline) were searched. Screening and data extraction were performed independently by two reviewers. FINDINGS Forty-eight studies were included. CONCLUSIONS Although community-based intravenous treatment and CVADs have a significant impact on consumers and caregivers, there is scant research on their supportive care needs and information preferences. CLINICAL EVIDENCE Some consumers and caregivers may require additional support while undergoing community-based intravenous treatment.
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Affiliation(s)
- Rebecca Sharp
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia.,Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | - Qunyan Xu
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Nadia Corsini
- Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
| | - Lisa Turner
- Clinical Operations, Silver Chain Group, Australia
| | | | - Julie Marker
- Cancer Voices South Australia, Adelaide, Australia
| | - Amanda Ullman
- Children's Health Queensland and Health Service/ School of Nursing, Midwifery and Social Work, The University of Queensland, Australia
| | - Adrian Esterman
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia.,Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, Australia
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Lizano-Díez I, Amaral-Rohter S, Pérez-Carbonell L, Aceituno S. Impact of Home Care Services on Patient and Economic Outcomes: A Targeted Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/10848223211038305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patient Support Programs (PSPs) reinforce patients’ care provided by health care professionals with the aim to improve adherence and patient empowerment. PSPs may include interventions such as home-based care, individualized medication counseling, support, training, and home delivery of medicines and/or devices. This study described these services and its impact on patient-reported outcomes and health care savings. We conducted an integrative literature review which was limited to publications from the last 10 years (2009-2019) and focused on diseases that require special support and/or parenteral administration. From 7040 total citations, we identified 64 home-based care services performed worldwide. Among the home-based care services, most were provided by nurses (n = 47/64; 73.4%) and addressed to cancer patients (n = 22/64; 34.4%); 23 out of 64 services (35.9%) incorporated telepharmacy. In general, home-based services and PSPs showed a positive impact on patients’ adherence to medication, patient satisfaction, and health-related quality of life. In addition, 14 (21.9%) services reported economic results, most of which showed that home therapy led to substantial cost savings.
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Eisenberg S, Klein C. Safe Handling of Hazardous Drugs in Home Infusion. JOURNAL OF INFUSION NURSING 2021; 44:137-146. [PMID: 33935248 DOI: 10.1097/nan.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chemotherapy agents used for cancer treatment are considered hazardous drugs (HDs). Guidelines and standards for handling HDs have been in place for several decades to protect oncology nurses working in hospitals and outpatient infusion areas. However, chemotherapy is frequently being administered in home settings, often by infusion nurses who do not necessarily have the requisite knowledge and training. Providing appropriate education for home infusion nurses is key to ensuring they are practicing in a manner that minimizes potential exposure to HDs.
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Affiliation(s)
- Seth Eisenberg
- Infusion Services, Seattle Cancer Care Alliance, Seattle, Washington (Mr Eisenberg); Cancer Treatment Centers of America, Philadelphia, and Community College of Philadelphia, Philadelphia, Pennsylvania (Ms Klein)
- Seth Eisenberg, ASN, RN, OCN®, BMTCN®, has been practicing in the field of oncology since 1983. His experience includes 35 years in blood and marrow transplantation and 21 years in ambulatory oncology infusion. He has published numerous articles on chemotherapy and biotherapy, as well as 6 book chapters (including a chapter for the Joint Commission Resources), and was a contributing author to the Oncology Nursing Society's (ONS') Safe Handling of Hazardous Drugs. He has also coedited the ONS Hematopoietic Stem Cell Transplantation: A Manual for Nursing Practice. Mr Eisenberg has presented nationally and internationally at nursing and pharmacy conferences. He has been the recipient of numerous awards, including the 2017 March of Dimes Research Advancement Award, the 2018 ONS Susan Baird Excellence in Clinical Writing Award, the 2020 Ruth McCorkle Lectureship Award, and, most recently, the 2021 Distinguished Award for Consistent Contribution to Nursing Literature
