A randomized crossover trial of giving high-dose cisplatin with or without an overnight stay in hospital: Patients' preferences, quality of life, safety and resource use

Abstract

6113 Background: Treatment with high dose cisplatin (HDC) previously required an inpatient (IP) admission with an overnight stay in hospital. Improvements in supportive care mean HDC can now be given as an out-patient (OP) regimen without an overnight stay in hospital. The aim of this trial was to determine whether it is preferable to give HDC as an IP or OP regimen. Methods: Eligible patients were starting CT with 2 or more cycles or HDC (100mg or more per dose) and were suitable for treatment as an OP (adequate transport, support, telephone, no significant comorbidities). All were to have an IP cycle and an OP cycle; the order (IP or OP first) was randomly allocated. Prehydration, antiemetics and administration of HDC were identical for IP and OP. IP went home the next morning after 3L of NS over 18 hrs. OP went home the same day after 2L NS over 6 hrs, and were phoned the next morning. The primary outcome was whether patients preferred treatment as an IP or OP. Secondary outcomes included aspects of health-related quality of life rated by patients with validated scales (GLQ-8 and UBQ-C) on days 8 and 21 of each cycle . Adverse events included delays, dose reductions, elevated creatinine, and hospital readmissions. Nurses recorded their time spent with patients. Results: 59 patients were randomised: 53 had both cycles as planned, and 6 did not (4 randomized to OP first v 2 to IP first, p = .7). Most patients preferred OP to IP treatment (36 v 13, p = .002); 40 wanted their next cycle as an OP (p < .0001). There were no significant differences in patients' ratings of nausea, vomiting, fatigue, anxiety, depression or overall quality of life. Adverse events were few and unrelated to IP v OP administration (respective numbers): delayed cycles (4 v 5), dose reductions (1 v 0), and hospital readmissions (9 v 7). Nursing time was longer for IP than OP (163 v 104 minutes, p < .001). Conclusions: Giving HDC as an OP regimen without an overnight stay in hospital was preferred by most patients (but not all), appeared safe, and used less resources. No significant financial relationships to disclose.