Cool_et_al_2021.pdf (328.27 kB)
Oncologic Home-Hospitalization Delivers a High-Quality and Patient-Centered Alternative to Standard Ambulatory Care: Results of a Randomized-Controlled Equivalence Trial
journal contribution
posted on 2023-07-26, 15:39 authored by Lieselot Cool, Jana Missiaen, Philip R. Debruyne, Hans Pottel, Veerle Foulon, Tessa Lefebvre, Laura Tack, Petra Archie, Dominique Vandijck, Koen Van EygenPURPOSE-
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.
History
Refereed
- Yes
Volume
7Page range
1564-1571Publication title
JCO Global OncologyISSN
2687-8941External DOI
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American Society of Clinical OncologyFile version
- Published version
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- eng
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2022-01-10Legacy creation date
2022-01-10Legacy Faculty/School/Department
Faculty of Health, Education, Medicine & Social CareUsage metrics
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