Outpatient care of patients with acute myeloid leukemia: Benefits, barriers, and future considerations.
Patients with acute myeloid leukemia (AML) who receive intensive induction or re-induction chemotherapy with curative intent typically experience prolonged cytopenias upon completion of treatment. Due to concerns regarding infection and bleeding risk as well as significant transfusion and supportive care requirements, patients have historically remained in the hospital until blood count recovery-a period of approximately 30 days. The rising cost of AML care has prompted physicians to reconsider this practice, and a number of small studies have suggested the safety and feasibility of providing outpatient supportive care to patients following intensive AML (re-) induction therapy. Potential benefits include a significant reduction of healthcare costs, improvement in quality of life, and decreased risk of hospital-acquired infections. In this article, we will review the currently available literature regarding this practice and discuss questions to be addressed in future studies. In addition, we will consider some of the barriers that must be overcome by institutions interested in implementing an "early discharge" policy. While outpatient management of selected AML patients appears safe, careful planning is required in order to provide the necessary support, education and rapid management of serious complications that occur among this very vulnerable patient population.
Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Virginia Tech Carilion Research Institute, Roanoke, VA, USA; Blue Ridge Cancer Care, Roanoke, VA, USA. Electronic address: jvaughn@vtc.vt.edu.
Jennifer E
JE
Vaughn
Hematology/Oncology Fellowship Program, University of Washington, Seattle, WA, USA.
Sarah A
SA
Buckley
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
Roland B
RB
Walter
D000553:Ambulatory Care / Q000191:economics / Q000379:methods* / Q000639:trends; D006801:Humans; D060828:Induction Chemotherapy; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000191:economics / Q000628:therapy*; D010351:Patient Discharge / Q000191:economics / Q000639:trends
Acute myeloid leukemia; Chemotherapy; Costs; Infection; Outpatient care; Quality of life