- Christina Klein, MSN, RN, CRNI®, OCN®, has 31 years' experience across the care continuum working in inpatient medical/surgical and critical care, outpatient infusion, home care infusion, vascular access, clinical education, and adjunct faculty nursing education. She is currently an oncology clinical educator at Cancer Treatment Center of America and adjunct faculty at Community College of Philadelphia. Her roles include educating clinical staff and onboarding new-to-practice and experienced nurses, direct patient care in the oncology outpatient infusion suite, and working with first-year nursing students in the clinical arena. Ms Klein is a member of the Infusion Nurses Certification Corporation RN Examination Council and an editorial reviewer for the Journal of Infusion Nursing
| | - Christina Klein
- Infusion Services, Seattle Cancer Care Alliance, Seattle, Washington (Mr Eisenberg); Cancer Treatment Centers of America, Philadelphia, and Community College of Philadelphia, Philadelphia, Pennsylvania (Ms Klein)
- Seth Eisenberg, ASN, RN, OCN®, BMTCN®, has been practicing in the field of oncology since 1983. His experience includes 35 years in blood and marrow transplantation and 21 years in ambulatory oncology infusion. He has published numerous articles on chemotherapy and biotherapy, as well as 6 book chapters (including a chapter for the Joint Commission Resources), and was a contributing author to the Oncology Nursing Society's (ONS') Safe Handling of Hazardous Drugs. He has also coedited the ONS Hematopoietic Stem Cell Transplantation: A Manual for Nursing Practice. Mr Eisenberg has presented nationally and internationally at nursing and pharmacy conferences. He has been the recipient of numerous awards, including the 2017 March of Dimes Research Advancement Award, the 2018 ONS Susan Baird Excellence in Clinical Writing Award, the 2020 Ruth McCorkle Lectureship Award, and, most recently, the 2021 Distinguished Award for Consistent Contribution to Nursing Literature
- Christina Klein, MSN, RN, CRNI®, OCN®, has 31 years' experience across the care continuum working in inpatient medical/surgical and critical care, outpatient infusion, home care infusion, vascular access, clinical education, and adjunct faculty nursing education. She is currently an oncology clinical educator at Cancer Treatment Center of America and adjunct faculty at Community College of Philadelphia. Her roles include educating clinical staff and onboarding new-to-practice and experienced nurses, direct patient care in the oncology outpatient infusion suite, and working with first-year nursing students in the clinical arena. Ms Klein is a member of the Infusion Nurses Certification Corporation RN Examination Council and an editorial reviewer for the Journal of Infusion Nursing
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Mittaine‐Marzac B, Zogo A, Crusson J, Cheneau V, Pinel M, Brandely‐Piat M, Amrani F, Havard L, Balladur E, Louissaint T, Nivet L, Ankri J, Aegerter P, De Stampa M. COVID-19 outbreak: An experience to reappraise the role of hospital at home in the anti-cancer drug injection. Cancer Med 2021; 10:2242-2249. [PMID: 33665971 PMCID: PMC7982610 DOI: 10.1002/cam4.3682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/28/2020] [Accepted: 12/01/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The COVID-19 outbreak has posed considerable challenges to the health care system worldwide, especially for cancer treatment. We described the activity and the care organisation of the Hospitalisation At Home (HAH) structure during the pandemic for treating patients with anti-cancer injections. METHODS We report the established organisation, the eligibility criteria, the patient characteristics, the treatment schemes and the stakeholders' role during two 5-week periods in 2020, before and during the French population's lockdown. RESULTS The increase of activity during the lockdown (+32% of treated patients, +156% of new patients and +28% of delivered preparations) concerned solid tumour, mainly breast cancer, even if haematological malignancies remained the most frequent. Thirty different drugs were delivered, including three new drugs administered in HAH versus 19 during the routine period (p < 0.01). For those clinical departments accustomed to using HAH, the usual organisation was kept, but with adjustments. Five clinical departments increased the number of patients treated at home and widened the panel of drugs prescribed. Three oncology departments and one radiotherapy department for the first time solicited HAH for anti-cancer injections, mainly for immunotherapy. We adjusted the HAH organisation with additional human resources and allowed to prescribe drugs with an infusion time of <30 min only for the new prescribers. CONCLUSION HAH allowed for the continuation of anti-cancer injections without postponement during the pandemic, and for a decrease in unnecessary patient travel to hospital with its concomitant COVID-19 transmission risk. Often left out of guidelines, the place of HAH in treating cancer patients should be reappraised, even more so during a pandemic.
