Compliance, satisfaction, and quality of life of patients with colorectal cancer receiving home chemotherapy or outpatient treatment: a randomised controlled trial
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7290.826 (Published 07 April 2001) Cite this as: BMJ 2001;322:826
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As suggested by Borras et al. [1], home chemotherapy is quite likely
to be more satisfactory than outpatient treatment for colorectal cancer
patients.
There is however an even more satisfactory way to administer
chemotherapy in these patients: ambulatory chrono-therapy [3-9].
Home chemotherapy may well “increase patients’ compliance with
treatment and satisfaction, particularly with regard to nursing care” [1].
Ambulatory chrono-chemotherapy not only can do the same, but also it
decreases the toxicity of chemotherapy, and, to a lesser extent, increases
its efficiency [4-9]. It is also better tolerated psychologically, and
improves the patients’ quality of life [3].
References
1) Hrushesky WJ, Bjarnason GA. The application of circadian
chronobiology to cancer chemotherapy. In: Cancer. Principles and Practice
of Oncology. Fourth Edition. V.T. De Vita, S. Hellman, S.A. Rosenberg
(eds). Fourth Edition. JB Lippincott Company, Philadelphia. 1993, pp. 2666
-2686.
2) Borras JM, Sanchez-Hernandez A, Navarro M, Martinez M, Mendez E,
Ponton JLL, Espinas JA, Germa JR. Compliance, satisfaction, and quality of
life of patients with colorectal cancer receiving home chemotherapy or
outpatient treatment: a randomised controlled trial. BMJ 2001;322:826.
3) Bertolini R, Focan C, Bartholome F, Baro V. Comparative
psychological aspects of two different types of chemotherapeutic
administration (chronotherapy vs. traditional chemotherapy) on quality of
life of cancer patients at advanced stage. In Vivo. 1995;9: 583-587.
4) Falcone A, Allegrini G, Antonuzzo A, Brunetti I, Pfanner E,
Lencioni M, Masi G, Danesi R, Del Tacca M, Conte P. Infusions of
fluorouracil and leucovorin: effects of the timing and semi-intermittency
of drug delivery. Oncology. 1999;57: 195-201.
5) Focan C, Kreutz F, Focan-Henrard D, Moeneclaey N. Chronotherapy
with 5-fluorouracil, folinic acid and carboplatin for metastatic
colorectal cancer; an interesting therapeutic index in a phase II trial.
Eur J Cancer. 2000;36: 341-347.
6) Focan C, Levi F, Kreutz F, et al. Continuous delivery of venous 5-
fluorouracil and arterial 5-fluorodeoxyuridine for hepatic metastases from
colorectal cancer: feasibility and tolerance in a randomized phase II
trial comparing flat versus chronomodulated infusion. Anticancer Drugs.
1999;10: 385-392.
7) Giacchetti S, Perpoint B, Zidani R, et al. Phase III multicenter
randomized trial of oxaliplatin added to chronomodulated fluorouracil-
leucovorin as first-line treatment of metastatic colorectal cancer. J Clin
Oncol. 2000;18: 136-147.
8) Lévi F, Zidani R, Misset JL. Randomised multicentre trial of
chronotherapy with oxaliplatin, fluorouracil, and folinic acid in
metastatic colorectal cancer. International Organization for Cancer
Chronotherapy. Lancet. 1997;350: 681-686 (Comment in Lancet. 1997;350:
1325-1326).
9) Mormont MC, Waterhouse J, Bleuzen P, Giacchetti S, Jami A, Bogdan
A, Lellouch J, Misset JL, Touitou Y, Levi F. Marked 24-h rest/activity
rhythms are associated with better quality of life, better response, and
longer survival in patients with metastatic colorectal cancer and good
performance status. Clin Cancer Res. 2000;6: 3038-3045.
Competing interests: No competing interests
Some important considerations regarding Chemotherapy at home
First of all I would like to convey my appreciation to Borras et al
for performing this trial which will definitely lead the way forward on
this important issue of provision of oncological care to cancer patients
at home. I would like to make some comments re; this trial.
[ 1 ] Large teaching hospital setting
This study is performed in a large teaching hospital. One cannot
expect to achieve similar results in the common setting of peripheral
clinics ,where chemotherapy day unit facilities are provided to a wider
population of patients who attend the day units with a wide range of
malignancies. The geographical considerations are quite important and one
has to see the provision of specialised facilities in a district hospital
setting.
[ 2 ] Non – Compliance Rate
The overall compliance with treatment in this study is quoted as 64
%,33out of 45in the chemo at home arm & 23 out of 42 in the
chemotherapy at outpatients clinic arm.[ table – 2 ] .The non-compliance
rate of 35.6% [ 45% ( 19 out of 42 patients )in the Outpatients arm and
27% ( 12 out of 45 patients ) in the Home arm ] is quite high and in my
personal opinion one has to keep this figure in mind before drawing any
conclusions from this study. It represents more than a third of the total
participants of the study.
[ 3 ] Safety
It is quoted that home chemotherapy seems an acceptable and "safe"
alternative to outpatient treatment that may improve compliance with
treatment. [ Ref.; 1 ] As I mentioned earlier compliance with treatment
has to be taken within the context of absolute numbers as we know that
more than third of the patients were not able to complete their prescribed
course of systemic chemotherapy. It would be appropriate to define and
describe the term "safety" before drawing any firm inferences.
[ 4 ] Availability of resources
In the United Kingdom Systemic Chemotherapy can only be administered
by certified nursing staff.
Availability of trained staff is a major issue of concern and
consideration in this scenario. This fact becomes more pronounced in the
setting of peripheral oncology services where provision of care at home is
an important component of overall management of cancer patients.
[ 5 ] Personal Qualities of Nursing
Further elaboration is required for the proper description of this
item.[ table – 3 ]. I presume that the nurses involved in the
administration of chemotherapy both at home and at the outpatient’s clinic
have the same qualifications and have the same standard of specialised
professional training .
[ 6 ] Satisfaction with the health care
A significant difference was found between groups in the perception
of nursing availability,with the hospital outpatients considering that
they had to wait longer to receive chemotherapy than the patients treated
at home [ table – 3 ]. This factor cannot be compared effectively in the
two arms of a study as it looks quite obvious that a patient visiting an
outpatient clinic is expected to wait for some length of time before a
health carer, specialist oncology nurse in this case, is available to
attend him or her.
REFERENCE
1 Borras A, Sanchez-Hernandez A, Navarro M, Martinez M, Mendez E,
Ponton JLL, Espinas JA , Germa JR.Compliance , Satisfaction, and Quality
of life of patients with colorectal cancer receiving home chemotherapy or
outpatient treatment : a randomised controlled trial. BMJ 2001;7290: 826 –
828.
With regards,
Yours sincerely,
Ahmed Nadeem Abbasi,
Locum Consultant,
Dept. of Clinical Oncologist,
Singleton Hospital ,
SWANSEA,
SA2 8QA.
E – Mail : reply@doctor.com
Competing interests: No competing interests