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Rebecca Olin, MD, MS

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Pilot Program for Safely Administering Outpatient Chemotherapy Amid COVID-19

By: Jocelyn Solis-Moreira, MS
Posted: Monday, December 21, 2020

The COVID-19 pandemic has caused tremendous strain on the health-care system, resulting in a limited capacity to admit patients and treatment delays, especially for those with cancer. However, a team led by Alexandra Nelson, MSN, FNP, ARNP, of Seattle Care Cancer Alliance, found that adhering to the Advanced Practice Provider program’s guidelines, based on a recent pilot study, may circumvent this issue and enable safe delivery of chemotherapy to patients with acute myeloid leukemia (AML). Their work was presented at JADPRO Live 2020 (Abstract JPL812) and published in the Journal of the Advanced Practitioner in Oncology.

“This program should find wider use, even beyond the time of COVID-19,” wrote the authors.

Three patients with AML underwent three types of outpatient intensive induction chemotherapy, including a FLAG-IDA plus gilteritinib regimen, a 7+3 regimen, and a GCLAM plus midostaurin regimen. All patients were evaluated daily by their primary advanced practitioner; they also obtained a complete blood cell count, prothrombin time and internal normalized ratio, comprehensive metabolic panel, fibrinogen, lactate dehydrogenase levels, and uric acid. For chemotherapy-related complications, advanced practice practitioners were trained to recognize and arrange hospital admissions if necessary.

The investigators reported that outpatient chemotherapy was safely delivered to patients with AML. The patient administered the 7+3 chemotherapy regimen completed 5 of 7 days in the outpatient setting. In contrast, the other two patients completed 1 and 2 of 5 days of outpatient chemotherapy. All patients did have complications causing hospital admittance. Two patients had disseminated intravascular coagulation, and one patient had a neutropenic fever. However, all patients were eventually discharged, with a 30-day mortality rate of zero.

Certain factors contributed to the program’s results, according to the investigators. “This program was successful because the patients all resided within 30 minutes of the cancer center and had a caregiver,” they noted.


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