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Affiliation(s)
- Bénédicte Mittaine‐Marzac
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
- Hôpital Paul BrousseCESP ‐ Centre de recherche en Epidémiologie et Santé des Populations ‐ U1018INSERMUniversité Paris‐Saclay (UPSUniversité de Versailles Saint‐Quentin (UVSQParisFrance
| | - Arsene Zogo
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | | | - Valerie Cheneau
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | - Marie‐Claire Pinel
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | | | - Fatma Amrani
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | - Laurent Havard
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | - Elisabeth Balladur
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | - Taina Louissaint
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | - Laurence Nivet
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
| | - Joel Ankri
- Hôpital Paul BrousseCESP ‐ Centre de recherche en Epidémiologie et Santé des Populations ‐ U1018INSERMUniversité Paris‐Saclay (UPSUniversité de Versailles Saint‐Quentin (UVSQParisFrance
| | - Philippe Aegerter
- Hôpital Paul BrousseCESP ‐ Centre de recherche en Epidémiologie et Santé des Populations ‐ U1018INSERMUniversité Paris‐Saclay (UPSUniversité de Versailles Saint‐Quentin (UVSQParisFrance
| | - Matthieu De Stampa
- Hospitalisation à Domicile Assistance Publique des Hôpitaux de ParisParisFrance
- Hôpital Paul BrousseCESP ‐ Centre de recherche en Epidémiologie et Santé des Populations ‐ U1018INSERMUniversité Paris‐Saclay (UPSUniversité de Versailles Saint‐Quentin (UVSQParisFrance
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Impacts on health outcomes and on resources utilization for anticancer drugs injection at home, a complex intervention: a systematic review. Support Care Cancer 2021; 29:5581-5596. [PMID: 33763728 DOI: 10.1007/s00520-021-06145-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND As hospital-based home care is a complex intervention, we critically appraised the key elements that could ensure the completeness of assessment and explain the heterogeneity of the literature results about the comparison between home and hospital setting for the anticancer drugs injection within the same standards of clinical care. METHODS Systematic review was conducted. Medline, Embase, Cochrane Library, Web of Sciences, and Cumulative Index of Nursing and Allied Health (Cinahl) searched to February 1, 2019, and combined with grey literature. Methodological quality has been rated using the "Quality Assessment Tool for Quantitative Studies" developed by the Effective Public Health Practice Project (EPHHP) in addition to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement for economic studies and the consolidated criteria for reporting qualitative research (COREQ) checklist for qualitative studies. RESULTS Of 400 records identified, we identified 13 relevant studies (nine quantitative and four mixed-method studies). The quality of studies was hardly strong. The home-based anticancer injection involved highly heterogeneous home care interventions that generally kept a strong link with the hospital setting. The study schemes limited the comparison of clinical outcomes (OS, PFS, toxicity). Unlike the quality of life remaining similar, patients preferred to be treated at home. Cost savings were in favor of Hospital at Home, but the charge categories used to compare or the home intervention were heterogeneous and rarely integrating relatives' duties and hospital staff's time. Qualitative studies highlighted about benefits and barriers of home. CONCLUSION The current state of evidence shows as it still remains difficult to appraise the anticancer injection at home when considering the details of this complex intervention, the role of each stakeholder, and the missing data.
