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A home-based maintenance therapy program for acute lymphoblastic leukemia-practical and safe?

Bob Phillips¹, Michael Richards, Rachel Boys

¹Regional Department of Paediatric Haematology/Oncology, St James's Hospital, Leeds, UK. bob.phillips@doctors.org.uk

Journal of Pediatric Hematology/Oncology

|June 8, 2011

Summary

A home maintenance program for childhood acute lymphoblastic leukemia (ALL) improved treatment adherence from 24% to 78% with increased support. Factors like increasing age and stable partnerships positively influenced adherence.

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Area of Science:

Pediatric Oncology
Pharmacoeconomics
Health Services Research

Background:

The maintenance phase of childhood acute lymphoblastic leukemia (ALL) treatment involves daily oral chemotherapy and regular blood monitoring.
Traditional outpatient clinic visits for monitoring can cause significant family disruption.
A home-based maintenance program was developed to mitigate these challenges.

Purpose of the Study:

To evaluate the effectiveness and parental satisfaction of a home maintenance program for childhood ALL.
To identify predictors of nonadherence to oral chemotherapy in this patient population.

Main Methods:

Implementation of a home maintenance program involving near-home blood tests, remote pharmacist/nurse review, and telephone/written communication.
Assessment through tablet counting and before-and-after parental satisfaction audits over two years.
Preliminary analysis of adherence predictors.

Main Results:

No critical incidents were reported during the program's first two years.
Initial poor adherence rates (24%) significantly improved to 78% after enhanced support.
Increasing patient age (r=0.37, P=0.02) and stable caretaker partnerships (P<0.01) were associated with better adherence.

Conclusions:

A home maintenance program can effectively improve adherence in childhood ALL treatment.
Targeted support and consideration of family structure are crucial for optimizing adherence.
This model reduces hospital visits and family burden, enhancing treatment management.