| Background:Outpatient chemotherapy or Ambulatory chemotherapy is popular as a treatment model for Patients with cancer in developed countries. Our study aim at safety analysis and medical cost s evaluation of outpatient chemotherapy in patients with gastric cancer (GC). Meanwhile, we explored the the efficacy of different chemotherapy regimens for advanced gastric cancer.Methods:Compared with 311 patients with GC receiving hospitalized chemotherapy enrolled in the same period, we analyzed the medical data of 101 patients with GC receiving outpatient chemotherapy treatment between January 2013 and July 2013 in Cancer Hospital, Chinese Academy of Medical Sciences. Medical data on patient clinical characteristics, chemotherapy regimens, length of hospital stay, the incidence of adverse events and medical costs was analyzed. Tumor response of different palliative chemotherapy regimens was assessed based on the Response Evaluation Criteria in Solid Tumors (RECIST) criteria in 210 patients with advanced gastric cancer.Results:The chemotherapy-related adverse events were similar in outpatient and hospitalized chemotherapy group. The grade 1-4 rate of gastrointestinal toxicity such as nausea, vomiting, diarrhea in outpatient chemotherapy patients was lower than those in hospitalized chemotherapy patients (P<0.05). Meanwhile, frequency of>grade3 leukopenia,≥grade3 gastrointestinal toxicity, infection in outpatient chemotherapy group was lower than those in hospitalized chemotherapy group (P<0.05), but the rate of phlebitis in outpatient chemotherapy patients is higher (P<0.05).Compared with the hospitalized chemotherapy, outpatient chemotherapy shortened hospitalization days (1.5 days vs3.6 days, P<0.001) and reduced the medical costs. The average total cost per chemotherapy session of outpatient and hospitalized chemotherapy group was ￥9887.84 andY 12299.14, respectively (P<0.05). The cost of outpatient chemotherapy was reduced by 19.6%. The drug cost of outpatient and hospitalized chemotherapy group was Y 8955.13 and Y 10413.52, and no significant difference was observed(P= 0.093).The drug cost ratio of outpatient chemotherapy group (9.4%) were lower than that of hospitalized chemotherapy group (15.3%, P<0.001). Patients receiving DCF or modified DCF as first-line chemotherapy regimen had a higher response rate than thoes receiving the combination of platinum and fluoropyrimidine (42.6% vs 21.7%, P=0.032). The response rates were 16.7% and 7.1% in patients with taxanes plus fluoropyrimidine regimen and patients with irinotecan plus fluoropyrimidine regimen as second-line chemotherapy. No statistically significant difference was observed (P>0.05).Conclusion:Compared with hospitalized chemotherapy, the outpatient chemotherapy treatment significantly reduce medical costs and shorten hospitalization days. As an effective and safe mode, outpatient chemotherapy treatment should be promoted. Compared with the platinum-fluoropyrimidine regimen, DCF or modified DCF significantly improved the response rate in advanced gastric cancer. As second-line chemotherapy, taxanes plus fluoropyrimidine regimen and irinotecan plus fluoropyrimidine regimen had similar efficacy. |
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