Cost effectiveness of integrated medicine in patients with cancer receiving anticancer chemotherapy.

PURPOSE: Ambulatory chemotherapy is patient friendly but may result in toxicity-induced unscheduled hospitalizations (TIUHs). This emerging issue may increase health care costs. We studied the cost effectiveness of a hospital-home monitoring program based on systematic iterative telephone calls after chemotherapy. PATIENTS AND METHODS: We retrospectively evaluated the rates of chemotherapy-induced unscheduled hospitalizations in patients who were treated in August 2008. Patients were contacted by telephone 1 day before chemotherapy and on the second and eighth days after undergoing chemotherapy. Costs associated with TIUHs were calculated and compared with those of a cohort concomitantly treated using the standard follow-up procedure. RESULTS: A total of 259 patients entered the hospital-home monitoring program. They were compared with 86 patients who had similar characteristics but underwent the standard treatment and follow-up procedure. Inclusion in the hospital-home monitoring program resulted in patients experiencing TIUHs approximately half as frequently as patients in the other group (2.4% v 4.9%; P < .01). Patients in the program experienced TIUHs for a median length of stay of 4 days, representing a nonsignificant reduction in duration of hospitalization (P not significant). Consequently, through a two-fold reduction in TIUH annual incidence, this program represents a reduction in unscheduled hospitalizations per year of 383 days, decreasing hospital costs by €201.468 ($292,468) per year. CONCLUSION: The hospital-home monitoring program is a cost-effective strategy for offering ambulatory chemotherapy treatment to patients with cancer. This program has become our standard procedure for ambulatory chemotherapy in patients with cancer.

Vinorelbine and oxaliplatin in stage IV nonsmall cell lung cancer patients unfit for cisplatin: a single-center experience.

Many patients with stage IV nonsmall cell lung cancer (NSCLC) are unfit for cisplatin-based chemotherapy because of poor performance status, impaired renal function or severe comorbidity. We documented the feasibility of a combination of weekly vinorelbine and biweekly oxaliplatin in a population of stage IV NSCLC patients unable to receive cisplatin. Fifty-five chemo-naive patients (40 males, median age 60 years, range 43-84) were treated on an outpatient basis, and received every 2 weeks: vinorelbine 25 mg/m intravenously on day 1 and 60 mg/m orally on day 8, and oxaliplatin 85 mg/m intravenously on day 1. Patients were considered unfit for cisplatin because of performance status > or =2 (30 patients), impaired renal function (17 patients) or severe comorbidities (eight patients). Twenty-two patients (40%) had two or more metastatic sites, and 14 (25%) had central nervous system metastases. A total of 288 cycles were given (median per patient: 4, range 1-11). The planned dose intensity of vinorelbine was administered in 65% of patients. One complete and 13 partial responses were observed, providing an objective response rate of 26% (95% confidence interval: 14.4-37.6). The median progression-free survival and overall survival were 3.5 months and 9.5 months, respectively. The 1-year survival rate was 24% (95% confidence interval: 12.7-35.3). The main grade 3/4 toxicities were: neutropenia (15 patients, 27%), anaemia (12 patients, 22%) and peripheral neuropathy (eight patients, 15%). Three patients (5.5%) experienced febrile neutropenia. In a nonselected NSCLC patient population, the vinorelbine-oxaliplatin doublet had clinical activity in the same range as cisplatin-based combinations. This doublet allows combining a platinum derivative with a sustained dose intensity of vinorelbine in unfit patients.