After children with leukemia receive a course of chemotherapy at a hospital, are they better off remaining in the hospital, or going home with their families?
The answer is not obvious, which is why the Patient-Centered Outcomes Research Institute (PCORI) is funding a three-year, $1.8 million multicenter study to learn more. A pediatric oncologist at The Children’s Hospital of Philadelphia (CHOP) is leading a collaborative study with 10 other U.S. pediatric hospitals to gather data from patients, families and clinicians.
“The study will not only give us clear data on the safety of each discharge strategy, but will also ask patients and families about their preferences,” said the study’s principal investigator, Richard Aplenc, MD, a CHOP pediatric oncologist. “Both types of information will help us as oncologists to better work with families to find the best strategy for their children.”
Leukemia is the most common pediatric cancer. The study focuses on acute myeloid leukemia (AML), the most life-threatening form of leukemia, which requires the most intensive chemotherapy.
While medical advances have improved survival in AML, chemotherapy results in significant side effects. Because killing cancer cells destroys a patient’s white blood cells, the child is vulnerable to life-threatening bloodstream infections.
Because of this risk, some physicians prefer to keep children in the hospital for close monitoring. Other doctors worry that the prolonged post-chemotherapy hospital stay is too challenging for children and families, and advise patients to go home and return to the hospital if a fever occurs.
No one knows whether keeping the child in the hospital reduces the risk of infection or improves the odds that the child will undergo the next course of chemotherapy on schedule.
The study, entitled “Home or Away from Home” will compare physician-directed and patient-centered outcomes in two groups of patients — those who stay and those who go home. Covering nearly 400 patients from the participating children’s hospitals, the study will measure outcomes, including bloodstream infection and chemotherapy delays.
The researchers will also perform in-person interviews with patients and caregivers, and carry out quality-of-life surveys. To help include patient and family concerns, the study team will call on family consultants, staff members of a cancer advocacy foundation and the members of the Patient Advocacy Committee of the Children’s Oncology Group, a national collaborative research organization representing pediatric cancer centers in the U.S. and Canada.
“We are very excited about this highly collaborative study that we hope will help us improve our care for children with acute myeloid leukemia,” added Aplenc.
The PCORI is an independent, nonprofit organization authorized by Congress in 2010 to fund research to provide patients, caregivers and clinicians with the evidence-based information they need to make better-informed healthcare decisions.