The University of Arizona Cancer Center, Tucson, AZ, USA.
Support Care Cancer. 2022 Mar;30(3):2755-2766. doi: 10.1007/s00520-021-06653-4. Epub 2021 Nov 26.
To characterize and compare both the outcome and cost of treatment of outpatient (OP) and inpatient (IP) ifosfamide therapy.
A single-center retrospective chart review of patients 18 years and older receiving ifosfamide therapy. The primary endpoint compares and evaluates the side effect profiles of ifosfamide-treated patients in the OP/IP settings. The adverse event grading system was characterized using the CTCAE Version 5.0. The highest grade was documented per cycle. The secondary endpoint of this study compares the costs of OP/IP therapy. It was assumed that the cost of medication was equivalent for IP/OP treatments. The cost saved with OP administration was determined by the average cost of hospital stay for IP admission.
Ifosfamide therapy of 86 patients (57 OP, 29 IP) was reviewed. The predominant OP regimens were doxorobucin-ifosfamide-mesna (AIM) with 43.9% and ifosfamide-etoposide (IE) with 29.8%. Grade 4 anemia, thrombocytopenia, and neutropenia were most frequent in IP vs OP therapies (22.9% IP vs 4.3% OP, 21.6% IP vs 9.2% OP, and 22.8% IP vs 19.6% OP respectively). Neutropenic fever (NF) occurred in 20 OP patients which were predominantly treated with AIM or IE and led to average hospital stay of 6 days. Neurotoxicity, treated with methylene blue (MB) occurred in 4 OP patients. OP therapy saved a total of 783 hospital days, leading to a cost savings of $2,103,921.
Transitioning ifosfamide to the OP setting is feasible for academic and community infusion centers with the OP administration being safe, well-tolerated, and associated with decreased total cost of care. The current processes allow for safe transition of chemotherapy of chemotherapy under times of COVID.
描述和比较门诊（OP）和住院（IP）异环磷酰胺治疗的结果和成本。
对 18 岁及以上接受异环磷酰胺治疗的患者进行单中心回顾性图表审查。主要终点比较和评估 OP/IP 环境中接受异环磷酰胺治疗的患者的副作用谱。使用 CTCAE 版本 5.0 对不良事件分级系统进行了描述。记录每个周期的最高等级。本研究的次要终点比较 OP/IP 治疗的成本。假设 IP/OP 治疗的药物费用相同。通过平均住院费用来确定 OP 给药节省的成本。
共回顾了 86 名患者（57 名 OP，29 名 IP）的异环磷酰胺治疗情况。主要的 OP 方案是多柔比星-异环磷酰胺-美司钠（AIM），占 43.9%，异环磷酰胺-依托泊苷（IE）占 29.8%。4 级贫血、血小板减少和中性粒细胞减少在 IP 与 OP 治疗中最为常见（22.9% IP 与 4.3% OP，21.6% IP 与 9.2% OP，22.8% IP 与 19.6% OP）。20 名 OP 患者出现中性粒细胞减少性发热（NF），主要采用 AIM 或 IE 治疗，平均住院时间为 6 天。4 名 OP 患者发生神经毒性，用亚甲蓝（MB）治疗。OP 治疗共节省 783 个住院日，节省费用 2103921 美元。
学术和社区输注中心将异环磷酰胺转为 OP 治疗是可行的，OP 给药安全、耐受良好，并与降低总治疗成本相关。在 COVID 期间，目前的流程允许安全地进行化疗的转换。