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Wardley A, Canon JL, Elsten L, Peña Murillo C, Badovinac Crnjevic T, Fredriksson J, Piccart M. Flexible care in breast cancer. ESMO Open 2021; 6:100007. [PMID: 33450658 PMCID: PMC7811121 DOI: 10.1016/j.esmoop.2020.100007] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/03/2020] [Indexed: 12/30/2022] Open
Abstract
Treatment of patients with cancer in hospitals or clinics is resource-intensive and imposes a burden on patients. 'Flexible care' is a term that can be used to describe treatment administered outside the oncology ward, oncological outpatient clinic or office-based oncologist setting. Programmes that reduce travel burden by bringing cancer treatment to the patient's home, workplace or closer to the patient's home, in the form of satellite clinics or mobile cancer units, expand treatment capacity and are well received. Clinical trial data show that, compared with intravenous administration, subcutaneous (s.c.) administration of trastuzumab is preferred by patients with breast cancer (BC), saves healthcare professionals' (HCPs) time, reduces drug preparation and administration time and reduces direct and indirect costs. As such, s.c. trastuzumab is well suited to flexible care. The results of a Belgian study (BELIS) show that home administration of s.c. trastuzumab is feasible and preferred by patients with BC. Numerous programmes and pilot studies in Europe show that s.c. trastuzumab can be administered effectively in the patient's home, in primary care settings or local hospitals. Such programmes require planning, training, careful patient selection and technology to link patients, caregivers and specialists in oncology clinics. Once these elements are in place, flexible care offers patients with BC a choice of how treatment may be delivered and lead to improved quality of life, while reducing pressure on HCPs and hospitals. The concept of flexible care is particularly relevant amid the COVID-19 pandemic where guidelines have been developed encouraging remote care.
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Affiliation(s)
- A Wardley
- NIHR Manchester Clinical Research Facility at The Christie and Division of Cancer Sciences and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - J-L Canon
- Service d'Oncologie-Hématologie, Site Notre-Dame, Grand Hôpital de Charleroi (GHdC), Charleroi, Belgium
| | - L Elsten
- Department of Medical Oncology, Amphia Hospital, Breda, The Netherlands
| | - C Peña Murillo
- Global Product Development, Medical Affairs, Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - J Fredriksson
- Global Product Development, Medical Affairs, Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - M Piccart
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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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.
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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
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10
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Cool L, Missiaen J, Vandijck D, Lefebvre T, Lycke M, De Jonghe PJ, Vergauwe P, Foulon V, Pottel H, Debruyne P, Van Eygen K. An observational pilot study to evaluate the feasibility and quality of oncological home-hospitalization. Eur J Oncol Nurs 2019; 40:44-52. [DOI: 10.1016/j.ejon.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 02/07/2023]
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Paracha N, Abdulla A, MacGilchrist KS. Systematic review of health state utility values in metastatic non-small cell lung cancer with a focus on previously treated patients. Health Qual Life Outcomes 2018; 16:179. [PMID: 30208899 PMCID: PMC6134713 DOI: 10.1186/s12955-018-0994-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/08/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Health state utility values (HSUVs) are an important input to economic evaluations and the choice of HSUV can affect the estimate of relative cost-effectiveness between interventions. This systematic review identified utility scores for patients with metastatic non-small cell lung cancer (mNSCLC), as well as disutilities or utility decrements relevant to the experience of patients with mNSCLC, by treatment line and health state. METHODS The MEDLINE®, Embase and Cochrane Library databases were systematically searched (September 2016) for publications describing HSUVs in mNSCLC in any treatment line. The EQ-5D website, the School of Health and Related Research Health Utilities Database (ScHARRHUD) and major pharmacoeconomic and clinical conferences in 2015-2016 were also queried. Studies in adults with previously treated mNSCLC were selected for further analysis. The information extracted included study design, description of treatment and health state, respondent details, instrument and tariff, HSUV or (dis) utility decrement estimates, quality of study, and appropriateness for use in economic evaluations. RESULTS Of 1883 references identified, 36 publications of 34 studies were included: 19 reported EQ-5D scores; eight reported HSUVs from valuations of vignettes made by members of the public using standard gamble (SG) or time trade-off (TTO); two reported SG or TTO directly elicited from patients; two reported EQ-5D visual analogue scale scores only; one reported Assessment of Quality of Life instrument scores; one reported HSUVs for caregivers to patients with mNSCLC using the 12-item Short-Form Health Survey; and one estimated HSUVs based on expert opinion. The range of HSUVs identified for comparable health states showed how differences in study type, tariff, health state and the measures used can drive variation in HSUV estimates. CONCLUSIONS This systematic review provides a set of published HSUVs that are relevant to the experience of adult patients previously treated for mNSCLC. Our review begins to address the challenge of identifying reliable estimates of utility values in mNSCLC that are suitable for use in economic evaluations, and also highlights how varying estimates result from differences in methodology.
