Comparison of High Dose Methotrexate Administration Between the Inpatient and Outpatient Setting in Children with Acute Lymphoblastic Leukemia

PURPOSE: Methotrexate (MTX) is one of the most widely used anticancer agents, with indications and established protocols in a range of childhood and adult cancers. High dose MTX (HD-MTX) requires aggressive care to prevent toxicity. Limited inpatient conditions are forcing major changes in health care delivery patterns and decisions. We conducted a retrospective study to describe the safety, feasibility and cost-effectiveness of HD-MTX administration in the outpatient setting. METHODS: Patients with acute lymphoblastic leukemia who underwent HD-MTX (3 g/m2) administration in either the inpatient (N=70) or outpatient setting (N=70) from January to July 2012 were included. In the outpatient setting, HD-MTX was administered intravenously (IV) over 6 hours and included hydration with sodium bicarbonate (2000 ml/m2/for 12 hours). Daily visits to the outpatient setting followed. Leucovorin was given 24 hours after MTX at a standard dose (15 mg/m2 IV bolus) every 6 hours. We compared the serum drug levels of MTX, hematologic and renal toxicity, hepatotoxicity, frequency of subsequent unscheduled outpatient visits and readmission episodes, medical expenses and duration of hospital stay between the two groups. RESULTS: HD-MTX administrations were successfully completed in both groups. No significant differences were found between the two groups for the parameters studied. Patients who received HD-MTX in the inpatient setting had 2.37 times and 2.24 times greater medical expenses and duration of hospital stay respectively than outpatient recipients. CONCLUSION: This study suggests that HD-MTX administration done with aggressive monitoring in the outpatient setting is safe and efficient, without a greater incidence of major toxicities.

Stress, Coping, and Depression in Patients Following Hemopoietic Stem Cell Transplantation / 기본간호학회지

PURPOSE: This study was done to identify the level of stress, coping, and depression among hemopoietic stem cell transplantation patients who received care in an outpatient center. METHOD: Data were collected from 81 patients who underwent hemopoietic stem cell transplantation at C University S Hospital between August 2005 and February 2006. RESULTS: Stress and depression were significantly higher following hemopoietic stem cell transplantation in women, and in patients who were worse off financially or who were in bad health. The highest item of stress was 'economic burden for treatment'. There were significantly higher levels of emotion-focused coping among patients who had a spouse and who received motivation from the doctor. The highest item for problem-focused coping was 'try to look at the bright side of life'. The highest items for emotion-focused coping were to 'have faith that treatment will be finished quickly' and 'believe that your situation will improve'. Stress was significantly correlated with depression among these patients. CONCLUSION: It is necessary to develop nursing interventions to enhance positive coping and to decrease stress and depression among patients who have a hemopoietic stem cell transplantation.