0utpatient and Home Chemotherapy: Preliminary Results of the Experience of the Limousin (France) Hematological Care Network.

Among innovative drugs used for hematologic malignancies, three are widely prescribed: bortezomib intravenously administered, alemtuzumab and azacitidine subcutaneously administered. Course frequencies require a large number of hospitalizations days. That adds stress to patients by reducing their comfort of life and increases the workload of medical persons and costs. Therefore, home chemotherapy appears as an alternative. We report an observational study of exporting chemotherapy through hospital at home (HaH). The objective is to study the feasibility before the establishment of a regional process, in partnership with all of regional HaH.

Materials and methods: In our region, medical coordinators of private and public outpatients departments HaH, participate in multidisciplinary meetings together with the hematologists. The prescriptions are validated in a regional multidisciplinary meeting (myeloid and lymphoid) and coordinated by the hematologist. The first day (D1) of each course is performed in day hospitalization or conventional hospitalization. If no relevant adverse event noticed, the rest of the course continues through HaH. Steps of HaH: 1) Medical prescription by authorized physician or hematologist from licensed hospital, 2) Medical validation “chemotherapy OK”, 3) Chemotherapy preparation in hospital pharmacy in accordance with legal requirements, 4) Chemotherapy providing to HaH responsible for a) transport according to legal requirements, b) receipt and administration at home, c) patient monitoring and traceability treatment by medical coordinator, practitioners and nurses, d) waste recovery.

In our region, from January 2009 to June 2010, it has been outsourced 1458 chemotherapy preparations corresponding to 1322 home chemotherapy courses for 112 patients with hematologic malignancies. The home chemotherapy courses concern respectively the three drugs as: azacitidine 593 courses (45%), bortezomib 512 (39%) and alemtuzumab 217 (16%). If any adverse event appears during the HaH, the patient is readdressed to the hospital until recovering.

Activity is increasing, 647 HaH courses were conducted during 2009, while 675 HaH courses have already been conducted during the 5 first months of 2010.

The increase of outsourcing of chemotherapy responds to a need for both patients and professional private or public health. The expected benefits include improved patient comfort, decongestion of hospital department and lower transport costs while maintaining safety for the patient and the medical persons.

This study confirmed the home chemotherapy feasibility for these three molecules. However outsourcing needs to be framed by conventions between hospitals and HaH. The feasibility stage is validated. The extension of the home chemotherapy our region is in process through the coordination of the “Agence Régionale de Santé”, HEMATOLIM (Limousin Hematological Care Network), licensed establishments, hospital pharmacies, prescribers and HaH. Practioners and liberal nurses should be involved, the patient remains at the center of the device.

No relevant conflicts of interest to declare.