Authors' objectives:

This study aims to assess the evidence concerning effectiveness, safety, patient preference and satisfaction, patient quality of life, and costs of home chemotherapy for cancer.

Authors' recommendations: Our review of the evidence in the scientific literature concerning home chemotherapy for cancer was enriched with semi-structured interviews with service providers in Quebec and Ontario. There is insufficient evidence on the clinical effectiveness of home chemotherapy compared to non-home settings. There is more evidence to show that home treatment can be delivered safely, with few serious complications or accidents, although patients must be carefully selected and trained. Where home chemotherapy replaces inpatient treatment, convincing evidence of cost savings for hospitals and families arises from only one pediatric study. In studies where home chemotherapy replaces outpatient treatment, the mixed findings and variable study quality prevent a conclusion on the cost implications. Home chemotherapy causes cost shifting within the health care system from hospitals to home care organizations. Effects on costs to Quebec hospitals and home care services, and to cancer patients and their families/informal caregivers, require more study. Improvements in patient quality of life at home have not been well documented in the literature, but are consistently reported anecdotally by care providers. Patient preference for and satisfaction with home therapy is supported, although the published evidence in this regard mostly arises from studies where acceptance of the approach is required to participate. Interviews with clinical and administrative personnel in Quebec and Ontario showed variable delivery of home chemotherapy, with greater uniformity of services and more structured programs where inter-organizational collaboration was supported. Interviews with rural providers pointed to a need for alternative outpatient delivery 'closer to home' in remote areas. Establishing safe chemotherapy practices at home is resource intensive and requires a well-integrated, collaborative team of health care professionals. Chemotherapy delivery in any setting requires specially trained personnel. The home delivery model cannot wholly replace outpatient treatment, especially in the rural setting, but can be a safe and acceptable option for some cancer patients who choose it, particularly those receiving simple continuous infusion treatment. Certain conditions must be in place in order to ensure high quality chemotherapy in the home setting; these aspects should be taken into account when such initiatives are implemented. We make several recommendations about these conditions. This assessment has led us to an additional recommendation related to access to chemotherapy: for rural cancer patients in Quebec, priority needs to be given to the establishment of 'closer to home' chemotherapy.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.aetmis.gouv.qc.ca/fr/publications/scientifiques/cancer/2004_0 2_en.pdf

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Agence d'évaluation des technologies et des modes d'intervention en santé

Contact Address: 2021, avenue Union, Bureau 10.083,Montreal, Quebec H3A S29, Canada.Tel: +1 514 873 2563; Fax: +1 514 873 1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS)