Investigators Highlight Benefits of Outpatient Delivery of Intensive Chemotherapy

Findings from a 5-year quality improvement project suggest that intensive chemotherapy can be safely and effectively delivered in the outpatient setting for patients with hematological malignancies, according to a poster presented during the 2023 ASCO Quality Care Symposium.

“Outpatient delivery of intensive chemotherapy for hematological malignancies is an effective approach, which results in comparable safety outcomes and significant improvements in cost-effectiveness, resource utilization, and quality-of-life outcomes,” study authors wrote in the poster.

Key Outcomes

Overall, investigators observed that 64.3% of patients developed febrile neutropenia in the inpatient setting vs 27.5% of patients in the outpatient setting (P < .001). Similarly, the rate of positive blood cultures was 28.6% in patient in the inpatient setting vs 10.6% in the outpatient setting (P < .001).

The rate of reported deaths during treatment was 4% in the inpatient setting vs 0.5% in outpatient setting (P = .003).

According to an analysis of reported outcomes in the EORTC QLQ Core questionnaire, patients who received their therapy in the outpatients setting also experienced significant improvements in quality of life.

Additionally, the administration of chemotherapy in the outpatient setting was associated with a 53.4% reduction in total occupied bed days. In total, this intervention was estimated to save the hospital $2.88 million throughout 2018 and 2022.

Methodology

Investigators leveraged the Plan-Do-Study-Act framework to develop their approach. Under this methodology, a multidisciplinary team was established to identify the best strategies to deliver chemotherapy in the outpatient setting and improve the rate of healthcare resource utilization.

These investigators collected the records of all the patients who underwent chemotherapy in an inpatient setting from 2016 to 2017 and reviewed them retrospectively.

Certain designs were deemed necessary to administer outpatient intensive chemotherapy. First, an outpatient chemotherapy clinic was created, clinical pathways and administration protocols were developed for the clinic, educational materials were made available for both patients and healthcare staff, and it was established that the clinic could facilitate rapid access to emergency care services, if need be.

For the purposes of this study, investigators enrolled 288 patients; 24.3% of whom (n = 70) received inpatient chemotherapy and 75.7% (n = 218) of whom received outpatient chemotherapy.

The median patient age was 34 and 38 years old, between the inpatient and outpatient arms, respectively (P = .027).

Findings in Context

According to the study authors, there has been a shift towards outpatient therapy administration because of the potential improvements in quality-of-life measures that this strategy affords. Outpatient care is also strategic to optimizing healthcare resources, they said.

Next steps will be to test these results in larger, multicentric, and randomized clinical trial, across both solid and hematologic malignancies. Investigators should also evaluate the feasibility of outpatient induction therapy moving forward, they concluded.

Reference

Dayil LB, Omer MH, Salama H, et al. Outpatient versus inpatient delivery of intensive chemotherapy for patients with hematological neoplasms: A 5-year experience from a tertiary center. Presented at: ASCO Quality Care Symposium. October 27-28, 2023; Boston, MA.