"Haematologic home care in Modena: an operating model involving hospital, community health services and fundraising organisation". Abstract presented at the 10th Congress of the Italian Association of Medical Oncology AIOM (Verona, 2008).

1. session P Annals of Oncology
P26 SECOND-LINE TREATMENT FOR NON-SMALL-CELL LUNG P28 IMPROVING EFFICIENCY OF A MEDICAL ONCOLOGY IN-
CANCER: ARE THE COSTS AFFORDABLE? PATIENT UNIT
Bearz A, Vaccher E, Spina M, Lleshi A, Schioppa O, Giacalone A, Tirelli U Ucci G, Anghilieri M, Villa S, Plebani D, Ferraioli L, Colli A
CRO-IRCCS, Aviano UO Oncologia Medica, Dipartimento di Area Medica e Dipartimento Oncologico,
Azienda Ospedaliera di Lecco. Lecco – Italy
Introduction: Advanced non-small-cell lung cancer (NSCLC) is a major health
problem in Western countries. Overall about 20% of all patients affected by NSCLC Background: Most italian hospitals are organized to fullfill routine diagnostic and
receive second-line chemotherapy. Single agent Docetaxel and Pemetrexed, and the clinical requirements only during week days. This limitation is not usually taken into
tyrosine kinase inhibitor Erlotinib are approved as second-line treatment options by account for admission of elective cases and often patients stay in hospital on the week-
Regulatory Agency in Italy. Moreover, expensive new compounds will be upcoming end waiting for completion of diagnostic/therapeutic procedures. This report
available, in first or further-line setting. summarizes the experience of the medical oncology (MO) of the Lecco Hospital with
We analyzed the costs related to second-line chemotherapy in NSCLC patients treated a flexible organization of admission and discharge of elective cases.
in the context of the Italian health system. Methods: From January to December 2007, in-patient elective and emergent cases were
Patients and Methods: We evaluated the costs as if sustained in Aviano, North-Eastern allowed to reach a total occupancy of 16 beds from Monday to Friday, while only 12
Italy, for a patient with NSCLC in second-line treatment for the three available drugs patients were allowed on the week-end. Oncologic emergencies on the week-end were
respectively. Considering a patient with an average body-surface area of 1.8 m2, we admitted either by MO unit or, temporarily, by the Internal Medicine unit. Patients
compared the costs among the three treatments; Pemetrexed and Docetaxel are usually needs were discussed before admission and diagnostic and therapeutic procedures were
administered in the outpatient setting. strictly programmed; special emphasis was given to agree appropriate protocols for
Results: The table shows the costs in Euro (C) per month of treatment for the three
= patients discharge with house doctors and home care services in order to reassure
available drugs in second-line treatment for NSCLC. patients and their families and ensure continuation of treatment or follow-up within or
outside the hospital. The experimental period was compared to the same period of
2006, when no action was taken in order to allow for the reduced hospital activity on
Docetaxel Pemetrexed Erlotinib the week-end and 16 in-patients were eventually allowed for the whole week.
Drug cost (1 month) 945 2250 1730 (865) Results: Results are summarized in the table below:
Antiemetics 2.50 2.50 À
Chemotherapy daycare Mean pts Total nr. Total Mean duration Mean Total
Nursing 10.7 0.70 À allowed/ of pts days of of admission DRG turnover
Physician 9 9 9 day managed in-patients (days) weight (Eurox1000)
Complication costs
Hospitalization 448 156 À 2006 15,2 781 5468 7,85 1,214 2.463
G-CSF 26 4.20 À 2007 14,8 839 5059 7,01 1,216 2.529
Total 1440.70 2422.40 1730 (865) % À3 +7,4 À7,5 À11 +0,2 +2,6
*In Italy there is an agreement between the pharmaceutical company (Roche), and the
Government for the reimbursement of half the costs of Erlotinib for the first two In addition, a total of 40 nursing hours per week were saved for other offices.
months of treatment only (shown in brackets). Conclusions: Flexible admission and discharge of elective cases to the inpatient ward of
Conclusion: It is difficult to believe that a public health system may afford such a MO unit may improve efficiency and save costs. A motivated staff and compliant
expensive treatments. The costs related to second-line treatment for NSCLC may not territorial services are important.
