A NATIONAL DANISH PROOF OF CONCEPT ON FEASIBILITY AND SAFETY OF HOME -BASED INTENSIVE CHEMOTHERAPY IN PATIENTS WITH ACUTE MYELOID LEUKEMIA
Author(s): ,
Kristina Nørskov
Affiliations:
Hematology,University Hospital of Copenhagen,Copenhagen Ø,Denmark
,
Katrine Fridthjof
Affiliations:
Amgros,Ambros,Copenhagen Ø,Denmark
,
Peter Kampmann
Affiliations:
Hematology,University Hospital of Copenhagen,Copenhagen Ø,Denmark
,
Anne Dünweber
Affiliations:
Hematology,University Hospital of Copenhagen,Copenhagen Ø,Denmark
,
Toni Renaberg
Affiliations:
Hematology,University Hospital of Copenhagen,Copenhagen Ø,Denmark
,
Claudia Schöllkopf
Affiliations:
Hematology,University Hospital of Copenhagen,Copenhagen Ø,Denmark
,
Syed Azar Ahmad
Affiliations:
Hematology,University Hospital of Copenhagen,Copenhagen Ø,Denmark
,
Katrine Schou
Affiliations:
Hematology,Zealand University Hospital,4000 Roskilde,Denmark
,
Cecilie Fremming Jensen
Affiliations:
Hematology,Zealand University Hospital,4000 Roskilde,Denmark
,
Peter Møller
Affiliations:
Hematology,Zealand University Hospital,4000 Roskilde,Denmark
,
Birgitte Wolf Lundholm
Affiliations:
Hematology,Odense University Hospital,5000 Odense C,Denmark
,
Claus Marcher
Affiliations:
Hematology,Odense University Hospital,5000 Odense C,Denmark
,
Anne Katrine Ørntoft
Affiliations:
Hematology,Aarhus University Hospital,8000 Aarhus C,Denmark
,
Hans Beier Ommen
Affiliations:
Hematology,Aarhus University Hospital,8000 Aarhus C,Denmark
,
Lotte Andersen
Affiliations:
Hematology,Aalborg University Hospital,9000 Aalborg,Denmark
,
Connie Fruergaard Hasselgren
Affiliations:
Hematology,Aalborg University Hospital,9000 Aalborg,Denmark
,
Marianne Severinsen
Affiliations:
Hematology,Aalborg University Hospital,9000 Aalborg,Denmark
,
Mia Klinten Grand
Affiliations:
Department of Biostatistics,University of Copenhagen,1014 Copenhagen K,Denmark
,
Mary Jarden
Affiliations:
Hematology,University Hospital of Copenhagen,Copenhagen Ø,Denmark
,
Tom Møller
Affiliations:
Center for Health Research,University Hospital,2200 Copenhagen N,Denmark
Lars Kjeldsen
Affiliations:
Hematology,University of Copenhagen,Copenhagen Ø,Denmark
EHA Library. Nørskov K. 06/09/21; 324542; S134
Kristina Nørskov
Kristina Nørskov
Contributions
Abstract
Presentation during EHA2021: All Oral presentations will be made available as of Friday, June 11, 2021 (09:00 CEST) and will be accessible for on-demand viewing until August 15, 2021 on the Virtual Congress platform.

Abstract: S134

Type: Oral Presentation

Session title: AML classification

Background
Advances in treatment modalities have made it possible to offer chemotherapy to patients at home without health care professionals being present. Home-based chemotherapy treatment has shown to provide several benefits in patients with cancer however existing evidence does not include patients with hematologic malignancies. In addition, there is no best practice models which can guide coordination and standardization of home-based chemotherapy treatment. Thus, it is relevant to investigate the feasiblity and safety of home-based treatment in this population.   

Aims
To investigate the feasiblity and safety of home-based intensive chemotherapy in patients with newly diagnosed acute myeloid leukemia or high-risk myelodysplastic syndrome, and to examine quality of life and psychological wellbeing.

Methods
A national multicenter single-arm feasibility study that included patients from six sites in Denmark with newly diagnosed with acute leukemia or high-risk myelodysplastic syndrome receiving intensive induction and consolidation like chemotherapy (n=104). Participants received intensive chemotherapy on programmed CADD Solis infusion pumps through a central venous catheter. Supportive care was offered in the outpatient unit every second or third day for transfusion or surveillance of infection. Outcome measures included feasibility (primary outcome), safety, anxiety and depression measured by the Hospital Anxiety and Depression Scale, and quality of life by the Functional Assessment of Cancer Therapy – Leukemia and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. 