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Affiliation(s)
| | - Ahmed Abdulla
- F. Hoffmann-La Roche AG, Basel, Switzerland
- Present address: Digipharm, Zug, Switzerland
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Pangeni R, Choi JU, Panthi VK, Byun Y, Park JW. Enhanced oral absorption of pemetrexed by ion-pairing complex formation with deoxycholic acid derivative and multiple nanoemulsion formulations: preparation, characterization, and in vivo oral bioavailability and anticancer effect. Int J Nanomedicine 2018; 13:3329-3351. [PMID: 29922055 PMCID: PMC5995301 DOI: 10.2147/ijn.s167958] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective The current study sought to design an oral delivery system of pemetrexed (PMX), a multitargeted antifolate antimetabolite, by enhancing its intestinal membrane permeability. Materials and methods PMX was ionically complexed with a permeation enhancer such as Nα-deoxycholyl-l-lysyl-methylester (DCK) and prepared as an amorphous solid dispersion by mixing with dispersants such as 2-hydroxypropyl-beta-cyclodextrin (HP-beta-CD) and poloxamer 188 (P188), forming an HP-beta-CD/PMX/DCK/P188; the complex was incorporated into multiple water-in-oil-in-water nanoemulsions in a supersaturated state (HP-beta-CD/PMX/DCK/P188-NE). Results After complex formation, the partition coefficient and in vitro membrane permeability of PMX were markedly increased, but it showed similar cytotoxic and inhibitory effects on cancer cell proliferation/migration. Furthermore, the intestinal membrane permeability and epithelial cell uptake of PMX were synergistically improved after HP-beta-CD/PMX/DCK/P188 was incorporated into a nanoemulsion with a size of 14.5±0.45 nm. The in vitro permeability of HP-beta-CD/PMX/DCK/P188-NE across a Caco-2 cell monolayer was 9.82-fold greater than that of free PMX, which might be attributable to the partitioning of PMX to the epithelial cells being facilitated via specific interaction of DCK with bile acid transporters, as well as the enhanced lipophilicity accompanied by surfactant-induced changes in the intestinal membrane structure and fluidity. Therefore, the oral bioavailability of HP-beta-CD/PMX/DCK/P188-NE in rats was evaluated as 26.8%±2.98% which was 223% higher than that of oral PMX. Moreover, oral HP-beta-CD/PMX/DCK/P188-NE significantly suppressed tumor growth in Lewis lung carcinoma cell-bearing mice, and the tumor volume was maximally inhibited by 61% compared with that in the control group. Conclusion These results imply that HP-beta-CD/PMX/DCK/P188-NE is an effective and promising delivery system for enhancing the oral absorption of PMX. Thus, there is the potential for new medical applications, including applications in metronomic cancer treatment.
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Affiliation(s)
- Rudra Pangeni
- College of Pharmacy and Natural Medicine Research Institute, Mokpo National University, Muan-gun, Jeonnam, Republic of Korea
| | - Jeong Uk Choi
- College of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - Vijay Kumar Panthi
- College of Pharmacy and Natural Medicine Research Institute, Mokpo National University, Muan-gun, Jeonnam, Republic of Korea
| | - Youngro Byun
- Department of Molecular Medicine and Biopharmaceutical Science, Graduate School of Convergence Science and Technology, College of Pharmacy, Seoul National University, Seoul, Republic of Korea
| | - Jin Woo Park
- College of Pharmacy and Natural Medicine Research Institute, Mokpo National University, Muan-gun, Jeonnam, Republic of Korea
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Organization, quality and cost of oncological home-hospitalization: A systematic review. Crit Rev Oncol Hematol 2018; 126:145-153. [DOI: 10.1016/j.critrevonc.2018.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/24/2018] [Accepted: 03/21/2018] [Indexed: 11/23/2022] Open
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14
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Dexamethasone alleviates pemetrexed-induced senescence in Non-Small-Cell Lung Cancer. Food Chem Toxicol 2018; 119:86-97. [PMID: 29753869 DOI: 10.1016/j.fct.2018.05.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/05/2018] [Accepted: 05/09/2018] [Indexed: 01/01/2023]
Abstract
