Transitioning adriamycin ifosfamide mesna (AIM) chemotherapy in sarcoma patients to the outpatient setting: Evaluation of outpatient chemotherapy in an oncology care model setting.

Abstract

e19149 Background: The combination of doxorubicin, ifosfamide and mesna (AIM) significantly improves outcomes among patients with advanced soft tissue sarcomas. The rising cost of inpatient care, alternative payment model changes and patient preferences has prompted institutions to consider shifting therapy to the outpatient setting. However, the safety and feasibility of outpatient AIM chemotherapy is not well established. The University of Arizona Cancer Center developed an Outpatient Program (OP) to facilitate administration of traditional inpatient chemotherapy regimens in the outpatient setting. We transitioned AIM based chemotherapy to the outpatient setting based on selective criteria and caregiver support. The transition to outpatient treatment could lead to large cost-savings implications under the oncology care model. Methods: The current retrospective analysis evaluated the safety and efficacy of outpatient AIM chemotherapy for sarcoma administered in the outpatient setting. An economic study evaluated AIM in the outpatient setting, address, cost of labs, chemotherapy and bed days saved from transitioning chemotherapy from the inpatient setting. Results: Twenty-one patients with soft-tissue sarcoma were treated with outpatient AIM, for a total of 83 cycles. The median age was 60 (27-73) with 6 females and 15 males being evaluated. The median number of cycles per patient was 3.9 (range, 1-6), an average of 4.68 days of infusion days per cycle. Notable side effects included three patients ifosfamide-induced neurologic syndrome and 2 with hematuria. Acute grade 3 and 4 hematological toxicities were observed in 16 and 15 of patients, respectively with 11 occurrences of febrile neutropenia in 9 patients. Of the 21 patients, 15 patients (71%) were hospitalized at least once and 9 patients (43%) were hospitalized due to neutropenic fever. Total bed days saved by transitioning AIM outpatient was 390, for a total hospital cost savings of $1,043,250. Current costs savings for laboratory, chemotherapy and patient assistance access is still being tabulated. Conclusions: The combination of ifosfamide and mesna as a continuous outpatient infusion is feasible and well-tolerated using proper selection of patient and caregiver evaluation. This new model of administration provides an opportunity to decrease cost of care, improve patient satisfaction and reduce utilization of healthcare resource for community and academic cancer center sites.