Safe early discharge for patients undergoing high dose chemotherapy with or without stem cell transplantation: a prospective analysis of clinical variables predictive for complications after treatment

• Published in: Journal of clinical nursing 2011-02, Vol.20 (3-4), p.388-395
• Main Authors: Mank, Arno, van der Lelie, Johannes, de Vos, Rien, Kersten, Marie Jóse
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adolescent; Adult; Aged; ambulatory care; Anti-Bacterial Agents - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Chemotherapy; Clinical medicine; Discharge; early discharge criteria; Female; Fever - epidemiology; haematopoietic stem cell transplantation; Hospitalization; Humans; Incidence; Infection - epidemiology; infection control; Male; Middle Aged; Mucositis - epidemiology; Neoplasms - nursing; Neoplasms - therapy; Netherlands - epidemiology; Neutropenia - epidemiology; Nursing; Oncology; Patient Discharge - statistics & numerical data; Predictive Value of Tests; Prospective Studies; risk assessment; Statistics, Nonparametric; Stem Cell Transplantation - adverse effects; Stem cells
• ISSN: 0962-1067; 1365-2702
• DOI: 10.1111/j.1365-2702.2010.03473.x

Aim.  To identify which patient groups can be safely discharged early after high dose chemotherapy. Background.  Until recently, the standard of care for patients with haematological malignancies who have been treated with high dose chemotherapy has been to hospitalise them until neutrophil recovery and clinical improvement. Over the past years, a more liberal approach has resulted in a tendency to discharge patients earlier. However, currently it is unclear which clinical variables are important and which patient groups are most suitable to be discharged early. Design.  Prospective cohort study. Methods.  The study group of 55 patients underwent 82 admission periods for a total of 2269 patient days, which could be classified into four categories: induction treatment, consolidation treatment and autologous or allogeneic stem cell transplantation. Different clinical variables potentially interfering with early discharge were subsequently analysed for their association with each treatment group. Results.  The median duration of admission was 27 days. The incidence of fever (82·9%) and use of intravenous antibiotics (79·3%) was high in all treatment groups. The only statistically significant differences between groups were found for performance status and mucositis. In the patient group undergoing consolidation chemotherapy for acute myeloid leukaemia, the performance status was better and mucositis was less severe. The decline in performance status and the severity of mucositis were as expected most obvious 10–14 days after the start of chemotherapy. Conclusion.  Patients undergoing consolidation chemotherapy appear to be the most suitable candidates for early discharge, especially in the first‐week postchemotherapy treatment. Early discharge can also be considered in patients with a good performance status in the autologous stem cell transplantation group, directly after transplantation. Relevance to clinical practice.  An important factor in developing an early discharge programme is a good infrastructure, both at home and in the hospital.