LUXEMBOURG-In an effort to beat the skyrocketing costs of high-dose
chemotherapy and transplantation, physicians at the Scripps Clinic,
La Jolla, Calif, have launched a total outpatient therapy program
that attempts to eliminate expensive hospital admissions.
"There is no question that high costs are a major impediment
to the widespread use of transplantation," said Barry Meisenberg,
MD, at the 7th International Symposium of the Multinational Association
of Supportive Care in Cancer.
He emphasized that outpatient chemotherapy with stem-cell support,
followed by prophylactic antibiotics and daily outpatient visits,
can safely trim as much as 40% off bills that traditionally run
between $100,000 and $150,000.
The Scripps Clinic approach was modeled after a program that originated
at Duke University Medical School in 1992, but with several important
differences, said Dr. Meisenberg, director of the Bone Marrow
Transplant Program at Scripps.
Patients at Duke receive their high-dose chemotherapy as inpatients
and are then discharged for outpatient supportive care. After
employing this so-called subtotal outpatient strategy in 84 patients,
Scripps oncologists inaugurated their total outpatient program,
in which patients undergo high-dose chemotherapy and follow-up
To accomplish this, Dr. Meisenberg's group modified their chemotherapy
regimens to exclude drugs that necessitate continuous bladder
irrigation, hyperhy-dration, and hourly monitoring of fluid input
and output. In addition, while Duke physicians combine bone marrow
transplants with stem-cell reinfusion, the Scripps team uses peripheral
blood stem cells only.
Finally, the Duke program has been limited to women with breast
cancer treated with cisplatin (Platinol), cyclophosphamide (Cytoxan,
Neosar), and carmustine (BiCNU), while Scripps has expanded the
concept to include patients with other solid tumors, non-Hodgkin's
lymphoma, and multiple myeloma, who undergo treatment with a variety
of intensive regimens.