Results
In total, 104 patients were included, receiving 264 treatments during the intervention. Total number of days slepping at home during treatment was 1.096 (mean 4.57, SD 3.0) out of 1.644 treatment days  (66 %). Patients with no admissions during treatment were in cycle one (n=2), cycle two (n=29), cycle three (n=22), and cycle four (n=11). An overall trend showed a decrease in participants not discharged during treatment and hospital admission days with the greatest decline from treatment cycle one to cycle two. Patients reported high satisfaction with home-based treatment which had positive influence on their ability to be involved in their own treatment as well as socially and physically active. Most participants felt safe while receiving treatment in their home. Reasons for contacting the hospital were either due to fever, nausea or bleeding (n=60), or pump alarm (n=65) which in the majority of cases could be solved by phone (72%). No unexpected adverse events occurred during the intervention. Overall, patients improved in all quality of life 

Conclusion
Providing home-based intensive chemotherapy treatment was feasible and safe in this population and provided a valuable alternative to receiving treatment in an inpatient setting. This may strengthen the existing supportive care services in Denmark for this population, and the findings are potentially transferable and valuable to a broader context of patients with cancer or other life-threatening diseases. With home-based treatment of acute leukemias, a considerable number of hospital beds can be freed up for other patients in need of in-hospital treatment.

Keyword(s): Acute myeloid leukemia, Chemotherapy, Quality of life, Safety

Presentation during EHA2021: All Oral presentations will be made available as of Friday, June 11, 2021 (09:00 CEST) and will be accessible for on-demand viewing until August 15, 2021 on the Virtual Congress platform.

Abstract: S134

Type: Oral Presentation

Session title: AML classification

Background
Advances in treatment modalities have made it possible to offer chemotherapy to patients at home without health care professionals being present. Home-based chemotherapy treatment has shown to provide several benefits in patients with cancer however existing evidence does not include patients with hematologic malignancies. In addition, there is no best practice models which can guide coordination and standardization of home-based chemotherapy treatment. Thus, it is relevant to investigate the feasiblity and safety of home-based treatment in this population.   

Aims
To investigate the feasiblity and safety of home-based intensive chemotherapy in patients with newly diagnosed acute myeloid leukemia or high-risk myelodysplastic syndrome, and to examine quality of life and psychological wellbeing.

Methods
A national multicenter single-arm feasibility study that included patients from six sites in Denmark with newly diagnosed with acute leukemia or high-risk myelodysplastic syndrome receiving intensive induction and consolidation like chemotherapy (n=104). Participants received intensive chemotherapy on programmed CADD Solis infusion pumps through a central venous catheter. Supportive care was offered in the outpatient unit every second or third day for transfusion or surveillance of infection. Outcome measures included feasibility (primary outcome), safety, anxiety and depression measured by the Hospital Anxiety and Depression Scale, and quality of life by the Functional Assessment of Cancer Therapy – Leukemia and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. 

Results
In total, 104 patients were included, receiving 264 treatments during the intervention. Total number of days slepping at home during treatment was 1.096 (mean 4.57, SD 3.0) out of 1.644 treatment days  (66 %). Patients with no admissions during treatment were in cycle one (n=2), cycle two (n=29), cycle three (n=22), and cycle four (n=11). An overall trend showed a decrease in participants not discharged during treatment and hospital admission days with the greatest decline from treatment cycle one to cycle two. Patients reported high satisfaction with home-based treatment which had positive influence on their ability to be involved in their own treatment as well as socially and physically active. Most participants felt safe while receiving treatment in their home. Reasons for contacting the hospital were either due to fever, nausea or bleeding (n=60), or pump alarm (n=65) which in the majority of cases could be solved by phone (72%). No unexpected adverse events occurred during the intervention. Overall, patients improved in all quality of life 

Conclusion
Providing home-based intensive chemotherapy treatment was feasible and safe in this population and provided a valuable alternative to receiving treatment in an inpatient setting. This may strengthen the existing supportive care services in Denmark for this population, and the findings are potentially transferable and valuable to a broader context of patients with cancer or other life-threatening diseases. With home-based treatment of acute leukemias, a considerable number of hospital beds can be freed up for other patients in need of in-hospital treatment.

Keyword(s): Acute myeloid leukemia, Chemotherapy, Quality of life, Safety

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