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01-05-2016 | Original Article

Home management of acute medical complications in cancer patients: a prospective pilot study

Authors: C. Font, F. Fernández-Avilés, C. Calderon, T. García-Fernández, N. Arab, E. Pineda, E. Buxó, P. Ayora, M. Carreño, V. Pereira, M. Viladot, C. Moreno, C. Gallego, A. Hernando, N. Creus, C. Barrera, R. Alcaraz, J. Sanchez, A. Prat, A. Tuca

Published in: Supportive Care in Cancer | Issue 5/2016

Abstract

Background

The development of reliable alternatives to conventional hospitalization in patients with cancer would have great clinical and economical value. The aim of the present study was to assess the feasibility of a home-based nursing intervention model as a safe alternative for the management of acute medical complications in cancer patients who would otherwise require conventional hospitalization.

Patients and methods

From October 2013 to October 2014, we prospectively evaluated the outcomes of consecutive acute medical episodes treated at home under the home-based intervention program named the Bridge Project (BP). Episodes were classified as “avoided hospitalization in outpatients” (AHO) vs. “reduced hospitalization in inpatients” (RHI). The primary end-point was to assess the rate and causes of BP intervention failure (unplanned hospital readmission or death).

Results

Two hundred and forty-six consecutive episodes (52 % AHO and 48 % RHI) involving 203 patients (55 % male; mean age 63 years) were enrolled. The main conditions managed at home were non-neutropenic infections (40 %), febrile neutropenia (20 %), and cancer-related complications (28 %). The median duration of the BP intervention was 5 days (range 1–16 days). No deaths were reported at home. Unplanned hospital readmissions occurred in 9 % of episodes (14 % in AHO vs. 4 % in RHI; p = 0.001). Five of the 22 readmitted patients (22.7 % of the BP failures; 2.5 % of the whole series) died during hospitalization. The BP intervention burden was 1353 days, representing a potential saving of 14 % of days of hospitalization during the study period.

Conclusions

The BP is a safe intervention which can potentially avoid or reduce the length of hospitalization in selected cancer patients with acute medical complications. Our findings support further development of innovative home-based clinical approaches to promote potentially avoidable hospitalization in this setting.

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Title: Home management of acute medical complications in cancer patients: a prospective pilot study
Authors: C. Font
F. Fernández-Avilés
C. Calderon
T. García-Fernández
N. Arab
E. Pineda
E. Buxó
P. Ayora
M. Carreño
V. Pereira
M. Viladot
C. Moreno
C. Gallego
A. Hernando
N. Creus
C. Barrera
R. Alcaraz
J. Sanchez
A. Prat
A. Tuca
Publication date: 01-05-2016
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 5/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-015-3006-0

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Abstract

Background

Patients and methods

Results

Conclusions

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