title: Hospital and home chemotherapy for children with leukemia: a randomized cross-over study.
abstract: BACKGROUND
  The study objective was to compare a hospital-based and a home-based chemotherapy program for children with acute lymphoblastic leukemia (ALL) in relation to Quality of Life (QOL), safety, caregiver burden, and costs.
  
  
  METHODS
  A randomized cross-over trial (RCT) design with repeated measures was conducted with 23 children with ALL who attended the oncology outpatient clinic of a metropolitan university affiliated tertiary level pediatric hospital and who also received home visits from a community health services care provider in central Canada.
  
  
  RESULTS
  During the home-treatment phase, children were more capable of maintaining their usual routines than when receiving hospital chemotherapy (Wilcoxon statistic = 80, P = 0.023), but they appeared to experience greater emotional distress (Wilcoxon sign rank statistic S = 66, P = 0.043) according to parental report. Treatment location had no effect on caregiver burden and adverse effects. No significant differences between groups existed with respect to societal costs of care. As the child's age increased, QOL improved relative to younger children (t(20) = -2.37, P = 0.02), the time burden related to child care tasks was reduced (t(21) = -3.56, P = 0.002), caregiver effort/difficulty in physical and behavioral support decreased (t(21) = -2.09, P = 0.049) and the odds of experiencing one or more adverse events decreased (OR = 0.79, CI = (0.63-1.00), chi(1) (2) = 4.01, P = 0.045).
  
  
  CONCLUSIONS
  With few differences noted between groups, these results indicate preliminary support for administrating some or all of a child's chemotherapy at home. Home chemotherapy was associated with specific improvements and decrements in parent reported QOL. No effects were seen on burden of care, adverse events, or cost. Overall, young age adversely affected QOL, burden of care, and adverse events. These data provide important information to families and caregivers as they consider home or hospital-based therapy in childhood ALL.
authors.affiliation: Faculty of Nursing and Medicine, University of Toronto, Toronto, Ontario, Signy Hildur Eaton Chair in Paediatric Nursing Research, Sick Kids Hospital, 555 University Avenue, Toronto, Ontario, Canada. b.stevens@utoronto.ca
authors.forename: Bonnie
authors.initials: B
authors.lastname: Stevens
authors.forename: Ruth
authors.initials: R
authors.lastname: Croxford
authors.forename: Patricia
authors.initials: P
authors.lastname: McKeever
authors.forename: Janet
authors.initials: J
authors.lastname: Yamada
authors.forename: Marilyn
authors.initials: M
authors.lastname: Booth
authors.forename: Stacey
authors.initials: S
authors.lastname: Daub
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
authors.forename: Janet
authors.initials: J
authors.lastname: Gammon
authors.forename: Mark
authors.initials: M
authors.lastname: Greenberg
mesh_terms: D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017281:Cost of Illness; D018592:Cross-Over Studies; D005192:Family Health; D017048:Health Care Costs; D018575:Home Care Services, Hospital-Based / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric; D006801:Humans; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data; D009864:Ontario; D010043:Outcome and Process Assessment, Health Care; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000523:psychology; D011788:Quality of Life; D012449:Safety; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires