Abstract P5-07-05: Improving Health-Related Quality of Life with Outpatient High-Dose Methotrexate Regimen Among Solid Tumor Oncology Patients with Intracranial Metastases: A Qualitative Study
Authors: Min Heun , Weil Elizabeth , Nelson Maggie , Charlson John , Conroy Meghan , Powell Miracle , Cheng Yee Chung , Chaudhary Lubna N. , Burfeind John , Retseck Janet , Sriram Deepika , Kamaraju Sailaja 
Published: March 2023

Introduction: Breast cancer patients with intracranial (IC) metastases including leptomeningeal metastasis (LM) confer poor prognosis. Upon disease progression with standard lines of therapy, high-dose intravenous methotrexate (HD IV MTX) is offered to patients given its effective CNS penetrance. HD IV MTX is commonly administered inpatient, requiring extended hospitalization, rigorous leucovorin rescue, IV hydration, and urine alkalinization. Currently, quality of life (QoL) aspects of inpatient v. outpatient regimens remain unknown. Methods: An outpatient MTX protocol with daily visits to outpatient infusion centers was institutionally developed. Study eligibility criteria included solid tumor diagnoses with IC±LM metastasis, disease progression on standard of care treatment, and transition from inpatient to outpatient regimen within the past 12 months. For eligible patients upon consent, qualitative semi-structured phone interviews were conducted with focus on physical functioning and symptom burden. Thematic analysis was utilized. Results: Of the 10 patients who were screened, three (breast=2, sarcoma=1) were eligible. Patient demographics included 2 Caucasians, 1 African American, mean age of 52 years, and s/p prior whole brain radiation. Among QoL measures, no differences in functional status were reported between the two regimens. Single sarcoma patient reported less nausea and emesis with the outpatient regimen. All patients agreed on convenience, autonomy, greater personal and family time, and stronger emotional support while undergoing the outpatient protocol. Despite honorable mentions of inpatient onsite staff and services, all patients reported higher QoL experienced with outpatient MTX protocol vs. inpatient. Conclusions: Interview analysis determined that patient autonomy and nonobligatory hospitalization are key outpatient MTX treatment hallmarks that greatly enhanced patient QoL. Despite the small preliminary patient pool, this study delineates the feasibility in development of an institutionalized patient-centered outpatient MTX protocol. Future clinical trials will additionally be dedicated in conducting a cost-effective analysis comparing both MTX regimens.

Citation Format: Heun Min, Elizabeth Weil, Maggie Nelson, John Charlson, Meghan Conroy, Miracle Powell, Yee Chung Cheng, Lubna N. Chaudhary, John Burfeind, Janet Retseck, Deepika Sriram, Sailaja Kamaraju. Improving Health-Related Quality of Life with Outpatient High-Dose Methotrexate Regimen Among Solid Tumor Oncology Patients with Intracranial Metastases: A Qualitative Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-05.