In May 2013, the American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society (ONS) released updated chemotherapy administration safety standards. Since 2011, these guidelines have included both outpatient and inpatient facilities.

The document, which includes safety standards for staffing, chart documentation, general chemotherapy practices, chemotherapy orders/prescriptions, drug preparation, patient consent and education, chemotherapy administration, and monitoring and assessment, includes similar standards across outpatient and inpatient facilities.

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Furthermore, this update added safety standards for the use of oral chemotherapy as the use of these agents has been increasing. Unlike typical oral medications for chronic conditions, oral anticancer drugs often have varying schedules of administration.

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Rather than receiving intravenous drug therapy in a controlled outpatient facility or inpatient setting, patients are taking these agents at home, and therefore should receive patient education and should be visiting the outpatient setting frequently for monitoring of adherence and toxicity.7

Ultimately, more patients with cancer are receiving drug therapy in the outpatient setting rather than the inpatient setting due to the numerous advantages; however, costs vary widely between outpatient hospitals and individual, private oncologists’ offices.

References

  1. Dollinger M. Guidelines for hospitalization for chemotherapy. Oncologist. 1996;1(1&2):107-111.
  2. Jacobson M, Earle CC, Price M, Newhouse JP. How Medicare’s payment cuts for cancer chemotherapy drugs changed patterns of treatment. Health Aff (Millwood). 2010;29(7):1391-1399.
  3. Helwick C. A conversation with Joseph S. Bailes, MD, ASCO Immediate Past Chair of Govern29ment Relations. The ASCO Post. 2010;1(4):28-30. Accessed 14 Nov 2014.  http://issuu.com/ascopost/docs/tap-vol-1-issue-4/29?zoomed=&zoomPercent=&zoomX=&zoomY=¬eText=¬eX=¬eY=&viewMode=magazine.
  4. IMS Finds 340B Drives Up Cancer Treatment Costs. AIRx 340B: Alliance for Integrity and Reform. http://340breform.org/userfiles/FINAL%20AIR340B%20Press%20
    Release%20on%20IMS%20Study%20May%207,%202014.pdf    . Published May 7, 2014. Accessed November 14, 2014.
  5. “Clinical Policy Bulletin: Chemotherapy, Inpatient.” Aetna. http://www.aetna.com/cpb/medical/data/500_599/0570.html. Published September 12, 2014. Accessed November 14, 2014.
  6. Joo E-H, Rha S-Y, Ahn JB, Kang H-Y. Economic and patient-reported outcomes of outpatient home-based versus inpatient hospital-based chemotherapy for patients with colorectal cancer. Support Care Cancer. 2011;19(7):971-978.
  7. Neuss MN, Polovich M, McNiff K, et al. 2013 Updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. J Oncol Pract. 2013;9(2s):5s-13s.

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General Oncology In The Clinic