be affordable, due to the high incidence of NSCLC and the palliative role of those
treatments. In a population of cancer patients with poor prognosis, cost-utility
analyses, or the inclusion of quality indicators in the calculation of costs, would be P29 AN AUDIT OF NON-URGENT ATTENDANCES OF CANCER
important to a better understanding of costs and benefits. PATIENTS (PTS) TO THE EMERGENCY DEPARTMENT (ED) OF A
DISTRICT GENERAL HOSPITAL IN NORTH-EASTERN ITALY
P27 HAEMATOLOGIC HOME CARE IN MODENA: AN OPERATING
MODEL INVOLVING HOSPITAL, COMMUNITY HEALTH SERVICES Follador A1, Fanzutti M2, Adami G2, Merlo V1, Rijavec E1, Belvedere O3,
AND FUNDRAISING ORGANISATION Rizzato S1, Pertoldi F4, Piga A1
1
Dipartimento di Oncologia Azienda Ospedaliero - Universitaria di Udine, Italy;
2
Alfieri Pierluigi, Favale Enzo Day Hospital Oncologico - Dipartimento di Medicina, Ospedale San Daniele del
Servizio di assistenza domiciliare ematologica AIL Modena ONLUS - Divisione di Friuli (Ud), Italy; 3Leeds Institute of Molecular Medicine, St. James’s University
Ematologia - Policlinico di Modena Hospital Leeds, UK; 4Dipartimento di Emergenza Ospedale San Daniele del Friuli
(Ud), Italy
Home care has achieved a relevant role in the global management of cancer patients
improving quality of life and reducing health care costs. In the last decade many efforts Background: Many pts with cancer present to ED at some point during their disease.
have also been made in order to assist patients with blood malignancies who are fragile, Management of non-urgent problems at ED may not be optimal for these pts with
such as elderly and not-self sufficient people, irrespective of disease phase (terminal, estabilished diagnosis of cancer. We report an audit of non-urgent attendances of
chronic, advanced). cancer pts to the ED of San Daniele del Friuli District Hospital in North-Eastern Italy
Here we describe our experience in Modena, where a haematologic home care service is that serves a population of around 50,000 and has a 5-day oncology day unit but not an
active on the basis of a protocol agreed in 1998 by university hospital division inpatient facility.
(Policlinico), community health system (ASL) and the fundraising organisation A.I.L. Methods: To identify non-urgent attendances of cancer pts between January 2004 and
(Italian Association against Leukaemia-Lymphoma-Myeloma). December 2006, we retrospectively searched the ED electronic medical record database
Eligibility criteria are: diagnosis of blood malignancy, age > 18, poor performance using the precoded search strings: ‘‘white code’’ (defined by the Italian 4-level triage
status, distance from university hospital < 15 km, availability of a care-giver, scale as ‘‘non-urgent cases’’), ‘‘common medical problems’’ and ‘‘cancer related
appropriate home logistics. According to the Emilia-Romagna model for integrated problems’’.
domiciliary assistance (ADI) home care team is composed by general practitioner Results: Overall, 315 attendances were identified, accounting for 0.4% of all ED
(therapeutic responsible), community nurses, consultant haematologist and, when attendances. Pts characteristics: M/F 51/49%, median age 71 yrs (range 31-98). Most
needed, by other specialists, psychologist and social assistant. frequent malignancies included gastrointestinal (17%), lung (15%), genitourinary
In the period July 1999 – March 2008 344 patients (median age=75) have been referred (13%), breast (11%) and hepatobiliary/pancreatic (10%) cancers. In all, 74% of pts
to this service (non-Hodgkin’s lymphoma=89, multiple myeloma=65, acute myeloid were judged by ED physicians as having advanced disease. Most frequent symptoms/
leukaemia=56, myelodisplastic syndrome and other anaemias=45, chronic signs included pain (31%); cachexia (31%); gastrointestinal symptoms (20%);
myeloproliferative disorders including chronic myeloid leukaemia=41, chronic respiratory problems (15%); neurological problems (15%); fever (11%); edema/ascites
lymphocytic leukaemia=25, acute lymphocytic leukaemia=11, Hodgkin’s (11%); asthenia (11%); anemia (5%). Most attendances were between 8 am and 8 pm
lymphoma=8, autoimmune thrombocytopenia=4). (78%). While 30% were referred by their general practitioner, 70% of pts self-
Main activity indicators are here reported: median duration of assistance = 190 days; presented. Management/investigation during ED attendance included blood tests
median frequency of haematologist’s visits = 1 every 8 days; total number of blood and (41%); ECG (38%); radiology (30%); 45% received drug therapy and 19% were
platelet transfusions = 2030; median number of hospital admissions = 0.95 per patient; referred for a specialist opinion. Most pts were admitted to hospital, either in the
percentage of patients died at home = 38%. Medical (62%) or Surgical Departments (4%). A further 7% of pts were kept under
This valid integration between hospital and community services is possible thanks to an observation in the ED observation area, 25% were discharged.
efficient operating model, an effective clinical approach and a convenient use of means Conclusion: This audit shows that attendance of cancer pts with non-urgent
and resources. The role of no-profit organisations like A.I.L. is essential to sustain these complaints is not a significant burden on ED. Future prospective studies might help to
programs until a full recognition comes from public health services. identify reasons for the use of ED and to improve medical care sources.
ix124 | session P: organization and pharmacoeconomic aspects, patient care and elderly Volume 19 | Supplement 9 | October 2008