Pemetrexed (PEM) is a novel and multi-targeted antifolate used as an antineoplastic agent for non-small cell lung cancer (NSCLC) and pleural mesothelioma. Although glucocorticoid was often used with PEM to reduce toxicity during the chemotherapy, it is not clear yet whether glucocorticoid co-administration could affect PEM efficacy in NSCLC. Here we established NSCLC cell lines and examined the effects of dexamethasone (DEX) on PEM sensitivity in vitro and in xenograft models. DEX co-administration reduced chemotherapy sensitivity to PEM in xenograft models. DEX co-administration promoted cell growth and weakened senescence growth arrest, such as altered secretions of proinflammatory and mitogenic cytokines, reminiscent of a senescence associate secretory phenotype (SASP). CSCs in DEX co-administration group were subsequently found to be less sensitive towards PEM treatment as measured by cell proliferation and generation of tumor spheres in the presence of PEM. Survival molecule B-cell lymphoma-2 (Bcl-2) may involve in this process and blockage of Bcl-2 could reverse altered senescence and CSCs abilities, thus alleviated PEM insensitivity. As such, DEX might suppress the antitumor activity of PEM through altered SASP level that had induced traits similar to CSCs.
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15
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Bertrand A, Favier B, Devaux Y, Goy F, Marcault-Derouard A, Veyet V, Cervos M, Schell M. [Intravenous chemotherapy at home: A pediatric monocentric experience]. Bull Cancer 2018; 105:155-161. [PMID: 29395041 DOI: 10.1016/j.bulcan.2017.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/06/2017] [Accepted: 10/07/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Our home care unit (HCU) developed the administration of IV chemotherapy at home for some pediatric oncologic patients. METHODS We conducted a retrospective monocentric analysis, leading to identify patients with at least one sequence of chemotherapy at home in 2015. RESULTS Two hundred and forty four sequences of home chemotherapy have been administered in 2015. We identified two situations for home IV chemotherapy. Pediatric oncologist of day hospital prescribes the sequence. The chemotherapy is delivered at hospital for the first day. HCU takes over for the next days at home. For a sequence replacing a conventional hospitalization, the attending physician examines the patient, and confirm the clinical validation. The pediatric oncologist of HCU checks lab exams, and prescribes the chemotherapy. For both situations, IV chemotherapy is prepared by our hospital pharmacy, delivers at home or at day hospital, and HCU team manages home material and organizes hospitalization. CONCLUSIONS This kind of organization allows setting up home IV CT for more and more patients. It allows to limit daily hospitalization for some patients living far from the hospital, and whose therapies lead to several hospitalizations.
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Affiliation(s)
- Amandine Bertrand
- Centre Léon-Bérard, hospitalisation à domicile pédiatrique, IHOPe, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France.
| | | | - Yves Devaux
- Centre Léon-Bérard, hospitalisation à domicile adulte, 28, rue Laennec, 69008 Lyon, France
| | - Florence Goy
- Centre Léon-Bérard, hospitalisation à domicile pédiatrique, IHOPe, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
| | | | - Véronique Veyet
- Centre Léon-Bérard, hospitalisation à domicile pédiatrique, IHOPe, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
| | - Marie Cervos
- Centre Léon-Bérard, hospitalisation à domicile pédiatrique, IHOPe, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
| | - Matthias Schell
- Centre Léon-Bérard, hospitalisation à domicile pédiatrique, IHOPe, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France; ESPPéRA, ERRSPP Rhône-Alpes, 1, place du Pr-J.-Renaut, 69373 Lyon cedex 08, France
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16
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Shen L, Niu X, Jian H, Xu Y, Yu Y, Lu S. Assessment of interfering factors and clinical risk associated with discontinuation of pemetrexed maintenance therapy in advanced non-squamous non-small cell lung cancer. Lung Cancer 2017; 111:43-50. [PMID: 28838396 DOI: 10.1016/j.lungcan.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 06/04/2017] [Accepted: 07/03/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Pemetrexed continuation maintenance therapy after induction with platinum-based chemotherapy is a standard treatment option for non-squamous non-small cell lung cancer (NSCLC) patients. However, discontinuation of maintenance therapy is still a challenge in clinical practice. We aimed to investigate interfering factors and clinical risk associated with discontinuation of pemetrexed maintenance therapy (PMT). MATERIALS AND METHODS Data of patients with locally advanced or metastatic non-squamous NSCLC who received PMT between December 2011 and October 2015 were retrospectively analyzed. Patients' characteristics, performance status (PS), response and toxicity evaluation were collected. The reasons for PMT discontinuation were summarized. