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Published on: September 18, 2013
Hospital and home chemotherapy for children with leukemia: a randomized cross-over study
Bonnie Stevens1, Ruth Croxford, Patricia McKeever
1Faculty of Nursing and Medicine, University of Toronto, Toronto, Ontario, Signy Hildur Eaton Chair in Paediatric Nursing Research, Sick Kids Hospital, 555 University Avenue, Toronto, Ontario, Canada. b.stevens@utoronto.ca
Insights
Home chemotherapy for acute lymphoblastic leukemia (ALL) in children shows preliminary support, with improved routines but increased emotional distress. Treatment location did not impact caregiver burden, safety, or costs, offering valuable insights for families considering home-based therapy.
Area of Science:
- Pediatric Oncology
- Health Services Research
- Quality of Life Studies
Background:
- Acute lymphoblastic leukemia (ALL) treatment in children often involves intensive chemotherapy.
- Comparing hospital-based versus home-based chemotherapy is crucial for optimizing patient and family outcomes.
- Key factors for comparison include Quality of Life (QOL), safety, caregiver burden, and costs.
Purpose of the Study:
- To compare hospital-based and home-based chemotherapy programs for pediatric ALL.
- To evaluate the impact on children's Quality of Life (QOL).
- To assess safety, caregiver burden, and associated costs.
Main Methods:
- A randomized cross-over trial (RCT) design with repeated measures was employed.
- The study included 23 children diagnosed with ALL.
- Data were collected from children receiving care at a tertiary pediatric hospital and via home visits from community health services.
Main Results:
- Home chemotherapy allowed children to maintain routines better but increased reported emotional distress.
- No significant differences were observed in caregiver burden or adverse events between home and hospital settings.
- Societal costs of care did not differ significantly between the two treatment locations.
Conclusions:
- Preliminary evidence suggests home-based chemotherapy for pediatric ALL is a viable option with few overall differences compared to hospital-based care.
- Home chemotherapy demonstrated specific improvements and decrements in parent-reported QOL.
- Younger age was associated with poorer QOL, increased care burden, and higher risk of adverse events, highlighting age as a critical factor in treatment considerations.
Background:
The study objective was to compare a hospital-based and a home-based chemotherapy program for children with acute lymphoblastic leukemia (ALL) in relation to Quality of Life (QOL), safety, caregiver burden, and costs.
Procedure:
A randomized cross-over trial (RCT) design with repeated measures was conducted with 23 children with ALL who attended the oncology outpatient clinic of a metropolitan university affiliated tertiary level pediatric hospital and who also received home visits from a community health services care provider in central Canada.
Results:
During the home-treatment phase, children were more capable of maintaining their usual routines than when receiving hospital chemotherapy (Wilcoxon statistic = 80, P = 0.023), but they appeared to experience greater emotional distress (Wilcoxon sign rank statistic S = 66, P = 0.043) according to parental report. Treatment location had no effect on caregiver burden and adverse effects. No significant differences between groups existed with respect to societal costs of care. As the child's age increased, QOL improved relative to younger children (t(20) = -2.37, P = 0.02), the time burden related to child care tasks was reduced (t(21) = -3.56, P = 0.002), caregiver effort/difficulty in physical and behavioral support decreased (t(21) = -2.09, P = 0.049) and the odds of experiencing one or more adverse events decreased (OR = 0.79, CI = (0.63-1.00), chi(1) (2) = 4.01, P = 0.045).
Conclusions:
With few differences noted between groups, these results indicate preliminary support for administrating some or all of a child's chemotherapy at home. Home chemotherapy was associated with specific improvements and decrements in parent reported QOL. No effects were seen on burden of care, adverse events, or cost. Overall, young age adversely affected QOL, burden of care, and adverse events. These data provide important information to families and caregivers as they consider home or hospital-based therapy in childhood ALL.
