Ambulatory chemotherapy enables the administration of brief and longer chemotherapy infusions from the comfort of patients’ homes using a portable pump. It is essential to provide it to qualified applicants to guarantee their safety and the treatment session’s success. This necessitates a precise mix of professional evaluation and patient acceptance.
The pump and the access device are the two primary components of this therapeutic technique.
Numerous pump designs and mechanisms are available on the market, the most recent being the portable disposable elastomeric pump.
Clinicians, in collaboration with a multidisciplinary medical team, often choose the kind of access device; where shared decision making is used, patients are also included.
Despite reports of pump programming difficulties or breakdowns, research is continuing to develop novel solutions that will enable its usage.
Background and definitions
Historically, chemotherapy infusions were administered only on an inpatient basis in cancer wards. For decades, the increasing cancer incidence on a global scale has placed a burden on hospital resources, as well as patient travel and waiting periods, negatively impacting their treatment experience.
Oncology clinical practice breakthroughs steadily pushed chemotherapy supply to outpatient settings and then closer to the patient’s home, optimizing hospital capacity and patient happiness. The location and method of administration of the treatment are determined by the recommended chemotherapy regimen and the patient’s medical state.
These treatment regimens have been used inconsistently across and within nations. While treatment in a single-day chemotherapy center is well established on the majority of continents, ambulatory and home chemotherapy are more prevalent in industrialized and Western nations such as Canada and the United Kingdom.
Ambulatory chemotherapy (AC) enables the administration of both short (5-7 hours) and longer (1-5 days) chemotherapy infusions from the comfort of patients’ homes through a portable pump.
Depending on the capacity of the linked infusion pump and the duration of the continuous infusion, it may be necessary to change it throughout therapy. This is accomplished via the use of a visiting home nurse, patients or caregivers at home, or during another hospital visit. On the market, there are a variety of portable infusion pumps with varying characteristics. These might be peripherally linked to the patients or through a central access device.
The goal of this review is to discuss ambulatory chemotherapy delivery and to exchange practice experiences pertinent to this topic. This study will discuss the two primary components of ambulatory chemotherapy, the pump and central access devices; the many varieties, their safety, and the available experience. Additionally, the evaluation will give insight on the assessment procedures required for patients judged fit for AC, as well as the influence of the latter on healthcare delivery.
Assessment of patients undergoing ambulatory chemotherapy
It is critical to give AC to qualified applicants to guarantee their safety and the treatment session’s effectiveness. This necessitates a precise mix of professional evaluation and patient acceptance.
Five checkpoints compose clinical evaluation, the first of which is a stable clinical condition that allows for safe hospital release. This might be accomplished via the use of performance assessments such as the Eastern Cooperative Oncology Group’s (ECOG) or Karnofsky performance scales.
The second hurdle concerns the chemotherapeutic agent’s appropriateness for mobile administration. Pilot investigations on Ifosfamide, Trabectidin, and Fluorouracil demonstrated that these medications may be safely delivered ambulatory without requiring constant medical monitoring. Newton et al. provide additional chemotherapy regimens that were delivered as case studies at University College London Hospitals NHS Foundation Trust.
The third criterion is to have a mode of communication, such as a cell phone, in order to ease access to assistance in the event of an emergency.
The fourth checkpoint assesses the ability to care for oneself and control adverse effects. It requires a clean house certified by the patient, as well as helpful family members eager to accompany patients to treatment sessions and learn support methods.
Proximity to a hospital is the sixth step that ensures emergency assistance is available. If a journey duration of 30-60 minutes is appropriate, patients are asked to stay in a nearby hotel.
Patients’ acceptance of AC is shown by their permission to receive it, particularly their willingness to participate actively in the therapy. Patients’ autonomy is only implied in cultures and nations that practice shared decision making. The dissemination of AC was investigated via a qualitative study done with cancer patients in Lebanon, a small Mediterranean country. The findings indicated that a lack of patient empowerment resulted in oncologists making all treatment-related choices on behalf of patients.
Telehealth systems have recently expanded care management outside hospital wards. Extensive research is being conducted on remote monitoring of AC patients in order to enhance patient comfort and safety. As established in multiple studies, this telemonitoring possibility gives virtual assistance and a feeling of security to patients.
As a result, when patients are correctly screened for AC, they have better health outcomes.