Nurse-Led Program Improves Health, Financial Outcomes in Outpatient Chemotherapy

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Patients assigned to nurse-led care received a consultation prior to chemotherapy and follow-ups during chemotherapy.
Patients assigned to nurse-led care received a consultation prior to chemotherapy and follow-ups during chemotherapy.

A nurse-led care program may be cost effective for patients with breast cancer undergoing 4 to 6 cycles of outpatient chemotherapy, according to a study published in the European Journal of Oncology Nursing.

The administration of chemotherapy has changed in recent years, transitioning increasingly from inpatient to outpatient settings. However, due to the adverse events associated with chemotherapy, outpatient administration often leads to a need for emergent care and additional economic burden. Nurse-led care may not only improve the quality of life, but also the use of healthcare resources and financial toxicity.

For this study, researchers randomly assigned 124 patients with breast cancer receiving 4-cycle or 6-cycle adjuvant chemotherapy for the first time to routine care or nurse-led care. Patients assigned to nurse-led care received a nurse consultation prior to chemotherapy and telephone follow-ups during chemotherapy, addressing management strategies, as well as various psycho-social and health-related needs.

Overall, there were 81 unscheduled hospital visits and 43 admissions. The most commonly observed causes for utilizing healthcare resources were infections and fevers, skin, digestive, and mouth/teeth/throat problems.

There were no differences in health service utilization among patients receiving 4 cycles of chemotherapy in either study arm. Among patients undergoing 6 cycles, however, patients assigned to routine care had more than a 2-fold increase in emergency department visits compared with patients in the nurse-led care arm (P=.038).

For patients undergoing 4 and 6 cycles of chemotherapy, the incremental cost-utility ratios were £8856 and £18,936 per quality-adjusted life year gained, respectively. 

The authors concluded that “nurse-led care reduces emergency departments visits made by breast cancer patients undergoing 6-cycle adjuvant chemotherapy. For breast cancer patients undergoing 4-cycle chemotherapy and 6-cycle chemotherapy, the nurse-led care could be cost-effective.”

Reference

Lai XB, Ching S, Wong F, et al. The cost-effectiveness of a nurse-led care program for breast cancer patients undergoing outpatient-based chemotherapy – a feasibility trial[published online July 23, 2018]. Eur J Oncol Nurs. doi: 10.1016/j.ejon.2018.07.001

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