BMJ 2001;322:826 ( 7 April )

Papers

Compliance, satisfaction, and quality of life of patients with colorectal cancer receiving home chemotherapy or outpatient treatment: a randomised controlled trial

J M Borras, head of the unit, a A Sanchez-Hernandez, medical oncologist, b M Navarro, medical oncologist, b M Martinez, research nurse, a E Mendez, research fellow, a J L L Ponton, head of department, c J A Espinas, research fellow, a J R Germa, head of department. b

a Cancer Prevention and Control Unit, Catalan Institute of Oncology, Gran Via Km 2,7 s/n, 08907-Hospitalet, Spain, b Department of Medical Oncology, Catalan Institute of Oncology, c Department of Pharmacy, Catalan Institute of Oncology

Correspondence to: J M Borras jmborras{at}ico.scs.es

Objective: To compare chemotherapy given at home with outpatient treatment in terms of colorectal cancer patients' safety, compliance, use of health services, quality of life, and satisfaction with treatment.
Design: Randomised controlled trial.
Setting: Large teaching hospital.
Participants: 87 patients receiving adjuvant or palliative chemotherapy for colorectal cancer.
Interventions: Treatment with fluorouracil (with or without folinic acid or levamisole) at outpatient clinic or at home.
Main outcome measures: Treatment toxicity; patients' compliance with treatment, quality of life, satisfaction with care, and use of health resources.
Results: 42 patients were treated at outpatient clinic and 45 at home. The two groups were balanced in terms of age, sex, site of cancer, and disease stage. Treatment related toxicity was similar in the two groups (difference 7% (95% confidence interval -12% to 26%)), but there were more voluntary withdrawals from treatment in the outpatient group than in the home group (14% v 2%, difference 12% (1% to 24%)). There were no differences between groups in terms of quality of life scores during and after treatment. Levels of patient satisfaction were higher in the home treatment group, specifically with regard to information received and nursing care. There were no significant differences in use of health services.
Conclusions: Home chemotherapy seemed an acceptable and safe alternative to hospital treatment for patients with colorectal cancer that may improve compliance and satisfaction with treatment.


What is already known on this topic
Home chemotherapy programmes have been proposed as an alternative to hospital treatment

However, they are more costly, and there is little evidence on their impact on outcomes such as compliance, quality of life, or use of other health services

What this study adds
Home chemotherapy was not associated with an increased use of health services such as primary care or emergency departments

Home chemotherapy had no effect on patients' quality of life but increased their compliance with treatment and satisfaction, particularly with regard to nursing care

Home chemotherapy seems an acceptable and safe alternative to outpatient treatment that may improve compliance with treatment



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