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Is community treatment best? A randomised trial comparing delivery of cancer treatment in the hospital, home and GP surgery

Title: Is community treatment best? A randomised trial comparing delivery of cancer treatment in the hospital, home and GP surgery
Authors: Corrie, PG
Moody, AM
Armstrong, G
Nolasco, S
Lao-Sirieix, S-H
Bavister, L
Prevost, AT
Parker, R
Sabes-Figuera, R
McCrone, P
Balsdon, H
McKinnon, K
Hounsell, A
O'Sullivan, B
Barclay, S
Item Type: Journal Article
Abstract: Background: Care closer to home is being explored as a means of improving patient experience as well as efficiency in terms of cost savings. Evidence that community cancer services improve care quality and/or generate cost savings is currently limited. A randomised study was undertaken to compare delivery of cancer treatment in the hospital with two different community settings. Methods: Ninety-seven patients being offered outpatient-based cancer treatment were randomised to treatment delivered in a hospital day unit, at the patient’s home or in local general practice (GP) surgeries. The primary outcome was patient-perceived benefits, using the emotional function domain of the EORTC quality of life (QOL) QLQC30 questionnaire evaluated after 12 weeks. Secondary outcomes included additional QOL measures, patient satisfaction, safety and health economics. Results: There was no statistically significant QOL difference between treatment in the combined community locations relative to hospital (difference of −7.2, 95% confidence interval: −19·5 to +5·2, P=0.25). There was a significant difference between the two community locations in favour of home (+15·2, 1·3 to 29·1, P=0.033). Hospital anxiety and depression scale scores were consistent with the primary outcome measure. There was no evidence that community treatment compromised patient safety and no significant difference between treatment arms in terms of overall costs or Quality Adjusted Life Year. Seventy-eight percent of patients expressed satisfaction with their treatment whatever their location, whereas 57% of patients preferred future treatment to continue at the hospital, 81% at GP surgeries and 90% at home. Although initial pre-trial interviews revealed concerns among health-care professionals and some patients regarding community treatment, opinions were largely more favourable in post-trial interviews. Interpretation: Patient QOL favours delivering cancer treatment in the home rather than GP surgeries. Nevertheless, both community settings were acceptable to and preferred by patients compared with hospital, were safe, with no detrimental impact on overall health-care costs.
Issue Date: 17-Sep-2013
Date of Acceptance: 1-Jul-2013
URI: http://hdl.handle.net/10044/1/72018
DOI: https://dx.doi.org/10.1038/bjc.2013.414
ISSN: 0007-0920
Publisher: Springer Nature [academic journals on nature.com]
Start Page: 1549
End Page: 1555
Journal / Book Title: British Journal of Cancer
Volume: 109
Copyright Statement: © 2013 Cancer Research UK. This work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/
Sponsor/Funder: NIHR Research for Patient Benefit
Funder's Grant Number: PB-PG-0107-12101
Keywords: Science & Technology
Life Sciences & Biomedicine
Oncology
cancer treatment
chemotherapy
community
care closer to home
outreach
QUALITY-OF-LIFE
CHEMOTHERAPY
PREFERENCES
CROSSOVER
Ambulatory Care
Female
Home Care Services
Hospitalization
Humans
Male
Neoplasms
Patient Satisfaction
Quality of Life
Surveys and Questionnaires
Treatment Outcome
United Kingdom
Humans
Neoplasms
Treatment Outcome
Ambulatory Care
Hospitalization
Quality of Life
Home Care Services
Patient Satisfaction
Female
Male
Surveys and Questionnaires
United Kingdom
Science & Technology
Life Sciences & Biomedicine
Oncology
cancer treatment
chemotherapy
community
care closer to home
outreach
QUALITY-OF-LIFE
CHEMOTHERAPY
PREFERENCES
CROSSOVER
1112 Oncology and Carcinogenesis
Oncology & Carcinogenesis
Publication Status: Published
Online Publication Date: 2013-08-29
Appears in Collections:School of Public Health