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier method and Cox proportional hazard model. RESULTS Of the 220 patients included for final analysis, 132 patients (60.0%) continued PMT until disease progression. The patients over 60 years old (p=0.021), the patients with PS 2 at the initiation of PMT (p=0.005) and the patients experienced grade 3/4 toxicity during PMT (p<0.001) had a higher discontinuation rate. The reasons for PMT discontinuation were the regarding toxicity (39.8%), high intensity of hospital visit (17.0%), treatment cost (13.6%), patients' preference (26.1%) and failure of pain control (3.4%). In univariate analysis, PS 0-1 at the initiation of PMT (5.6 versus 4.3 months, p=0.022) and PMT continuation (5.6 versus 4.3 months, p<0.001) were associated with improved PFS. And PMT continuation was associated with improved OS (19.2 versus 16.8 months, p=0.003) along with actionable mutations and PS 0-1 at the initiation of PMT. In multivariate analysis, PMT continuation (hazard ratio: 1.486; 95% CI: 1.050-2.104; p=0.025) was an independent prognostic factor regarding OS benefit assessed by Cox proportional hazard model. CONCLUSION Discontinuation of PMT is common in clinical practice. The survival benefit suggests that fit patients should be encouraged to continue PMT until disease progression.
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Affiliation(s)
- Lan Shen
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, PR China
| | - Xiaomin Niu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, PR China
| | - Hong Jian
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, PR China
| | - Yunhua Xu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, PR China
| | - Yongfeng Yu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, PR China
| | - Shun Lu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Xuhui District, Shanghai, 200030, PR China.
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Brown J, Cook K, Adamski K, Lau J, Bargo D, Breen S, Chawla A. Utility values associated with advanced or metastatic non-small cell lung cancer: data needs for economic modeling. Expert Rev Pharmacoecon Outcomes Res 2017; 17:153-164. [PMID: 28335636 DOI: 10.1080/14737167.2017.1311210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cost-effectiveness analyses often inform healthcare reimbursement decisions. The preferred measure of effectiveness is the quality adjusted life year (QALY) gained, where the quality of life adjustment is measured in terms of utility. Areas covered: We assessed the availability and variation of utility values for health states associated with advanced or metastatic non-small cell lung cancer (NSCLC) to identify values appropriate for cost-effectiveness models assessing alternative treatments. Our systematic search of six electronic databases (January 2000 to August 2015) found the current literature to be sparse in terms of utility values associated with NSCLC, identifying 27 studies. Utility values were most frequently reported over time and by treatment type, and less frequently by disease response, stage of disease, adverse events or disease comorbidities. Expert commentary: In response to rising healthcare costs, payers increasingly consider the cost-effectiveness of novel treatments in reimbursement decisions, especially in oncology. As the number of therapies available to treat NSCLC increases, cost-effectiveness analyses will play a key role in reimbursement decisions in this area. Quantifying the relationship between health and quality of life for NSCLC patients via utility values is an important component of assessing the cost effectiveness of novel treatments.
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Affiliation(s)
- Jacqueline Brown
- a Global Patient Outcomes and Real World Evidence , Eli Lilly and Company , Windlesham , UK
| | - Keziah Cook
- b Analysis Group, Inc , Menlo Park , CA , USA
| | | | - Jocelyn Lau
- b Analysis Group, Inc , Menlo Park , CA , USA
| | - Danielle Bargo
- c UK Health Outcomes and HTA team , Eli Lilly and Company Limited , Basingstoke , Hampshire , UK
| | - Sarah Breen
- c UK Health Outcomes and HTA team , Eli Lilly and Company Limited , Basingstoke , Hampshire , UK
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