title: Home-based zoledronic acid infusion therapy in patients with solid tumours: compliance and patient-nurse satisfaction.
abstract: OBJECTIVE
  This study aimed to explore patient and nurse satisfaction, compliance with best practice, technical feasibility and safety of home infusion of the bisphosphonate zoledronic acid (ZOL).
  
  
  METHODS
  This was a prospective 1-year survey of home ZOL therapy (4 mg Zometa, 15-min i.v., every 3-4 weeks) in patients with bone metastases secondary to a solid malignancy. A physician questionnaire, nurse satisfaction/feasibility questionnaire and patient satisfaction questionnaire were administered at several time-points.
  
  
  RESULTS
  Physician participation rate was 56.5% (87/154). Physicians enrolled 818 patients visited by 381 predominantly community nurses. Of the 788 case report forms received, 763 met inclusion criteria. Patient characteristics were as follows: median age, 68 years (30-95); M/F, 40/60; ECOG-PS 0 or 1, 78.6%; and primary tumour site, breast (55.2%), prostate (28.4%), lung (7.2%) or other (9.4%). Nurse satisfaction rates were high: organisation of home ZOL therapy, 90.9%; ease of infusion, 96.7%; patient-nurse relationship, 97.5%; and relationship with hospital staff, 73%. Patient satisfaction was also very high (95.3%). The main reasons were quality of the nurse-patient relationship (57.6%), less travel/waiting (68.8%), home environment (52.9%) and less disruption to daily routine (36.6%). ZOL therapy was well tolerated, the discontinuation rate due to adverse events (including deaths whether related to diseases progression or not) was 33.6%. The incidence of osteonecrosis of the jaw was 0.6% and of fractures, 0.2%. Practitioner compliance with best practice was 76.7-83.7% for recommended and/or tolerated dosage, 73% for dental hygiene checks at inclusion and 48-56% thereafter, 66% for pre-infusion hydration, and often undocumented for calcium/vitamin D supplementation.
  
  
  CONCLUSIONS
  Home ZOL therapy was well tolerated. Both patient and nurse satisfaction were very high. However, better compliance with best practice should be encouraged.
authors.affiliation: Hôpital Foch/Urology Department, Université Versailles St Quentin en Yvelines, 40 rue Worth BP 36, 92151, Suresnes Cedex, France. t.lebret@hopital-foch.org
authors.forename: Thierry
authors.initials: T
authors.lastname: Lebret
authors.forename: Jean-Loup
authors.initials: JL
authors.lastname: Mouysset
authors.forename: Alain
authors.initials: A
authors.lastname: Lortholary
authors.forename: Claude
authors.initials: C
authors.lastname: El Kouri
authors.forename: Laurent
authors.initials: L
authors.lastname: Bastit
authors.forename: Meryem
authors.initials: M
authors.lastname: Ktiouet
authors.forename: Khemaies
authors.initials: K
authors.lastname: Slimane
authors.forename: Xavier
authors.initials: X
authors.lastname: Murraciole
authors.forename: Stéphane
authors.initials: S
authors.lastname: Guérif
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000451:nursing / Q000556:secondary; D001943:Breast Neoplasms / Q000451:nursing / Q000473:pathology*; D004164:Diphosphonates / Q000008:administration & dosage* / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control; D018718:Home Infusion Therapy / Q000379:methods* / Q000451:nursing; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage* / Q000009:adverse effects; D008137:Longitudinal Studies; D008175:Lung Neoplasms / Q000451:nursing / Q000473:pathology; D008297:Male; D008875:Middle Aged; D064691:Nurses, Community Health / Q000523:psychology*; D010020:Osteonecrosis / Q000139:chemically induced; D010349:Patient Compliance / Q000523:psychology; D017060:Patient Satisfaction; D010820:Physicians / Q000523:psychology; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000451:nursing / Q000473:pathology; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid