Title: The delivery of chemotherapy at home: an evidence synthesis
Funder: Department of Health (England)

Abstract: Current government policy promotes patient choice and transfer of services closer to home; the Cancer Reform Strategy has pledged that care will be delivered in the most clinically appropriate and convenient setting for patients. Chemotherapy treatment delivered in the home can provide a number of potential benefits to patients such as less travelling and disruption to family life. Safety is a key issue due to the toxicity of the drugs and the need for specialist skills to administer and monitor treatment. Problems with toxicity need to be identified promptly; severe side-effects can be very disturbing and may influence a patient’s decision to continue with treatment. Preliminary literature searches indicate a limited volume of published evidence evaluating the costs and benefits of home chemotherapy. To date this evidence has not been systematically identified appraised and summarised.This project will look at the impact of the delivery of chemotherapy at home on quality of life safety patient satisfaction and costs. We will describe the patient pathway for delivering chemotherapy; we plan to focus on the provision of intravenous chemotherapy led and managed from the oncology department delivered either within the patient’s home in the community or on a hospital outpatient basis. From this pathway a decision model will then be developed to characterise patients’ treatment and resultant outcomes from alternative perspectives.The pathway and model will be generated in close consultation with our clinical collaborators and additional expert advice provided by a project advisory group (including representation from the patient cancer nurse specialist pharmacist and primary care ) to ensure that all relevant stakeholders are involved. We will also canvas views from pharmacy medical and nursing professionals in oncology departments in the UK about their experiences.The model will evaluate the potential costs and benefits attributable to the delivery of home chemotherapy from both the NHS and patient perspective. To inform the model we will undertake a systematic review of the existing evidence on the effectiveness cost-effectiveness safety and patient benefit of the delivery of chemotherapy at home. Initial scoping work suggests a limited evidence base therefore we will employ a broad search strategy to look for both quantitative and qualitative studies unpublished and grey literature. To further augment the evidence base and fully populate the model routine hospital data sources and expert opinion will be utilised where necessary. Probabilistic methods will be used to fully characterise the uncertainty in this data and if feasible a value of information analysis conducted.This research will bring together and assess the existing evidence surrounding the delivery of chemotherapy at home and provide a framework to evaluate alternative approaches. It will also identify any gaps in the evidence base for the delivery of chemotherapy at home which will inform research priorities for the future.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;6.1 PHARMACEUTICALS
Health categories: CANCER AND NEOPLASMS