Home care versus hospital care of patients with hematological malignancies and chemotherapy-induced cytopenia.
BACKGROUND
The purpose of this review study is to examine the accumulating evidence of safety of home care, with regard to infection-related morbidity and mortality, for patients with chemotherapy-induced cytopenia, in light of previous studies on the necessity of protective isolation (PI).


METHODS
The existing literature on PI, and home care of cytopenic patients after chemotherapy, published in the English language, based on a Medline search, is reviewed.


RESULTS
The studies published so far on home care versus hospital care are all non-randomized studies and confirm that home care of cytopenic patients is safe, in terms of morbidity and mortality due to infections. On the other hand, the majority of studies on the comparison of PI with standard hospital care conclude that an infection-preventive effect of PI exists. The pooled statistics performed confirmed that such an effect of PI exists regarding the occurrence of severe infections, although no benefit to mortality has been shown.


CONCLUSIONS
Regarding home care, only the results of a prospective, randomized study of sufficient power will enable definitive conclusions to be drawn as to whether home care is equally safe as hospital-based care with PI.
van Tiel
F H
FH
Department of Medical Microbiology, University Hospital Maastricht, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands. fvt@lmib.azm.nl
Harbers
M M
MM
Kessels
A G
AG
Schouten
H C
HC
D019072:Antibiotic Prophylaxis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D019337:Hematologic Neoplasms / Q000188:drug therapy*; D006699:Home Care Services; D006801:Humans; D017053:Infection Control; D007239:Infections / Q000401:mortality; D007297:Inpatients; D009017:Morbidity; D009503:Neutropenia / Q000139:chemically induced* / Q000150:complications*; D010045:Outpatients; D010356:Patient Isolation; D012449:Safety