Administrative and technical support of ambulatory infusional cancer chemotherapy (ICC)

The term "infusion" is generally equated with the parental administration of drugs in a continuous mode of delivery over some unspecified length of time. However, in terms of applicability to this paper, ICC will imply a minimum of a 24-hour delivery schedule and may include four to 7-day schedules up to protracted infusions covering many weeks. Infusional Cancer Chemotherapy programs may employ a single drug used with or without concomitant radiation therapy or admixtures of two and three drugs. Sequential alternating infusions of drug admixtures are a common mode of treatment which allow maximization of dose with minimal side effects and toxicities. The ICC model is based on the tenet that the quality of the program is directly related to the safety, efficiency, and continuity of the care provided. The supporting structures of an ICC program are rooted in four administrative and technical requisites. Strategies for program support include: 1) a team to carry out the treatment approach and to provide instructional and physical care support; 2) pre-established guidelines, protocols, policies, and procedures by which to administer the program; 3) achievement of a safe and reliable means of venous access which promotes the outpatient status; 4) a source for an accurate and reliable ambulatory infusion device and delivery system. A referral base may encompass a wide geographical area, and the patient population may be varied as to ethnicity, intellectual capacity, age, level of activity, family support and life style, thus it is important to develop a program to support the majority of patients as opposed to the carefully selected few.