Does chemotherapy always require hospitalization? This is probably one of your biggest concerns.
Traditionally, chemotherapy requires hospitalization for round-the-clock observation and treatment of cancer patients. In fact, the United States, the United Kingdom, Japan, Singapore and other countries with advanced medical technology and conditions have already popularized “daytime outpatient chemotherapy” – chemotherapy without hospitalization and going home the same day. The company’s main goal is to provide the best possible service to its customers.
So what are the advantages and disadvantages of daytime chemotherapy and am I a good candidate for it? This article will talk to you about it.
What are the differences between ambulatory chemotherapy and inpatient chemotherapy?
What is the difference between daytime chemotherapy and inpatient chemotherapy?
Daytime chemotherapy is for patients who are relatively stable and do not need a change in their chemotherapy regimen. The advantage is that they do not have to wait for a bed and can go home at night to rest. However, there are shortcomings of daytime chemotherapy and advantages of inpatient chemotherapy, and their main differences are as follows:
Table 1. Daytime chemotherapy for malignancy vs. inpatient chemotherapy
| Daytime chemotherapy | Inpatient chemotherapy | |
| Patient characteristics | Better performance status (PS) score | More first-time chemotherapy patients |
| Cost | relatively low, with declining bed and care costs | Relatively higher, including bed fees, nursing fees |
| Median length of stay*1 | 4.4±1.1 days | 13.5±2.3 days |
| Chemotherapy-related adverse reactions | Overall similar, but gastrointestinal reactions were significantly lower compared to the inpatient chemotherapy group*2 | Overall similar, but with reduced hematologic toxicity*3 |
| Other advantages | No waiting for a bed, can rest better | Relatively longer contact time with doctors and nurses, better health promotion; easier to detect adverse drug reactions in a timely manner |
| Other disadvantages | Scattered supervising physicians, short time for health promotion, complicated chemotherapy drugs, difficulty in implementing holistic care | Insufficient beds, etc. |
Note:
*1 Median length of stay is statistical data only, reflecting the overall difference in length of stay between the two modalities of chemotherapy, and does not represent actual length of stay;
*2 Fewer acute vomiting reactions than inpatients due to more daytime chemotherapy with carboplatin-containing regimens than cisplatin (P < 0.01);
*3 The reason may be due to the heavier myelosuppressive effect of carboplatin than cisplatin; in addition, the cumulative chemotoxicity of daytime chemotherapy patients with a history of previous chemotherapy is also important in causing myelosuppression.
What conditions require inpatient chemotherapy?
The need for hospitalization depends on a number of factors, such as the choice of chemotherapy regimen, the local allocation of medical resources, and the patient’s wishes.
Physicians usually recommend inpatient chemotherapy for the following conditions:
- Some clinical trials require inpatient chemotherapy to facilitate monitoring of your blood levels and adverse effects, etc;
- If you are having chemotherapy for the first time, your doctor will routinely pretreat you accordingly according to the different chemotherapy regimens, such as using paclitaxel preceded by diphenhydramine, dexamethasone, etc. to prevent allergic reactions. But even this cannot be avoided 100% of the time, so hospitalization for chemotherapy is required so that your doctor can keep a close eye on any adverse reactions you may have;
- If severe toxic side effects occur, hospitalization is required for close observation of the condition and chemotherapy is withheld;
- The requirements of the chemotherapy regimen, such as small cell lung cancer (SCLC) EP regimen (etoposide + cisplatin) chemotherapy, which requires three consecutive days of dosing;
- Other special reasons such as good PS score but difficulty in mobility (due to tumor or non-tumor factors).
In addition, due to health insurance-related policies, some patients will choose to be hospitalized for reimbursement. This issue is gradually being addressed with the Special Disease Clinic. If you qualify for outpatient care for special conditions, the cost of medications used in the outpatient setting can be reimbursed at the same rate as inpatient costs. In other words, although you are not hospitalized and do not need to be hospitalized, the cost of special disease treatment can still be treated as inpatient treatment costs. For details, you can consult your local medical insurance department and hospital.
Note: All chemotherapy mentioned in this article is of the intravenous drip type.
Co-authors: Dr. Yue-Li Sun Dr. Xiaoxiao Peng, Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute