Related Experiment Video
Updated: Oct 12, 2026
Cytotoxic Efficacy of Photodynamic Therapy in Osteosarcoma Cells In Vitro
Published on: March 18, 2014
Evidence-Based Criteria Supporting Early Discharge for Pediatric Patients With Osteosarcoma Receiving High-Dose
Erin Armideo1, Shannon Froio1, Meredith Johnson1
1Children's Hospital of Philadelphia, Pennsylvania.
Insights
An early discharge protocol for pediatric osteosarcoma patients receiving high-dose methotrexate (MTX) safely reduced hospital stays. Most patients met early discharge criteria without increased toxicity or readmission.
Area of Science:
- Pediatric Oncology
- Pharmacology
- Clinical Protocol Development
Background:
- High-dose methotrexate (MTX) is a critical chemotherapy for osteosarcoma.
- Extended hospital stays are common for monitoring MTX toxicity and clearance.
- Optimizing discharge protocols can improve patient experience and resource utilization.
Purpose of the Study:
- To evaluate the safety and efficacy of an early discharge protocol for pediatric osteosarcoma patients on high-dose MTX.
- To determine if the protocol reduces length of stay without increasing adverse events.
Main Methods:
- Retrospective descriptive cohort study.
- Included pediatric patients (5-25 years) receiving MTX for osteosarcoma (Dec 2017-July 2019).
- Analyzed 141 MTX doses from 15 patients using electronic health record data.
Main Results:
- 67% (94/141) of MTX administrations met early discharge criteria.
- No increase in toxicity or hospital readmissions was observed.
- The protocol enabled earlier discharge for over half of the patients.
Conclusions:
- Early discharge is feasible for pediatric osteosarcoma patients on high-dose MTX when specific criteria are met (serum MTX < 0.4 μmol/L).
- Key elements include patient/family education, hydration, lab monitoring, and close follow-up.
- This protocol safely shortens hospital stays without compromising patient safety or increasing toxicity.
Purpose:
The purpose of this study is to describe the outcomes following the implementation of an early discharge protocol for pediatric patients with osteosarcoma receiving high-dose methotrexate (MTX) to determine if the protocol safely decreased length of stay without increased toxicity.
Methods:
This was a retrospective descriptive cohort design. Participants included children, 5 to 25 years of age, diagnosed with osteosarcoma, who received methotrexate between December 2017 and July 2019. A total of 141 doses across fifteen individual patients were included in the cohort. Data were abstracted from the electronic health record and analyzed using descriptive statistics.
Results:
The majority of administrations (n = 94, 67%) met early discharge criteria without an increase in toxicity or hospital readmission.
Conclusion:
Pediatric patients receiving high-dose MTX for osteosarcoma can be safely discharged from the hospital when serum MTX level < 0.4 μmol/L with the implementation of education, hydration goals, frequent lab monitoring, and close follow-up. More than half of patients on this study were able to be discharged from the hospital sooner than prior protocol. More importantly, this retrospective chart review highlighted the ability to maintain safe administration without increasing toxicity.
